伴咽喉反流的难治性鼻窦炎术后应用质子泵抑制剂的疗效观察

doi:10.6040/j.issn.1673-3770.0.2021.512

摘要/Abstract

摘要： 目的探讨伴咽喉反流(LPR)的难治性鼻窦炎(DTRS)术后应用质子泵抑制剂(PPI)的临床疗效。方法收集42例合并咽喉反流的难治性鼻窦炎患者案例,其中21例给予术后规范质子泵抑制剂治疗8周+常规围手术期处理(实验组),21例给予常规围手术期处理(对照组)。对比分析两组患者术前的一般资料、外周血嗜酸性粒细胞计数、视觉模拟量表(VAS)评分、外周血IgE、Lund-Kennedy鼻内镜评分、Lund-Mackay 鼻窦CT评分及反流症状指数量表(RSI)、反流体征评分量表(RFS)等的差异;收集两组患者术后第1、3、6及12个月复查时的鼻内镜评分、鼻窦CT评分、VAS评分、RSI及RFS评分结果,对两组患者的咽喉症状评分及客观检查结果较基线的变化及组间差异进行分析,评估质子泵抑制剂治疗对伴咽喉反流的难治性鼻窦炎的术后临床疗效。结果对两组患者术后1年的持续随访,最终实验组患者RFS、RSI、VAS评分、鼻内镜评分、鼻窦CT评分较对照组患者均显著降低［(2.57±1.54)分vs(3.57±1.60)分,P=0.045<0.05;(2.86±1.59)分vs(4.62±1.77)分,P=0.002<0.05;(3.43±1. 93)分vs(5.43±3.11)分,P=0.017<0.05;(1.00±0.78)分vs(2.10±1.09)分,P=0.018;(0.67±0.66)分vs(1.24±0.83)分,P=0.001<0.05］。结论伴咽喉反流的难治性鼻窦炎术后行质子泵抑制剂治疗可明显改善患者的鼻部症状、提高患者生活质量,降低咽喉反流相关症状体征,可作为该类患者的个体化治疗手段。

关键词: 难治性鼻窦炎, 质子泵抑制剂, 咽喉反流, 个体化治疗, 内窥镜, 随访

Abstract: Objective To explore the clinical effect of proton pump inhibitor(PPI)after the operation for difficult-to-treat rhinosinusitis(DTRS)with laryngopharyngeal reflux(LPR). Methods A total of 42 patients with DTRS with LPR were collected, of which 21 patients were given standard PPI treatment for 8 weeks plus routine perioperative treatment(experimental group), and 21 patients were given routine perioperative treatment(control group). The general information, peripheral blood eosinophil count, VAS score, peripheral blood IgE, Lund-Kennedy nasal endoscopy score, Lund-Mackay CT score, reflux symptom index scale(RSI)and reflux sign score(RFS)were compared between the two groups. The nasal endoscopic score, sinus CT score, VAS score, RSI and RFS scores of both groups were collected at the 1^st, 3^rd, 6^th and 12^th month after operation. Differences between the throat symptom score and objective examination results of both groups were analyzed, and the postoperative clinical effect of PPI therapy on DTRS with LPR was evaluated. Results After 1 year continuous follow-up, RFS, RSI, endoscopic score, sinus CT score and VAS scores were significantly lower compared with the control group ［(2.57±1.54)points vs.(3.57±1.60)points,P=0.045<0.05;(2.86±1.59)points vs.(4.62±1.77)points,P=0.002<0.05;(3.43±1.93)points vs.(5.43±3.11)points, P=0.017;(1.00±0.78)points vs(2.10±1.09)points, P=0.018<0.05;(0.67±0.66)points vs.(1.24±0.83)points,P=0.001<0.05］ Conclusion PPI after operation for DTRS with LPR can obviously improve nasal symptoms, improve quality of life and reduce the symptoms and signs related to throat reflux, which can be used as an individualized treatment for these patients.

Key words: Difficult-to-treat rhinosinusitis, Proton pump inhibitors, Laryngopharyngeal reflux, Individualized treatment, Endoscopy, Follow-up

中图分类号:

R765.4+1

曾宪廷,王广科,孙占伟,武天义,李世超,王卫卫. 伴咽喉反流的难治性鼻窦炎术后应用质子泵抑制剂的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 189-194.

ZENG Xianting, WANG Guangke, SUN Zhanwei, WU Tianyi, LI Shichao, WANG Weiwei. Postoperative efficacy of proton pump inhibitor in the treatment of difficult-to-treat rhinosinusitis with laryngopharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 189-194.

参考文献

[1] Wreesmann VB, Fokkens WJ, Knegt PP. Refractory chronic sinusitis: evaluation of symptom improvement after Denker's procedure[J]. Otolaryngol Head Neck Surg, 2001, 125(5): 495-500. doi:10.1067/mhn.2001.119484.
[2] Desrosiers M. Refractory chronic rhinosinusitis: pathophysiology and management of chronic rhinosinusitis persisting after endoscopic sinus surgery[J]. Curr Allergy Asthma Rep, 2004, 4(3): 200-207. doi:10.1007/s11882-004-0027-z.
[3] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001. Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis(2018)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001.
[4] Massoth L, Anderson C, McKinney KA. Asthma and chronic rhinosinusitis: diagnosis and medical management[J]. Med Sci(Basel), 2019, 7(4): 53. doi:10.3390/medsci7040053.
[5] 韩德民. 正确理解难治性鼻-鼻窦炎[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(2): 113-114. doi:10.3760/cma.j.issn.1673-0860.2013.02.012.
[6] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(Suppl S29): 1-464. doi:10.4193/Rhin20.600.
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组, 中华医学会耳鼻咽喉头颈外科学分会咽喉学组.咽喉反流性疾病诊断与治疗专家共识(2015年)[J]. 中华耳鼻咽喉头颈外科杂志, 2016,51(5):324-326. doi: 10.3760/cma/j/issn/1673-860.2016.05.002.
[8] Stevens WW, Peters AT, Tan BK, et al. Associations between inflammatory endotypes and clinical presentations in chronic rhinosinusitis[J]. J Allergy Clin Immunol Pract, 2019, 7(8): 2812-2820.e3. doi:10.1016/j.jaip.2019.05.009.
[9] Bohnhorst I, Jawad S, Lange BB, et al. Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease[J]. Am J Rhinol Allergy, 2015, 29(3): e70-e74. doi:10.2500/ajra.2015.29.4167.
[10] Arslan H, Çandar T, Kuran S, et al. New inflammatory parameters in laryngopharyngeal reflux[J]. J Laryngol Otol, 2016, 130(9): 878-882. doi:10.1017/S0022215116008653.
[11] 慕婷婷, 杨玉娟, 张宇, 等. IL-36在慢性鼻-鼻窦炎伴鼻息肉中的研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 114-118. doi: 10.6040/j.issn.1673-3770.0.2020.146. MU Tingting, YANG Yujuan, ZHANG Yu, et al. Research progress of IL-36 in chronic rhinosinusitis with nasal polyps[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(1): 114-118. doi: 10.6040/j.issn.1673-3770.0.2020.146.
[12] Mikami DJ, Murayama KM. Physiology and pathogenesis of gastroesophageal reflux disease[J]. Surg Clin North Am, 2015, 95(3): 515-525. doi:10.1016/j.suc.2015.02.006.
[13] Agrawal N, Yadlapati R, Shabeeb N, et al. Relationship between extralaryngeal endoscopic findings, proton pump inhibitor(PPI)response, and pH measures in suspected laryngopharyngeal reflux[J]. Dis Esophagus, 2019, 32(4): doy072. doi:10.1093/dote/doy072.
[14] 孙娜, 陈晓平. 咽喉反流与耳鼻咽喉科疾病[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 85-89. doi: 10.6040/j.issn.1673-3770.0.2016.213. SUN Na, CHEN Xiaoping. Laryngopharyngeal reflux and otorhinolaryngology diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(6): 85-89. doi: 10.6040/j.issn.1673-3770.0.2016.213.
[15] 梁芳芳. 咽喉反流相关鼻部疾病研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2015, 21(3): 264-266. doi:10.11798/j.issn.1007-1520.201503031.
[16] Chong LY, Head K, Hopkins C, et al. Saline irrigation for chronic rhinosinusitis[J]. Cochrane Database Syst Rev, 2016, 4(4): CD011995. doi:10.1002/14651858.CD011995.pub2.
[17] Sanan A, Rabinowitz M, Rosen M, et al. Topical therapies for refractory chronic rhinosinusitis[J]. Otolaryngol Clin North Am, 2017, 50(1): 129-141. doi:10.1016/j.otc.2016.08.011.
[18] Piromchai P, Kasemsiri P, Laohasiriwong S, et al. Chronic rhinosinusitis and emerging treatment options[J]. Int J Gen Med, 2013, 6: 453-464. doi:10.2147/ijgm.s29977.
[19] 王迪, 张慧慧, 文连姬, 等. 咽喉反流与老年患者耳鼻喉科疾病相关性研究进展[J]. 中国老年学杂志, 2018, 38(15): 3816-3819. doi:10.3969/j.issn.1005-9202.2018.15.090.
[20] Southwood JE, Hoekzema CR, Samuels TL, et al. The impact of pepsin on human nasal epithelial cells in vitro: a potential mechanism for extraesophageal reflux induced chronic rhinosinusitis[J]. Ann Otol Rhinol Laryngol, 2015, 124(12): 957-964. doi:10.1177/0003489415593556.
[21] 吴迪盼盼, 崔新华, 郭颖, 等. 窄带成像技术在咽喉反流诊断中的优势应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(3):31-36. doi: 10.6040/j.issn.1673-3770.1.2020.108. WU DIpanpan, CUI Xinhua, GUO Ying, et al. Narrow band imaging might contribute to the diagnosis of laryngopharyngeal refiux[J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3):31-36. doi: 10.6040/j.issn.1673-3770.1.2020.108.
[22] Gupta R, Sataloff RT. Laryngopharyngeal reflux: current concepts and questions[J]. Curr Opin Otolaryngol Head Neck Surg, 2009, 17(3): 143-148. doi:10.1097/MOO.0b013e32832b2581.
[23] 郎永耀, 杨云, 刘晴, 等. 咽喉反流性疾病的影响因素及治疗效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 119-123. doi: 10.6040/j.issn.1673-3770.0.2018.472. LANG Yongyao, YANG Yun, LIU Qing, et al. Analysis of influencing factors and observation of therapeutic effects in patients with laryngopharyngeal reflux disease[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 119-123. doi: 10.6040/j.issn.1673-3770.0.2018.472.
[24] 齐智伟, 陆鸿略, 张洁, 等. 奥美拉唑治疗反流性咽喉炎不同疗程的疗效评价[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(9): 693-697. doi:10.13201/j.issn.1001-1781.2018.09.012. QI Zhiwei, LU Honglue, ZHANG Jie, et al. Effect of different course of omeprazole in the treatment of laryngopharyngeal reflux[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(9): 693-697. doi:10.13201/j.issn.1001-1781.2018.09.012.
[25] Guo H, Ma H, Wang J. Proton pump inhibitor therapy for thetreatment of laryngopharyngeal reflux: A Meta-analysis of randomized controlled trials[J]. J Clin Gastroenterol, 2016, 50(4): 295-300. doi: 10.1097/MCG.0000000000000324.

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