辣椒素干预成人变应性鼻炎的循证医学评价

Evidence-based Assessment of Capsaic in for Allergic Rhinitis in Adults

目的评价采用辣椒素为干预措施对成人变应性鼻炎患者的症状和其他检测指标的意义,探索变应性鼻炎新的病理生理机制。方法通过CBMdisc、MEDLINE等数据库全面检索国内外的相关文献。选择以辣椒素为干预措施的随机对照试验或临床对照试验。试验的测量指标包括鼻症状、鼻分泌物中白细胞和白蛋白、鼻对组织胺的反应性、鼻生活质量等。结果较高质量治疗研究仅1篇,认为辣椒素可以降低鼻粘膜对组胺刺激的反应性。而低质量治疗研究3篇,治疗后有不同程度的症状改善(P<0.05)。阿托品、秋水仙素、利多卡因有不同程度阻断辣椒素刺激神经的作用,随着辣椒素剂量增加,鼻症状、鼻分泌物中白细胞、溶菌酶、白蛋白增多。结论辣椒素可降低鼻高反应性,对症状改善有待进一步研究;神经性炎症在变应性鼻炎发病中发挥了重要作用。

Objective To evaluate the effect of capsaicin on the symptom and examination in adult patients with allergic rhinitis and to explore new pathophysiological mechanisms of allergic rhinitis. Methods Search for all the related literature in MEDLINE and CBMdisc has been made. Randomised-controlled trials （RCTs） or controlled clinical trials （CCTs） for capsaicin were collected. Measurement variables included nasal symptoms, albumin and leukocyte counts in nasal lavage fluids ,responsiveness to histamine and rhinitis quality of life. Results There was one paper with better quality on designing. Capsaicin did have a small effect on the area of the curve of histamine dose response curves（P=0.03）. No significant effect of capsaicin on other outcomes was demonstrated. There were 3 papers with lower research quality on treatment. Capsaicin treatment reduces different degrees of allergic symptoms. Atropine, Colchicine and Lidocaine prevent the tendency of capsaicin to irritate nerve in different degrees. With dosage of Capsaicin increasing, nasal symptoms, albumin and leukocyte counts in nasal lavage fluids increased. Conclusion Capsaicin did have a small effect on the area of the curve of histamine dose response curves and improvement of the symptoms needs more research to be confirmed. Neurogenic inflammation plays an important role in pathogensis of allergic rhinitis.