长期小剂量克拉霉素在治疗儿童慢性鼻-鼻窦炎中的作用

Long-term low-dose clarithromycin in the treatment of pediatric chronic rhinosinusitis

目的探讨长期使用小剂量克拉霉素治疗儿童慢性鼻-鼻窦炎(chronic rhinosius-itis,CRS)的临床疗效。方法采用随机对照将74例诊断为CRS儿童分为常规治疗(38例)和克拉霉素治疗(36例)两组,常规治疗组采用喷鼻剂糠酸莫米松喷鼻和碱性盐水行鼻腔冲洗;克拉霉素组采用上述方法加用克拉霉素,疗程为12周。采用视觉模拟量表(visual analog scale,VAS)评估其症状,鼻内镜观察评估鼻腔,分别安排在治疗前,治疗后4、8和12周。鼻窦CT采用Lund-Mackay评分法,分别安排在治疗前和治疗后12周。结果两组病例经过4周治疗后,其症状VAS总分和鼻内镜评分均较治疗前明显下降(P<0.05),但两组间差异无显著性意义(P>0.05);经过8周治疗,两组病例症状VAS总分和鼻内镜评分均较治疗前和治疗4周明显下降(P<0.01),且克拉霉素组疗效明显优于常规治疗组(P<0.01);至治疗后12周,两组病例症状VAS总分和鼻内镜评分均较治疗前、治疗4周和治疗8周明显下降(P<0.01),鼻窦CT评分也较治疗前明显下降(P<0.01),两组间疗效差异亦有显著性意义(P<0.01)。结论长期小剂量克拉霉素应用治疗儿童CRS近期有着较好的疗效,是一种安全有效的治疗选择。

Objective To detect the effect of long-term low-dose clarithromycin in the treatment of pediatric chronic rhinosinusitis（CRS）.Methods 74 patients with pediatric CRS were randomly divided into clarithromycin group（36 cases）and control group（38 cases）.The patients in the control group received a 12-week treatments of alkaline nasal douche,and intranasal momestasone furoate.The patients in clarithromycin group received a 12-week treatments of clarithromycin,alkaline nasal douche and intranasal momestasone furoate.All patients underwent assessment of visual analogue score（VAS）and nasal endoscopy before and after the treatment.There were four time points for assessment including start time of the treatment,4 weeks,8 weeks and 12 weeks after the treatment.Results At 4 weeks after the treatment,the scores of VAS and endoscopic parameters in both groups got improved with the no significant difference（P0.05）.At 8 weeks and 12 weeks after the treatment,further improvement was allachieved in the scores and parameters,and the difference between the two groups was significant（P0.01）.In additon,CT examination at 12 weeks after the treatment showed that the improvement in the clarithromycin group was greater that in the control group（P0.01）.Conclusion With good therapeutic effect and safety,long-term,low-dose clarithromycin may be a valid alternative for pediatric CRS.