克拉霉素对细菌生物膜阳性慢性鼻-鼻窦炎患者术后疗效的影响

Low-dose and long-term administration of clarithromycin for chronic rhinosinusitis with bacterial biofilms

目的分析克拉霉素对细菌生物膜表达阳性慢性鼻．鼻窦炎（CRS）患者术后疗效的影响。方法选择2008年1月—2009年12月在金华市中心医院耳鼻咽喉科进行内镜下鼻窦手术的细菌生物膜阳性的CRS患者77例。其中42例患者在术后第3周起口服克拉霉素250mg／d，持续至少3个月。治疗3个月时行鼻内镜检查，术腔黏膜上皮化的患者，可停用克拉霉素；对术腔黏膜局部肿胀、肉芽或息肉形成及有脓性分泌物的患者，建议继续口服克拉霉素，直至患者术腔黏膜恢复正常，但总持续时间〈5月。另35例患者未予克拉霉素治疗。应用视觉模拟量表（VAS）及鼻内镜检查（Lund—kennedy评分）评估患者术后6个月病情改善程度。t检验分析克拉霉素对细菌生物膜表达阳性患者疗效的影响。结果克拉霉素治疗组42例患者中有2例因不同原因退出本研究。克拉霉素治疗组40例患者术后6个月VAS评分和Lund—kennedy评分分别为（8．04±0．8）分和（3．64±1．3）分，而对照组为（7．34±0．7）分和（4．54±1．7）分，差异有统计学意义（t=5．311和-3．187，P值均〈0．01）。结论小剂量、长期克拉霉素口服治疗能提高细菌生物膜阳性慢性鼻一鼻窦炎患者的术后疗效。

Objective To evaluate the efficacy of low-dose and long-term clarithromycin in treatment of chronic rhinosinusitis with positive bacterial biofilms. Methods Seventy-seven patients with chronic rhinosinusitis and positive bacterial biofilms underwent functional endoscopic sinusitis surgery between January 2008 and December 2009 in department of otolaryngology of Jinhua Central Hospital. Forty-two patients were treated with clarithromyein 250 mg/d orally for at least 3 months （ trial group）. At the end of 3 months patients received endoscopic examination, for patients with mucosal epithelialization the clarithromycin therapy was stopped; for those with mucosal edema, granulation or polyoid formations the clarithromycin treatment was continued, but no longer than 5 months. Thirty-five patients in control group were not given clarithromycin. All patients were assessed by visual analogue scale （VAS） and nasal endoscopic examination （Lund-kennedy score） 6 months after surgery, the results were compared between two groups. Results Two patients in the trial group did not complete the protocol. VAS score and Lund- kennedy score in trial group were 8.0 ± 0.8 and 3.6 ± 1.3 at 6 month after surgery respectively, while those in the control group were 7.3 ± 0. 7 and 4.5 ± 1.7, and the differences were of statistical significance （ t = 5.311 and - 3.187, P 〈 0. 01 ）. Conclusion Low-dose and long-term oral administration of clarithromycin has positive impact on the prognosis of bacterial biofilms positive patients with chronic rhinosinusitis.