鼻用糖皮质激素治疗血管运动性鼻炎的疗效分析

Analysis of efficacy of nasal corticosteroid treatment on vasomotor rhinitis

目的探讨鼻用糖皮质激素治疗血管运动性鼻炎的临床效果。方法选取血管运动性鼻炎25例,行鼻部症状视觉模拟评分、鼻阻力、鼻声反射、鼻腔及下气道NO的测量。鼻用糠酸莫米松喷雾剂治疗,观察治疗后1、2、3、4周时上述指标的变化。结果鼻用糠酸莫米松治疗后,除嗅觉减退外(t=-0.336,P=0.656),鼻堵(t=7.900,P=0.000)、喷嚏(t=13.129,P=0.000)、鼻痒(t=10.140,P=0.000)、流涕(t=11.8,P=0.000)症状较前好转;患者鼻NO(t=1.528,P=0.14)和下气道NO(t=1.755,P=0.092)表现为降低趋势,但无统计学意义;鼻腔阻力(t=17.384,P=0.000)有明显改变;鼻声反射参数鼻腔容积(t=-2.915,P=0.008)、鼻腔最小横截面积(t=-4.179,P=0.000)亦有统计学差异。结论对于血管运动性鼻炎,短期鼻喷激素治疗就可达到较好的症状以及通气功能的改善,但这是鼻部炎症受控制表现的第一步,其改善并不等于气道黏膜炎症的彻底恢复,鼻腔NO仍未回归正常,仍有继续治疗的必要。

OBJECTIVE To investigate the clinical efficacy of nasal corticosteroid treatment on vasomotor rhinitis. METHODS 25 outpatients with VMR who visited doctors in ENT department of Beijing Tongren Hospital were studied. Nasal symptoms were assessed using visual analogue scales. Nasal resistance, acoustic rhinometry was assessed to evaluate nasal ventilation function, and NO concentration of nasal and lower airway was also meassured. After using mometasone furoate, the changes of inflammation and function of upper airway as well as its influences in lower airway were recorded in 1, 2, 3 and 4 weeks respectively. RESULTS After treatment of mometasone furoate, nasal blockage（t =7.900, P =0.000）, sneezing（t =13.129, P =0.000）, nasal itching（t =10.140, P=0.000）, nasal discharge（t =11.8, P=0.000） had significantly improvement, except hyposmia（t =-0.336, P =0.656）. Nasal（t =1.528, P =0.14） and lower airway NO（t =1.755, P =0.092） had a decreasing trend, but there was no statistic difference. Nasal resistance（t =17.384, P=0.000）, nasal cavity（t =-2.915, P=0.008）, and nasal minimum cross-sectional area（t =-4.179, P=0.000） had statistic differences. CONCLUSION Shortterm therapy of nasal spray can improve nasal symptoms and patency function. But this is the first step to control nasal inf lammation. The improvement does not mean complete recovery of airway mucosal inflammation, as nasal NO has not yet returned to normal. So the patients need to continue treatment.