丙酸氟替卡松联合克拉霉素治疗慢性鼻窦炎伴鼻息肉的疗效和安全性分析

Study on Effect and Safety of Fluticasone Propionate Combined with Clarithromycin in Treating Chronic Sinusitis Complicating Nasal Polyps

目的探讨丙酸氟替卡松联合克拉霉素治疗慢性鼻窦炎伴鼻息肉的疗效以及安全性。方法将153例慢性鼻窦炎伴鼻息肉患者按随机数字表法分为联合组、激素组以及抗生素组,各51例。激素组患者给予丙酸氟替卡松喷鼻治疗,抗生素组患者给予克拉霉素片口服,联合组患者给予丙酸氟替卡松喷鼻以及口服克拉霉素片的联合治疗,比较3组患者治疗后3个月内的病情改善情况,并记录治疗过程中的不良反应。结果 3组患者治疗后各项临床症状均较治疗前有不同程度改善,但抗生素组患者的视觉模拟评分法(VAS评分)差值较小,低于激素组和联合组(P<0.05),联合组患者的改善最明显,评分明显高于激素组(P<0.05);抗生素组患者的治疗有效率最低,联合组治疗有效率最高,组间两两比较,差异有统计学意义(P<0.05);3组患者的耐受性均良好,其中抗生素组的总不良反应发生率为9.80%,激素组为7.84%,联合组为5.88%,3组比较差异无统计学意义(P>0.05)。结论丙酸氟替卡松联合克拉霉素治疗慢性鼻窦炎伴鼻息肉的疗效确切,且安全性较高,可以使部分患者在短期内免除手术。

Objective To research and analyze the effect and safety of fluticasone propionate combined with clarithromycin in treating chronic sinusitis complicating nasal polyps. Methods 153 cases of chronic sinusitis complicating nasal polyps treated in our hospital were taken as the research subjects and randomly divided into the combination group, hormone group and the antibiotic group according to the random number table method（S1 cases）. The hormone group was given fluticasone propionate by nasal spray. The antibiotic group took oral clarithromycin tablets and the combination group was given the combination therapy of fluticasone propionate by nasal spray and oral clarithromycin. The improvement of the disease condition after 3- month therapy was compared among 3 groups and the occurrence of adverse reactions during the treatment process was recorded. Results The variousl symptoms after treatment in three groups were improved compared with before treatment, but the improvement scores in the antibiotic group were smaller, which were lower than those in the combination group and the hormone group, the difference was statistically significant（ P 〈 0.05）. The improvement of the combination group was most obvious and its scores were significantly higher than that those in the hormone group（ P 〈 0. 05）. The effective rate in the antibiotic group was lowest, which in the combination group was highest, the difference between every two groups was statistically significant（P 〈 0.05）.The tolerance in the three groups was good. The total occurrence rate of adverse reactions was 9.80% in the antibiotic group, 7.84% in the hormone group and 5.88% in the combination group, but the differences among the three groups had no statistical significance（P 〉 0. 05）. Conclusion Fluticasone propionate combined with clarithromycin has the definite effect and high safety in treating chronic sinusitis complicating nasal polyps and can make partial patients to exempt operation in a short term.