鼻窦功能性手术治疗慢性鼻窦炎合并支气管哮喘的远期疗效评估

Chronic Sinusitis with Bronchial Asthma:Long-term Effect of Functional Endoscopic Sinus Surgery

目的:评价鼻窦功能性手术(FESS)治疗慢性鼻窦炎合并支气管哮喘的远期疗效。方法:选择自2011年1月至2013年1月我院收治的慢性鼻窦炎患者65例,行FESS治疗。根据是否合并患有支气管哮喘将患者分为观察组(慢性鼻窦炎合并支气管哮喘)和对照组(慢性鼻窦炎),选择同期健康志愿者作为正常组。采用酶联免疫吸附测定测定白细胞介素4(IL-4)、干扰素-γ(IFN-γ)水平、可溶性白细胞介素2受体(sIL-2R)和可溶性Ig E低亲和力受体(sCD23)的水平,并术后随访2年观察对比慢性鼻窦炎和支气管哮喘改善情况。结果:对照组和观察组患者手术后的IL-4、sIL-2R及sCD23水平降低,IFN-γ水平升高,且与手术前的差异均有统计学意义(P<0.05);两组患者术后2年的慢性鼻窦炎治愈率均高于术后1年;观察组患者术后1年和术后2年的哮喘完全控制率明显高于术前,且差异具有统计学意义(P<0.05),且术后2年哮喘完全控制率显著高于术后1年之间(P<0.05);观察组患者术后1年、2年哮喘平均发作率显著低于术前,且术后2年的哮喘平均发作率明显低于术后1年(P<0.05)。结论:FESS用于治疗慢性鼻窦炎合并支气管哮喘具有良好的临床疗效,能够显著改善患者的IL-4、IFN-γ、sIL-2R及sCD23水平,且随着时间的延长,其远期疗效较满意。

Objective： To evaluate the long-term effect of the functional endoscopic sinus surgery（FESS） in the treatment of chronic sinusitis with bronchial asthma. Methods： A total of 65 patients with chronic sinusitis, who were treated with FESS in Fifth Affiliated Hospital of Guangzhou Medical University from January 2011 to January 2013. were selected and divided into observation group（chronic sinusitis with bronchial asthma） and control group（chronic sinusitis） according to whether the patients complicated with bronchial asthma, all patients, meantime the healthy volunteers were chosen as the normal group. Then the levels of interleukin 4（IL-4）,interferon-γ（IFN-γ）, soluble interleukin 2 receptor（s IL-2R） and soluble Ig E low affinity receptors（sCD23） were detected by enzyme-linked immunosorbent assay,and during the 2 years of followed-up after operation, the improvement situation of chronic sinusitis and bronchial asthma of the patients were observed and compared. Results： The levels of IL-4, s IL-2R and sCD23 of the control group and observation group after operation were lower than before operation, while the level of IFN-γ was higher than before operation, the differences were statistically significant（P〈0.05）. The cure rates of chronic sinusitis in the two groups 2 years after operation were higher than those 1 year after operation. The total control rates of bronchial asthma in the observation group 1 year and 2 years after operation were significantly higher than those before operation, meanwhile the total control rate of bronchial asthma 2 years after operation was significantly higher than 1 year after operation, the differences were statistically significant（P〈0.05）. The asthma average attack rates in the observation group 1 year and 2 years after operation were significantly lower than before operation, meanwhile the asthma average attack rate 2 years after operation was lower than 1 year after operation, the differences were statistically significant（P〈0.05）. Conclusion：FESS has a good clinical effect in the treatment of patients with chronic sinusitis and bronchial asthma,which can remarkably improve the levels of IL-4, IFN-γ, s IL-2R and sCD23, and its long-term effect is satisfactory along with the extension of time.