高渗盐水鼻腔冲洗治疗血管运动性鼻炎的初步研究

Preliminary study on the treatment of vasomotor rhinitis by nasal irrigation with hypertonic saline

目的血管运动性鼻炎(vasomotor rhinitis,VMR)常表现为鼻塞和流涕,其发病机制尚不清楚,目前尚缺乏长期治疗VMR的有效方法。方法将患有VMR的49例患者随机分为两组:高渗盐水组25例,男14例,女11例;年龄19~66岁,平均年龄43.88岁;生理盐水组24例,男13例,女11例;年龄19~61岁,平均年龄为40.75岁。高渗盐水组以3%的盐水(温度为40℃)行鼻腔冲洗治疗,生理盐水组以生理盐水(温度为40℃)行鼻腔冲洗治疗,干预期为3个月,用视觉模拟量表(visual analog scale,VAS)评估患者鼻塞和流涕症状,用SF-12v2评估患者生活质量,该项研究还对两组患者干预前和干预3个月末时的鼻腔冲洗液(nasal lavage fluid,NLF)中黏蛋白(mucin,MUC)5B和P物质(substance P,SP)进行检测。结果 43例VMR患者完成了研究,干预3个月末时,高渗盐水组患者鼻塞和流涕VAS评分均降低,SF-12v2评分升高,NLF中MUC5B降低,但SP含量与干预前相比差异无统计学意义(P>0.05);生理盐水组患者干预前后鼻塞VAS评分、SF-12v2评分和NLF中SP比较,差异无统计学意义(P>0.05),但流涕VAS评分和NLF中MUC5B含量却出现显著降低;高渗盐水组和生理盐水组之间相比,鼻塞VAS评分和SF-12v2评分间差异具有统计学意义(P<0.05),流涕VAS评分、NLF中MUC5B和SP浓度无明显差异(P>0.05)。结论高渗盐水鼻腔冲洗是长期治疗VMR的有效手段。

Objective Patients with vasomotor rhinitis （VMR） usually complain of nasal obstruction and rhinorrhea. The exact mechanisms of VMR are not clear. At present, there is still no effective therapeutic method for VMR. Methods 49 patients with VMR were randomly divided into two groups. The hypertonie saline group included 25 cases （14 men, 11 women） with a mean age of 43.88 years old （ranged from19 to 66 years old） , and the normal saline group included 24 （13 men, 11 women） with a mean age of 40.75 years old （ranged from 19 to 61 years old）. The patients in the hypertonie saline group received nasal irrigation using 3.0% saline with a temperature of 40~C, and those in the normal saline group using 0.9% saline instead. The durations of the intervention period in both groups were 3 months. Visual analog scale （ VAS ） was used to evaluate the improvement of nasal symptoms including nasal obstruction and rbinorrhea, and the health-related quality of life was assessed with the 12-item Short Form Health Survey version 2.0 （SF- 12v2）. Contents of mucin （MUC） 5B and substance P （SP） in nasal lavage fluid （NLF） were assessed before and after treatment in the two groups. Results 43 of 49 patients completed the study. After treatment, the total VAS scores of nasal symptoms including nasal obstruction and rhinorrhea decreased, and SF-12v2 scores increased in the hypertonic saline group. Furthermore, MUCSB in NLF was also reduced, but SP showed no statistical change （P 〉 0.05 ）. In the normal saline group, the VAS score of nasal obstruction, SF-12v2 scores and the content of SP in NLF showed no significant changes after nasal irrigation （ all P 〉 0.05 ）. However, the VAS score of rhinorrhea and MUCSB in NLF were decreased after treatment in the normal saline group. After treatment, there were significant differences in the VAS score of nasal obstruction and SF-12v2 score （ all P 〈 0.05 ）, and no significant differences in the VAS score of rhinorrhea, SP and MUC5B in NLF between the two groups （ all P 〉 0.05 ）. Conclusion Hypertonic saline nasal irrigation is an effective long-term treatment for VMR.