鼻腔冲洗和鼻喷激素治疗血管运动性鼻炎的临床研究

Clinical study of nasal irrigation and budesonide nasal spray in the treatment of vasomotor rhinitis

目的血管运动性鼻炎(vasomotor rhinitis,VMR)是一种与变态反应和感染不相关的常见性疾病。VMR的具体发病机制尚不清楚,目前仍未发现可长期治疗VMR的有效方法,本文将鼻腔冲洗和鼻喷激素治疗VMR的疗效进行了对比,旨在选择可以长期、有效治疗该病的手段。方法将患有VMR的101位病人随机分为4组:对照组24例,平均年龄为40.75±13.46岁(19岁~61岁,男性13位,女性11位),布地奈德鼻腔喷雾治疗组(布地奈德组)25例,平均年龄41.16±13.56岁(18岁~66岁,男性13位,女性12位),鼻腔冲洗治疗组(鼻腔冲洗组)25例,平均年龄43.88±9.27岁(19岁~66岁,14位男性,11位女性)以及布地奈德鼻腔喷雾+鼻腔冲洗治疗组(联合治疗组)27例,平均年龄43.59±11.40岁(20岁~64岁,男性13位,女性14位)。对照组的病人不予以任何治疗措施,布地奈德组用布地奈德行鼻腔喷雾治疗(每次每侧鼻孔2喷,每日1次),鼻腔冲洗组以3%的温盐水(温度计检测水温为40°C)行鼻腔冲洗治疗,联合治疗组则同时应用以上两种治疗方法,干预期为3个月(90天),用视觉模拟量表(VAS)评估患者鼻部症状,用SF-12v2评估患者生活质量。结果 90例VMR患者完成了研究,干预后第3月末,鼻腔冲洗组(t=5.690,P<0.0001)和联合治疗组(t=7.054,P<0.0001)与对照组比较,其VAS评分降低,SF-12v2评分升高(t=3.660,P<0.001,t=4.971,P<0.0001),差异具有统计学意义,而布地奈德组(t=1.247,P>0.05,t=1.910,P>0.05)和对照组之间的评分无统计学差异,另外,鼻腔冲洗组(t=4.055,P<0.001,t=2.233,P<0.05)或联合治疗组(t=5.460,P<0.0001,t=3.714,P<0.001)与布地奈德组之间的两种评分均具有统计学差异,但是鼻腔冲洗组(t=1.814,P>0.05,t=1.257,P>0.05)和联合治疗组比较,这些评分无统计学差异。结论单纯布地奈德鼻腔喷雾不适用于VMR的长期治疗,鼻腔冲洗或布地奈德联合鼻腔冲洗的方法适于长期治疗VMR。

Objective Vasomotor rhinitis （VMR） is a common disease that is unrelated to allergy and infection. The exact pathogenesis of VMR is not clear. Effective long-term treatments for VMR have not been found to date. This paper compared the curative effect of nasal irrigation and budesonide nasal spray in the treatment of vasomotor rhinitis, aimed to select a long-term and effevtive treatment. Methods 101 patients with VMR were randomly divided into 4 groups. The mean age was 40.75±13.46 years old for the control group （range, 19-61 years old; 13 male, 11 female; n=24）, 41.16 ±13.56 years old for the budesonide nasal spray treatment group （budesonide group） （range, 18-66 years old;13 male, 12 female;n=25）, 43.88 ±9.27 years old for the nasal irrigation treatment group （nasal irrigation group） （range, 19-66 years old; 14 male, 11 female; n=25） and 43.59±11.40 years old for the budesonide nasal spray ＋ nasal irrigation group （combined treatment group） （range, 20-64 years old; 13 male, 14 female; n=27）. The control group patients were left untreated. Budesonide group took budesonide nasal spray treatment （each 2 sprays per nostril, 1 times daily）, nasal irrigation group used 3.0% saline with a temperature of 40℃ irrigate the nasal. Combined treatment group were given both treatments. The duration of the intervention period was 3 months （90 days）. Visual Analog Scale （VAS） was used to evaluate nasal symptoms and the health-related quality of life was assessed with the 12-item Short Form Health Survey version 2.0 （SF-12v2）. Results 90 VMR patients completed the study. At the end of the third month, the VAS score （t=5.690, P〈0.0001） （t=7.054, P〈0.0001） was diminished and SF-12v2 score （t=3.660, P〈0.001） （t=4.971, P〈0.0001） was elevated in nasal irrigation and combined treatment group versus control group, but there were no significant differences （t=1.247, P〉0.05, t=1.910, P＆gt;0.05） between budesonide and control group. In addition, there were statistically significant differences between nasal irrigation （t=4.055, P〈0.001, t=2.233, P〈0.05） or combined （t=5.460, P〈0.0001, t=3.714, P〈0.001） treatment group and budesonide group, but no statistical differences （t=1.814, P〉0.05, t=1.257, P〉0.05） were found between nasal irrigation and combined treatment group. Conclusion Simple budesonide nasal spray is not an appropriate long-term treatment for VMR. Nasal irrigation or combined treatment of budesonide with nasal irrigation may be an appropriate therapy.