维生素D对慢性鼻-鼻窦炎鼻内镜手术疗效的影响

Effect of Vitamin D on efficacy of endoscopic surgery for chronic rhinosinusitis

目的分析慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者的血清维生素D水平与鼻内镜临床疗效的相关性。方法 40例CRSwNP患者入院行鼻内镜手术,随机分为试验组和对照组。试验组每日口服维生素D(800 IU)+布地奈德喷鼻剂喷鼻,对照组只给予布地奈德喷鼻剂喷鼻,持续8周。实验前后分别测量血清25羟基维生素D水平,记录Lund-Kennedy评分、鼻腔鼻窦结局测试-20条、视觉模拟量表评分。结果筛查60例试验对象血清维生素D水平,其中80%患者伴有维生素D不足(<50 nmol/L);试验后两组间VD水平的差异有统计学意义(P=0.001);治疗后,试验组与对照组间鼻塞、脓涕、头面部疼痛、视觉模拟量表评分总分等评分的差异均具有统计学意义;两组间嗅觉障碍症状评分的差异无统计学意义。治疗后试验组与对照组间鼻腔鼻窦结局测试-20条评分、Lund-Kennedy评分的差异均具有统计学意义。结论在CRSwNP患者中血清维生素D水平普遍较低,临床上对患者予以补充维生素D后可显著提高患者血清中25羟基维生素D的水平,与改善CRSwNP患者的临床症状及提高临床综合治疗效果呈正相关。

OBJECTIVE To investigate the correlation between serum vitamin D levels and clinical efficacy of nasal endoscopic surgery for patients with chronic rhinosinusitis with nasal polyps（CRSwNP）. METHODS Forty patients with CRSwNP were enrolled in this study, and were randomly divided into experimental group and control group. The experimental group were treated with VD（800 IU） plus budesonide nasal spray, and the control group was only given budesonide nasal spray for 8 weeks. Serum levels of 25-hydroxyvitamin D were measured before and after the experiment. Lund-Kennedy score, SNOT-20 and VAS were recorded. RESULTS Eighty percent of patients had VD deficiency （〈50 nmol/L） before treatment. The difference of VD level between the 2 groups was statistically significant after treatment. There was no significant difference in the scores of olfactory disorder between the 2 groups. The scores of SNOT-20 and Lund-Kennedy scores between the experimental group and the control group were statistically significant. CONCLUSION In patients with CRSwNP, the serum vitamin D levels are generally low, the clinical supplement to patients with vitamin D can significantly increase the serum levels of 25-hydroxy vitamin D, improve clinical symptoms and clinical effect of comprehensive treatment.