单药加倍或多药联合治疗变应性鼻炎效果比较

Effects of double-dose antihistamine or combined therapy in allergic rhinitis

目的:比较口服单倍剂量抗组胺药与鼻喷糖皮质激素联用和口服双倍剂量抗组胺药,对于季节性变应性鼻炎的疗效及不良反应。方法:随机、平行对照研究,为期2周。将82例圆柏花粉过敏所致变应性鼻炎患者分为2个组:联合组每日口服依巴斯汀10mg加鼻喷糠酸莫米松200μg;双倍组每日口服依巴斯汀20mg。花粉季中,2组患者均记录每日鼻结膜炎症状评分及方案外按需用药情况。分组治疗2周后,反馈调查患者用药不良反应及剂型偏好。在治疗前后测量外周血中细胞因子IL-6、IL-8和TNF-α的水平。结果:在圆柏花粉播散期间,联合组的鼻结膜炎日均症状评分[(3.7±0.4)分]显著低于双倍组[(4.5±0.5)分],差异有统计学意义(P<0.001)。联合组的日均按需用药评分[(1.3±0.6)分]也显著低于双倍组[(1.7±0.7)分],差异有统计学意义(P<0.001)。联合组日均总药费为(7.08±0.33)元,低于双倍组[(7.28±0.51)元],差异有统计学意义(P=0.002)。2组药物不良反应发生率差异无统计学意义。分组治疗2周后,外周血炎症因子IL-6、IL-8和TNF-α的水平组间差异无统计学意义。结论:该研究提示在季节性变应性鼻炎的治疗中,鼻喷糖皮质激素和口服单倍剂量抗组胺药的联合疗法优于口服双倍抗组胺药的剂量增倍法。

Objective：To compare the efficacy and side effects of combined therapy with single-dose oral antihistamine and intranasal corticosteroid to monotherapy with double-dose oral antihistamine in the treatment of seasonal allergic rhinitis.Method：Eighty-two patients with seasonal allergic rhinitis caused by cypress pollen were enrolled in a randomized,parallel-group studycomparing 2 weeks therapy of either 10 mg oral ebastine plus 200μg intranasal mometasone furoate once daily（combined group）or 20 mg oral ebastine once daily（double-dose group）during the pollen season.Daily rhinoconjunctivitis symptom score and rescue medication use were recorded in both groups.After the treatment period,questionnaires were used to survey the side effects of medicines and dosage form preference of the patients.The levels of IL-6,IL-8 and TNF-αin the peripheral blood were measured before and after the therapy.Result：During the cypress pollen season,the daily rhinoconjunctivitis symptom score of the combined group（n=42,3.7±0.4）was significantly lower than that of double-dose group（n=40,4.5±0.5）,P〈0.001.The daily rescue medication score of the combined group（1.3±0.6）was also significantly lower than double-dose group（1.7±0.7）,P〈0.001.The daily medication cost of combined group was 7.08±0.33 Yuan,which was less than that of double-dose group（7.28±0.51 Yuan,P=0.002）.There was no statistical difference in the rate of adverse reactions between the two groups.The peripheral levels of IL-6,IL-8 and TNF-αin two groups did not show significant difference at the end of therapy.Conclusion：The combined therapy with single-dose oral antihistamine and intranasal corticosteroid was superior to the monotherapy with double-dose oral antihistamine in the treatment of seasonal allergic rhinitis in our study.