孟鲁司特联合小剂量阿奇霉素治疗儿童慢性鼻窦炎的真实世界研究

A Real World Research of Montelukast Combined with Small Doses of Azithromycin in the Treatment of Chronic Rhinosinusitis in Children

目的:应用真实世界研究(RWR)的方法,结合《欧洲鼻窦炎和鼻息肉指南2012版》,探讨应用孟鲁司特和小剂量阿奇霉素治疗儿童慢性鼻窦炎(CRS)的临床效果。方法:采用多中心前瞻性病例自身前后对照的研究方法,对确诊为CRS的138例患儿,应用孟鲁司特和小剂量阿奇霉素治疗12周以上,部分患儿加用短程抗生素、延长阿奇霉素和(或)孟鲁司特疗程,部分患儿加用鼻用皮质激素。疗程结束后,应用视觉模拟评分(VAS)进行主观评价和Lund-Mackay CT评分法进行客观评价。结果:以LundMackay CT评分<2分为停药指征,应用阿奇霉素和孟鲁司特治疗12周后,138例患儿平均VAS评分及平均Lund-Mackay CT评分均显著下降,其中107例患儿12周即完全停药;22例Lund-Mackay CT评分2~5分者停用阿奇霉素,继续口服孟鲁司特,12例加用糠酸莫米松鼻喷雾剂1~3个月后停药;9例Lund-Mackay CT评分>5分者延长阿奇霉素和孟鲁司特疗程,或加用短程抗生素及鼻用皮质激素等,总疗程延长至24周后停药。138例患儿均随访1年以上,除2例外,未见CRS复发症状。结论:根据《欧洲鼻窦炎和鼻息肉指南2012版》结合RWR方法的治疗原则,应用小剂量阿奇霉素和孟鲁司特治疗儿童CRS 12周,大部分患儿可获显著疗效。

Objective： To explore the clinical effect of montelukast and small dose of azithromycin in the treatment of children with chronic rhinosinusitis（ CRS） according to Real World Research（ RWR） combined with European position paper on rhionsinusitis and nasal polyps 2012（ EPOS 2012）. Methods： A multicenter prospective self-contrast method was applied. One hundred and thirty-eight children diagnosed as CRS were treated by montelukast and small doses of azithromycin more than 12 weeks. Some children were given short course of antibiotics,prolonged azithromycin and/or montelukast were applied to treatment. A small number of nasal corticosteroids were added. Visual analogue scale（ VAS） was used for subjective evaluation and Lund-Mackay CT scores was used for objective evaluation after the treatment. Results： After 12 weeks of treatment,average VAS and Lund-Mackay CT scores of 138 cases showed significant decreased. One hundred and nine cases were drug withdrawal after 12 weeks,while the other 9 cases（ with Lund-Mackay CT scores 〉5） were extended azithromycin and/or montelukast,or with short course of antibiotics and nasal corticosteroids,the total course of treatment was extended to 24 weeks. All the 138 cases were followed up for more than 1 year,except 2 cases,the others were without recurrence of CRS symptoms. Conclusion： Most children with CRS receive significant effect after application of small doses of azithromycin and montelukast treatment for 12 weeks based on the（ EPOS 2012） combine with RWR.