鼻渊舒联合布地奈德雾化吸入对慢性鼻-鼻窦炎术后患者炎症因子的影响

Effect of Biyuanshu Combined with Aerosol Inhalation of Budesonide on Serum Inflammatory Factors after Endoscopic Sinus Surgery in Treating for Chronic Rhinosinusitis

目的:观察鼻渊舒联合布地奈德雾化吸入治疗慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)鼻窦内窥镜术后的临床疗效,以及对血清中白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-5(interleukin-5,IL-5)、白细胞介素-6(interleukin-6,IL-6)和白细胞介素-17(interleukin-17,IL-17)水平的影响。方法:将126例CRS术后患者按随机数字表法分为对照组和观察组,每组63例。鼻窦内窥镜术后两组患者均给予左氧氟沙星胶囊治疗,每天0.3 g,每天2次,共治疗7 d。对照组采用布地奈德0.2 mg+生理盐水10 m L,超声雾化吸入,每天2次;观察组给予布地奈德0.2 mg+鼻渊舒口服液10 m L,超声雾化吸入,每天2次。两组患者疗程均为4周。并进行3个月随访。两组患者主观症状采用视觉模拟评分法(visual analogue scale,VAS),客观症状采用鼻内镜评分(endoscopic appearance scores,Lund-Kennedy),并进行鼻窦CT检查,采用鼻窦炎疾病特异性生存质量量表(sino-nasal outcome test-20,SNOT-20)评价患者生存质量;并检测血清IL-1β、IL-5、IL-6和IL-17水平。结果:观察组患者临床疗效优于对照组,差异有统计学意义(P<0.05);在4周治疗结束时和3个月随访后,观察组主观症状评分(鼻塞、流脓涕或鼻涕倒流、头昏或头痛、面部疼痛、嗅觉障碍)和Lund-Kennedy评分均低于对照组,差异均有统计学意义(P<0.01);在随访末,观察组患者Lund-dennedy评分、SNOT-20量表评分和鼻窦CT评分均低于对照组,差异均有统计学意义(P<0.01);治疗后观察组患者血清IL-1β、IL-5、IL-6和IL-17水平低于对照组,差异有统计学意义(P<0.01)。结论:鼻渊舒联合布地奈德雾化吸入能有效改善CRS术后患者的临床症状,提高患者生存质量,并下调血清炎症因子水平,促进患者的术后康复。

Objective ： To observe the effect of Biyuanshu combined with aerosol inhalation of Budesonide in treatment of chronic rhi- nosinusitis （CRS） after sinus surgery on serum IL-115, IL-5, IL- 6 and IL-17 levels. Methods ： 126 patients with CRS were randomly divided into control group and observation group, with 63 cases in each group. After sinus surgery, both groups of patients were giv- en levofloxacin capsules ,0.3 g per day, twice a day for 7 days. The control group was given Budesonide 0.2 mg ＋ normal saline 10 mL was given after surgery, and ultrasonic inhalation was performed twice a day. The observation was given Budesonide 0.2 mg ＋ Naoyuanshu oral solution 10 mL, ultrasonic nebulization ,2 times a day. Both groups of patients were treated for 4 weeks and were followed up for 3 months. Subjective symptoms were scored by using visual analogues, Lund-Kennedy scores were used for objective symptoms, CT and nasal endoscopy were performed for sinus, and quality of life was assessed by using the Sinusitis Disease-Specif- ic Quality of Life Scale （SNOT-20）. The serum IL-1β, IL-5, IL-6 and IL-17 levels was measured. Results：After Ridit analysis, the clinical efficacy of the observation group was better than that of the control group, and the difference was statistically significant （P 〈 0.05 ）. At the end of 4 weeks of treatment and after 3 months of follow-up, the observation group subjective symptom score （ nasal congestion, pus The sputum or nasal discharge, dizziness or headache, facial pain, olfactory disturbance ） and Lund-Kennedy score were lower than the control group, and the differences were statistically significant （P 〈 0.01 ）. At the end of follow-up, the observation group received nasal endoscopy score,the SNOT-20 scale score and the sinus CT score were significantly lower than that of the control group （ P 〈 0.01 ）. The serum IL-1β, IL-5, IL-6 and IL-17 levels were significantly lower than that of the obser- vation group after treatment （P 〈 0.01 ）. Conclusion ：Biyuansbu combined with Budesonide inhalation can effectively improve the clinical symptoms of patients with CRS,improve the quality of life of patients, down-regulate the level of serum inflammatory fac- tors. and nromote postoperative rehabilitation.