外用重组人碱性成纤维细胞生长因子溶液在鼻窦术后的临床研究

Clinical trial of recombinant human basic fibroblast growth factor for external use in patients after endoscopic sinus surgery

目的观察外用重组人碱性成纤维细胞生长因子溶液在鼻窦术后的临床疗效。方法将84例慢性鼻-鼻窦炎患者随机分为对照组42例及试验组42例。对照组对手术创面用常规凡士林纱布或海绵填塞,术后2 d松除纱布,以庆大霉素+生理盐水+肾上腺素对鼻窦实施冲洗,每天2次,连续冲洗7 d。试验组用含有外用重组人碱性成纤维细胞生长因子溶液的油纱条填塞鼻腔,术后2 d松除纱布,以外用重组人碱性成纤维细胞生长因子溶液+生理盐水+肾上腺素冲洗,每天2次,连续冲洗7 d。术后3个月比较2组临床疗效、症状评分、Lund-Kennedy内镜评分、术腔黏膜组织中血管内皮生长因子(VEGF)和表皮生长因子(EGF)表达情况。结果治疗后,试验组和对照组的治疗总有效率分别为97. 62%(41例/42例),80. 95%(34例/42例),差异有统计学意义(P <0. 05)。试验组和对照组的症状评分分别为(2. 58±0. 79),(5. 11±1. 03)分;LundKennedy内镜评分分别为(1. 45±0. 82),(2. 57±1. 11)分,差异均有统计学意义(均P <0. 05)。试验组VEGF、EGF阳性细胞表达与对照组比较,差异均有统计学意义(均P <0. 05)。结论在鼻窦术后应用外用重组人碱性成纤维细胞生长因子溶液能明显改善鼻腔症状,调节VEGF、EGF表达,促进鼻窦黏膜恢复,提高临床治愈率。

Objective To investigate the clinical effect of recombinant human basic fibroblast growth factor for external use( rh-b FGF) in patients after endoscopic sinus surgery( ESS). Methods A total of 84 cases of chronic rhinosinusitis with ESS were randomly divided into treatment group and control group,42 cases in each group. After surgery,control group was given routine nasal packing removed 2 d later,and normal saline + gentamicin + epinephrine were used for postoperative irrigation,twice a day for 7 consecutive days;while treatment group was given rh-bFGF gauze packing removed 2 d later,and rh-b FGF + normal saline + epinephrine were used for postoperative irrigation,twice a day for 7 consecutive days. After surgery for 3 months,the clinical efficacy,symptoms scores,Lund-Kennedy endoscope score,expression of vascular endothelial cell growth factor( VEGF) and epidermal growth factor( EGF) in mucosa tissues were compared between the two groups. Results After treatment,the total effective rates in treatment group and control group were 97. 62%( 41 cases/42 cases),80. 95%( 34 cases/42 cases),with significant difference( P < 0. 05). The symptom scores in treatment group and control group were( 2. 58 ± 0. 79),( 5. 11 ± 1. 03) points,the Lund-Kennedy endoscope score were( 1. 45 ± 0. 82),( 2. 57 ± 1. 11) points,all with significant difference( all P < 0. 05). The VEGF and EGF positive expression in treatment group had significant difference compared with control group( P < 0. 05). Conclusion Rh-b FGF in patients after ESS can significantly improve symptoms of nasal cavity,regulate VEGF and EGF expression,promote recovery of sinus mucosas and increase clinical rate.