维生素D联合枸地氯雷他定及糠酸莫米松鼻喷雾剂对慢性鼻窦炎鼻内镜术后患者的治疗效果

Curative Effects of Vitamin D Combined with Desloratadine and Mometasone Furoate Nasal Spray in Postoperation on Patients with Chronic Rhinosinusitis

目的:探讨维生素D联合枸地氯雷他定和糠酸莫米松鼻喷雾剂对慢性鼻窦炎(CRS)患者术后的治疗效果。方法:84例CRS患者随机均分为对照组(枸地氯雷他定联合糠酸莫米松鼻喷雾剂治疗)和观察组(枸地氯雷他定、糠酸莫米松鼻喷雾剂联合维生素D治疗),于术后1周、4周及8周时,采用鼻腔鼻窦结局测试-20(SNOT-20)对患者进行症状评分;于术后1周和8周时取鼻黏膜组织染色切片,检测白细胞介素-17(IL-17)水平和计数嗜酸性粒细胞(EOS),流式细胞仪检测患者外周静脉血T淋巴细胞亚群分化簇3(CD3^+)和分化簇4(CD4^+)水平,采用视觉类比法(VAS)和鼻内镜Lund-Kennedy法评估患者疼痛程度和鼻黏膜水肿、脓涕等症状。结果:2组患者术后未出现严重不良反应,术后8周症状评分均低于术后4周和术后1周,术后4周的症状评分均低于术后1周,且观察组术后4周及8周的症状评分均低于同时段对照组评分(P <0. 05);术后8周时,2组患者鼻黏膜组织IL-17、EOS水平、VAS和Lund-Kennedy评分均较术后1周降低,且观察组低于对照组(P <0. 05);术后8周时,2组患者外周血CD3^+和CD4^+水平均较术后1周升高(P <0. 05),且观察组高于对照组(P <0. 05)。结论:维生素D联合枸地氯雷他定及糠酸莫米松鼻喷雾剂治疗方案能缓解CRS术后临床症状,其机制可能与该方案能有效抗炎及调节机体免疫功能有关。

Objective:To explore the curative effects of vitamin D combined with desloratadine citrate disodium and mometasone furoate nasal spray in postoperation on patients with chronic rhinosinusitis.Methods:Eighty-four patients with CRS were randomly and evenly divided intothe control group(treatment with desloratadine citrate disodium combined with mometasone furoate nasal spray)and the observation group(treatment with vitamin D combined with desloratadine citrate disodium and mometasone furoate nasal spray).Sino-nasal outcome test-20(SNOT-20)was used to evaluate the symptom scores of the two groups at 1 week,4 weeks and 8 weeks after surgery.At 1 week and 8 weeks after the surgery,the nasal mucosa was stained,the levels of IL-17 and eosinophils(EOS)were measured.Flow cytometry was used to measure the levels of cluster of differentiation 3(CD3+)and cluster of differentiation 4(CD4+)of T lymphocyte subsets in peripheral venous blood,and visual analogue scale(VAS)and nasal endoscopic Lund-Kennedy were applied to evaluate the degree of pain and symptoms such as nasal mucosa edema and purulence.Results:There were no serious adverse reactions during the postoperative treatment in the two groups.The score of symptoms at 8 week after surgery in the two groups was lower than that at 4 week and at 1 week after surgery,and the score of symptoms at 4 week after surgery in the two groups were lower than that at 1 week after surgery.The score of symptoms at 4 week and 8 week of the observation group was lower than that of the control group(P<0.05).At 8 week after surgery,the level of mucosal tissue IL-17,the level of EOS and scores of VAS and Lund-Kennedy in the two groups decreased compared with those at 1 week,and the levels and scores in the observation group were lower than those in the control group(P<0.05).At 8 week after surgery,the levels of peripheral blood CD3+and CD4+in the two groups increased compared with those at 1 week(P<0.05),and the levels in the observation group were higher than those in the control group(P<0.05).Conclusion:Vitamin D combined with desloratadine and Mometasone Furoate Nasal Spray can alleviate the clinical symptoms of CRS in postoperative treatment.The mechanism may be related to the effective anti-inflammation and the regulation of immune functions.