维生素D联合布地奈德喷鼻剂对慢性鼻-鼻窦炎患者术后治疗的效果

Efficacy of Vitamin D Combined with Budesonide Nasal Spray in Postoperative Patients with Chronic Rhinosinusitis

目的探讨维生素D联合布地奈德喷鼻剂对慢性鼻-鼻窦炎(CRS)患者术后治疗的临床疗效及其对患者炎症因子水平及鼻腔黏膜超微结构的影响。方法将97例CRS患者随机分为对照组48例与观察组49例,2组均行鼻内镜手术。对照组术后给予维生素D联合糠酸莫米松鼻喷雾剂治疗,观察组术后给予维生素D联合布地奈德喷鼻剂治疗。治疗8周后比较2组的临床疗效及鼻黏膜组织炎症因子水平[包括白细胞介素-17(IL-17)表达率与嗜酸性粒细胞(EOS)数目]、鼻腔黏膜超微结构的变化情况。结果观察组治疗总有效率较对照组显著升高(93.88%比77.08%,χ2=4.2612、P=0.0390),IL-17表达率及EOS数目均较对照组显著降低(t=7.7414、9.7222,均P<0.001)。观察组鼻腔黏膜水肿、病理性腺体增生改善幅度优于对照组,且鼻腔黏膜纤毛排列比对照组更整齐浓密,柱状细胞排列比对照组更紧密。结论维生素D联合布地奈德喷鼻剂对CRS患者术后治疗效果确切,能够通过强效抗炎抗感染等作用改善临床疗效,通过抑制炎症细胞因子向炎症部位聚拢,降低血管通透性和炎症反应等机制降低炎性因子水平,修复鼻腔黏膜超微结构。

Objective To investigate the effects of vitamin D combined with budesonide nasal spray on inflammatory cytokines and nasal mucosal ultrastructure in patients who underwent operation for chronic rhinosinusitis(CRS).Methods A total of 97 patients undergoing nasal endoscopic surgery for CRS were randomly given vitamin D combined with either mometasone furoate aqueous nasal spray(control group,n=48)or budesonide nasal spray(observation group,n=49)after operation.Clinical outcome,interleukin-17(IL-17)expression,eosinophil count and nasal mucosal ultrastructure were compared between the two groups after treatment for 8 weeks.ResultsThe total effective rate in the observation group(93.88%)was higher than that in the control group(77.08%)(χ2=4.2612,P=0.0390).Furthermore,IL-17 expression and eosinophil count in the observation group were lower than those in the control group(t=7.7414 and 9.7222,respectively;P<0.001).Moreover,compared with the control group,nasal mucosal edema and pathological glandular hyperplasia were relieved in the observation group.In addition,nasal mucosal cilia and columnar cells in the observation group were arranged more tightly and orderly than those in the control group.Conclusion Vitamin D combined with budesonide nasal spray can repair the ultrastructure of nasal mucosa and reduce the levels of inflammatory cytokines in postoperative CRS patients through inhibiting the accumulation of inflammatory factors and decreasing vascular permeability and inflammatory response.