曲安奈德喷鼻对CRS切除术后患者鼻黏膜纤毛传输功能、Eos及IL-33的影响

Effect of triamcinolone acetonide nasal spray on nasal mucociliary transmission function,Eos,and IL-33 in patients after CRS resection

目的探讨曲安奈德喷鼻对慢性鼻-鼻窦炎(CRS)切除术后患者鼻黏膜纤毛传输功能、嗜酸性粒细胞(Eos)浸润及白细胞介素-33(IL-33)的影响。方法选取360例CRS切除术后患者作为研究对象,随机均分为对照组(生理盐水灌洗鼻腔)和观察组(曲安奈德喷鼻治疗),1次/d、连续治疗3个月,收集2组患者的一般临床资料、观察临床疗效及不良反应的发生情况,采用糖精清除试验评价2组患者治疗前、治疗后3个月时鼻黏膜纤毛传输功能[鼻黏膜纤毛清除率(NMCR)、鼻黏膜纤毛清除速度(NMCS)及鼻黏膜纤毛传输速度(NMTS)];取2组患者治疗前后的鼻黏膜组织,采用苏木精-伊红(HE)染色和免疫组织化学显色法检测治疗前后Eos计数;采集2组患者治疗前后空腹静脉血,采用酶联免疫法检测血清IL-33水平。结果观察组患者总治疗有效率高于对照组,差异有统计意义(P<0.05);2组患者治疗后NMCR、NMCS及NMTS均明显高于治疗前、且治疗后观察组患者指标高于对照组,差异均有统计意义(P<0.001);2组患者治疗后鼻黏膜Eos计数和血清IL-33水平均明显低于治疗前、且治疗后观察组低于对照组,差异均有统计学意义(P<0.001)。结论CRS切除术后采用曲安奈德喷鼻治疗,可提升患者鼻黏膜纤毛传输功能,降低Eos浸润及机体炎症反应,临床疗效显著。

Objective To investigate the effect of triamcinolone acetonide nasal spray on nasal mucociliary transmission,eosinophil(Eos)infiltration and interleukin 33(IL-33)after chronic rhinosinusitis(CRS)resection.Methods A total of 360 patients after CRS resection were selected as the research objects,and they were randomly divided into control group(normal saline lavage)and observation group(triamcinolone acetonide nasal spray treatment).Treatment was conducted once a day for three consecutive months,general clinical data was collected from both groups to observe clinical efficacy and occurrence of adverse reaction.Saccharin clearance test was adopted to evaluate nasal mucosal cilia clearance rate(NMCR),nasal mucosal cilia clearance rate(NMCS),nasal mucosal cilia transmission rate(NMTS)before and three months after treatment.Hematoxylin-eosin(HE)staining and immunohistochemistry were used to observe the Eos counts of the nasal mucosa before and after treatment in both groups.Collecting fasting venous blood before and after treatment in both groups for enzyme-linked immunosorbent assay to detect the serum IL-33 levels.Results The total clinical effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).After treatment,NMCR,NMCS,and NMTS of both groups were increased compared to before treatment,and that of observation group was higher than that of control group after treatment,differences were statistically significant(P<0.001).The Eos count and IL-33 level of both groups after treatment decreased compared with that of before treatment,and observation group decreased more significantly after treatment,and the difference was statistically significant(P<0.001).Conclusions The use of triamcinolone acetonide nasal spray treatment after CRS resection can improve the patient's nasal mucociliary transmission function,reduce Eos infiltration and body inflammation.It shows significant clinical effects.