短疗程糖皮质激素经鼻雾化吸入治疗慢性鼻窦炎伴鼻息肉效果Meta分析

Efficacy of short-course transnasal nebulization of glucocorticoids in treatment of chronic sinusitis with nasal polyps:a Meta analysis

目的系统评价短疗程(<1个月)糖皮质激素经鼻雾化吸入治疗慢性鼻窦炎伴鼻息肉的效果。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、万方和维普数据库中有关糖皮质激素经鼻雾化吸入与鼻喷法治疗慢性鼻窦炎伴鼻息肉的随机对照研究,检索时限从建库至2021年8月。由2位研究者完成筛选文献、提取资料及质量评价等相关工作,使用RevMan 5.3软件进行Meta分析。结果本研究共纳入7项随机对照研究(其中观察组126例,对照组124例),Meta分析结果显示,在降低慢性鼻窦炎伴鼻息肉患者鼻部症状视觉模拟量表评分(VAS)上,经鼻雾化吸入治疗优于鼻喷治疗,差异有统计学意义(P<0.05)。且与鼻喷治疗相比,短疗程使用糖皮质激素经鼻雾化吸入治疗能显著降低鼻内镜Lund-Kennedy评分(P<0.05),使息肉体积明显缩小。两组患者治疗后晨起血清皮质醇水平比较差异无统计学意义(P>0.05)。结论短疗程使用糖皮质激素经鼻雾化吸入可有效缓解鼻部症状体征,减小息肉体积,疗效优于传统的鼻喷疗法,且未发现肾上腺皮质轴抑制现象,短疗程使用期间没有明显不良反应发生,可作为慢性鼻窦炎伴鼻息肉患者术前及术后有效的治疗选择之一。

Objective To evaluate the efficacy of short-course transnasal nebulization of glucocorticoids in the treatment of chronic sinusitis with nasal polyps through systemic review.Methods The relevant studies were searched in PubMed,the Cochrane Library,Embase,CNKI,WanFang and VIP from inception to August 2021.The data were extracted and the quality of literature was evaluated by 2 reviewers;Revman 5.3 software was used for meta-analysis.Results Seven qualified RCTs were included for analysis.A total of 250 patients were involved in studies,including 126 cases in nebulization group and 124 cases in spray group.Meta analysis results showed that VAS score in nebulization group were significantly lower than that in spray group.The nebulization group was superior to the spray group in reducing Lund-Kennedy score(P<0.05).There was no significant difference in serum cortisol levels between two groups(P>0.05).Conclusion The short course transnasal inhalation of nebulized glucocorticoids can improve nasal symptoms,reduce polyp size in patients with chronic sinusitis and nasal polyps,it does not cause obvious HPA axis suppression.