不同时间点糖皮质激素类鼻喷剂治疗对过敏性鼻炎患者鼻腔微生态的影响

Glucocorticoid nasal spray treatment at different time points on nasal Microecology in patients with allergic rhinitis

目的探讨不同时间点糖皮质激素类鼻喷剂治疗对过敏性鼻炎患者鼻腔微生态的影响。方法前瞻性选取2021年2月至2022年2月复旦大学附属中山医院青浦分院耳鼻喉科门诊确诊的过敏性鼻炎患者83例为研究对象。运用随机数字表法按1∶1比例将患者随机分为研究组(n=42)和对照组(n=41)。研究组在晨起洗漱完毕后6∶00和晚上睡前21∶30生理性海水冲洗和布地奈德鼻喷雾剂喷鼻治疗;对照组每天上午9∶00和下午15∶00采用生理性海水冲洗和布地奈德鼻喷雾剂喷鼻治疗。治疗1个月后,对比两组患者的鼻腔菌群种类、鼻腔菌属检出率、症状体征积分和临床疗效。结果治疗1个月后,两组患者的Ace指数、Chao指数、Shannon指数以及Simpson指数比较,差异无统计学意义(P>0.05)。研究组中金黄色葡萄球菌、梭杆菌属、变形菌门、链球菌属、嗜血杆菌属及差异球菌属的相对丰度明显低于对照组,放线菌门、气球菌属、嗜胨菌属、痤疮丙酸杆菌、丙酸杆菌属、棒杆菌属相对丰度明显高于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者的鼻症状总积分量表(TNSS)、鼻炎伴随症状总分表(TNNSS)、鼻-结膜炎相关生活质量调查问卷(RQLQ)显著低于治疗前,且研究组患者的TNSS总分、TNNSS总分和RQLQ总分均明显低于对照组,差异均有统计学意义(P<0.05)。研究组的治疗总有效率为85.71%,明显高于对照组(73.17%),差异有统计学意义(P<0.05)。结论6∶00和晚上睡前21∶30生理性海水冲洗和布地奈德鼻喷雾剂喷鼻治疗过敏性鼻炎较上午9∶00和下午15∶00喷鼻更能有效改善过敏性鼻炎患者的鼻腔微生态失调、鼻症状、鼻炎伴随症状,提高治疗总有效率和患者的生活质量。

Objective To explore the effects ofGlucocorticoid nasal spray treatment on nasal Microecology in patients with allergic rhinitis at different time points.Methods A total of 83 patients with allergic rhinitis diagnosed in the outpatient department of otorhinolaryngology of Qingpu Branch of Zhongshan Hospital affiliated to Fudan University were prospectively selected as the research objects from February 2021 to February 2022.They were randomly divided into the study group(n=42)and the control group(n=41)at a ratio of 1∶1 by using the random number table.The study group was treated with physiological seawater washing and nasal spray of budesonide nasal spray at 6∶00 after washing in the morning and 21∶30 before going to bed at night;The control group was treated with physiological seawater washing and budesonide nasal spray at 9∶00 am and 15∶00 pm every day.After one month of treatment,the types of nasal flora,detection rate of nasal flora,symptom and sign scores and clinical efficacy of the two groups were compared.Results After 1 month of treatment,there was no statistically significant difference in Ace index,Chao index,Shannon index and Simpson index between the two groups(P>0.05).The relative abundance of Staphylococcus aureus,Fusobacterium,Proteus,Streptococcus,Haemophilus and difficile cocci in the study group were significantly lower than those in the control group,the relative abundance of actinomycetes,aerococcus,peptone bacteria,propionibacterium acnes,propionibacterium and corynebacterium in the study group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The total scores of total nasal symptoms score(TNSS),total nasal concomitant symptoms score(TNNSS),and rhinoconjunctivitis related to quality of life questionnaire(RQLQ)of the patients in the two groups after treatment were significantly lower than those before treatment,and the total scores of TNSS,TNNSS and RQLQ of the patients in the study group after treatment were significantly lower than those in the control group,the differences were statistically significant(P<0.05).The total effective rate of the study group was 85.71%,which was significantly higher than that of the control group(73.17%),the difference was statistically significant(P<0.05).Conclusion 6∶00 and 21∶30 before bedtime in the evening,physiological seawater flushing and nasal spray of budesonide in the treatment of allergic rhinitis are more effective than those at 9∶00 am and 15∶00 pm in improving the nasal microbes of allergic rhinitis patients.Dysbiosis,nasal symptoms,and accompanying symptoms of rhinitis can improve the total effective rate of treatment and the quality of life of patients.