三种不同方法治疗儿童变应性鼻炎继发慢性鼻窦炎的比较分析

Comparative analysis of three different methods in the treatment of chronic sinusitis secondary to allergic rhinitis in children

目的分析三种不同方法治疗儿童变应性鼻炎(AR)继发慢性鼻窦炎(chronic rhinosinusitis,CRS)的临床效果。方法回顾性分析2019年6月至2020年6月湖南省儿童医院收治的120例AR继发CRS患儿的临床资料,所有患儿均接受鼻用糖皮质激素(intranasal corticosteroids,INCS)治疗,根据不同治疗方案分为INCS单用组、联合冲洗组、联合内镜下鼻窦手术(endoscopic sinus surgery,ESS)组,每组40例。比较各组治疗4、8和12周的视觉模拟量表评分(visual analogue scale,VAS)、鼻内镜检查评分和鼻-结膜炎生活质量问卷(rhinoconjunctivitis quality of life questionnaire,RQLQ)评分,评估治疗12周的临床疗效;检测并比较鼻呼吸道一氧化氮(nitric oxide,NO)浓度、鼻腔分泌物中白细胞介素-17A(interleukin-17,IL-17A)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和免疫球蛋白E(immunoglobulin E,IgE)水平。结果联合冲洗组和联合ESS组治疗4、8、12周的VAS评分、鼻内镜检查评分和RQLQ评分均显著低于单用组(P<0.05)。联合冲洗组和联合ESS组治疗12周的临床疗效优于单用组(P<0.05)。联合冲洗组和联合ESS组治疗4、8、12周的鼻呼吸道NO浓度、IL-17A、TNF-α和IgE水平均显著低于单用组(P<0.05)。结论AR导致CRS患儿单用INCS疗效可能较差,往往需要联合鼻腔冲洗或ESS,对改善临床症状以及减轻鼻腔和呼吸道多种炎症因子的表达具有显著的影响。

Objective To evaluate the clinical effect of three different methods in treatment of chronic rhinosinusitis(CRS)induced by allergic rhinitis(AR)in children and the expressions of some inflammatory factors.Methods A total of 120 children diagnosed as CRS induced by AR from June 2019 to June 2020 were recruited and divided randomly into three groups,40 children in each group,respectively,including single INCS group,INCS combined with nasal irrigation group,INCS combined with endoscopic sinus surgery(ESS)group.Visual Analogue Scale(VAS)score,Nasal endoscopy score,rhinoconjunctivitis quality of life questionnaire(RQLQ)score were evaluated in the follow-up point at 4,8 and 12 weeks.clinical efficacy,nasal nitric oxide(NO)concentration,levels of IL-17A,TNF-αand IgE in nasal secretions or lavage fluid were analyzed.Results The VAS scores,Nasal endoscopy scores and RQLQ at 4,8 and 12 weeks follow-up point in combined with nasal irrigation and ESS groups were all significantly lower than INCS single group.clinical efficacy were better in both groups combined with nasal rrigation and ESS.,NO concentration and levels of IL-17A,TNF-αand IgE were also lower than INCS single group(P<0.05).Conclusions s It may bring poor efficacy using INCS single in the treatment of CRS children secondary to AR nasal irrigation or ESS may be often required,which play an important role in improving clinical symptoms,alleviating various inflammatory factors expressions in nasal allergic inflammation combined with CRS.