不同剂量糖皮质激素对嗜酸性慢性鼻窦炎伴鼻息肉患者的治疗效果

Effects of different doses of glucocorticoids in the treatment of patients with eosinophilic chronic rhinosinusitis and nasal polyps

目的探究嗜酸性慢性鼻窦炎伴鼻息肉患者FESS术后服用糖皮质激素不同剂量对鼻黏膜修复、复发的影响。方法选取120例慢性鼻窦炎伴鼻息肉患者,均接受FESS手术治疗,根据术后使用糖皮质激素的剂量差异分为低剂量组(15mg/d)和高剂量组(30 mg/d),每组60例。连续治疗2周,随访观察6个月。比较两组患者临床疗效、主观症状的视觉模拟评分(VAS),治疗前后鼻黏液纤毛清除功能,以及随访期间的复发率。结果治疗后,高剂量组患者临床总有效率高于对照组;与术前比较,术后2周两组TGF-β1、VEGF降低,黏液纤毛清除速度升高,糖精清除时间缩短,且术后2周高剂量组鼻黏膜修复各项指标优于低剂量组;术后2周两组各项症状评分均较术前降低,且高剂量组低于低剂量组(P<0.05);术后3个月、6个月,低剂量组和高剂量组复发率比较差异不显著(均P>0.05)。结论FESS手术后应用高剂量糖皮质激素治疗能够有效缓解患者临床症状,促进鼻黏膜修复,近期疗效显著,但是并未显著降低远期复发率。

Objective To investigate the effect of different doses of glucocorticoids on nasal mucosa repair and recurrence in patients with eosinophilic chronic rhinosinusitis and nasal polyps after FESS.Methods A total of 120 patients with chronic rhinosinusitis and nasal polyps were selected,all received FESS surgery,and were divided into a low-dose group(15 mg/d)and a high-dose group(30 mg/d)according to the difference in the dose of glucocorticoids used after surgery.60 cases in each group.All had continuous treatment for 2 weeks and follow-up observation for 6 months.The clinical efficacy,visual analogue scale(VAS)of subjective symptoms,nasal mucociliary clearance function before and after treatment,and the recurrence rate during the follow-up period were compared between the two groups.Results After treatment,the total clinical effective rate in the high-dose group was higher than that in the control group;compared with preoperative,TGF-β1 and VEGF decreased,the mucociliary clearance rate significantly increased,and the saccharin clearance time shortened in the two groups 2 weeks after the operation.2 weeks after operation,various indexes of nasal mucosa repair in the high-dose group were better than those in the low-dose group;2 weeks after operation,the symptom scores in both groups were lower than those before operation,and the high-dose group was lower than the low-dose group(P<0.05);At 3 and 6 months after operation,there was no significant difference in the recurrence rate between the low-dose group and the high-dose group(all P>0.05).Conclusion High-dose glucocorticoid therapy after FESS surgery can effectively relieve the clinical symptoms of patients and promote the repair of nasal mucosa.The short-term effect is significant,but the long-term recurrence rate is not significantly reduced.