预防性治疗季节性变应性鼻炎的效果观察

Preventive treatment of seasonal allergic rhinitis

目的探讨预防性治疗在防治季节性变应性鼻炎(AR)中的作用。方法选取就诊的季节性AR患者168例,根据随机数字表法分为布地奈德组、氯雷他定组、孟鲁司特组、对照组,前3组均在花粉飞散前2周开始应用不同的药物,对照组患者未提前用药。分别于用药前、用药后2周、停药后2周及4周对患者鼻眼部各症状、总症状(Uni-VAS)进行视觉模拟量表(VAS)及鼻结膜炎相关生活质量问卷(RQLQ)评分。结果用药前,4组患者鼻眼部各症状、Uni-VAS和RQLQ评分差异无统计学意义(P>0.05);用药后2周、停药后2周,孟鲁司特组、氯雷他定组、布地奈德组患者鼻眼部各症状,Uni-VAS和RQLQ评分均低于对照组(P<0.05);鼻塞症状评分由高到低依次为氯雷他定组、孟鲁司特组、布地奈德组(P<0.05),鼻痒、流涕、喷嚏等症状评分和总症状评分由高到低依次为孟鲁司特组、氯雷他定组、布地奈德组(P<0.05),氯雷他定组患者眼痒、流泪症状评分低于布地奈德组和孟鲁司特组(P<0.05);停药后4周,4组患者各症状、Uni-VAS和RQLQ评分差异无统计学意义(P>0.05)。结论花粉飞散前2周预防性药物治疗可有效控制花粉期到来时季节性AR的症状,改善患者生活质量,但不能有效控制整个花粉期的过敏症状。鼻用糖皮质激素对所有鼻部症状均有明显改善作用,口服抗组胺药对改善眼部症状更明显。

Objective To explore the role of preventive treatment in seasonal allergic rhinitis.Methods 168 patients with seasonal AR were randomly divided into budesonide group,loratadine group,montelukast group and control group.The first three groups were treated with different drugs for two weeks before the pollen dispersing,and the control group did not use the drugs in advance.The various symptoms,total symptoms and quality of life were evaluated respectively before,two weeks after commencing treatment,and two weeks,four weeks after discontinuation.Results Before treatment,there was no significant difference between the four groups of patients with various symptoms,Uni-vas and RQLQ scores(P>0.05);Two weeks after commencing treatment and two weeks after discontinuation,the scores of various symptoms,Uni-vas and RQLQ scores in budesonide group,loratadine group,montelukast group were lower than the control group(P<0.05);The score of the nasal symptoms from high degree to low was in loratadine group,montelukast group and budesonide group(P<0.05);The score of nasal itching,runny nose,sneezing symptoms and Uni-vas from high degree to low was in montelukast group,loratadine group and budesonide group(P<0.05);The score of eye itch,tear symptoms in Loratadine group was lower than that of montelukast group and budesonide group(P<0.05);There was no significant difference between the four groups of patients with various symptoms,Uni-vas and RQLQ scores four weeks after discontinuation(P>0.05).Conclusion It can effectively control the symptoms of seasonal AR and improve the quality of life during pollen period by prophylactic drug therapy two weeks before pollen dispersal,but it cannot control the allergic symptoms of the whole pollen season.Intranasal corticosteroids has a significant effect on all nasal symptoms,Oral antihistamines are more obvious in improving eye symptoms,and oral antihistamines are more effective in improving eye symptoms.