目的: 分析功能性鼻内窥镜手术（functional endoscopic sinus surgery,FESS）联合地塞米松鼻腔冲洗对慢性鼻窦炎（chronic sinusitis,CRS）患者临床症状、炎症反应及血清过敏原特异性IgE（specific immunoglobulin E,sIgE）、嗜酸性粒细胞（eosinophil,EOS）水平的影响。方法: 选取2022年10月—2023年10月在我院治疗CRS患者150例,按照乱数表法分为研究组及对照组,两组各75例,两组患者均行FESS术,对照组在此基础上用生理盐水鼻腔冲洗,研究组加用地塞米松鼻腔冲洗,比较两组临床症状改善、治疗前后炎症反应及对sIgE和EOS水平的影响。结果: 经治疗,研究组临床控制率（97.33%）高于对照组（89.33%）;两组临床症状VAS评分均有所降低,且研究组临床症状评分均低于对照组;治疗后,两组炎性因子水平IL-5、IL-6、IL-12水平均有所降低,且研究组低于对照组;两组治疗后sIgE、EOS水平均有所降低,且研究组低于对照组;研究组术后并发症发生率（13.33%）低于对照组术后并发症发生率（29.33%）,不良反应发生率比较差异无统计学意义。结论: 鼻窦炎患者实施FESS术后联合地塞米松冲洗鼻腔可改善患者临床症状,有效缓解炎症反应,降低sIgE、EOS水平,降低术后并发症。
Abstract
Objective To analyze the effects of functional endoscopic sinus surgery (FESS) combined with dexamethasone nasal irrigation on clinical symptoms, inflammatory response, specific immunoglobulin E (sIgE) and eosinophils (EOS) in patients with sinusitis. Methods A total of 150 patients with CRS in the hospital were enrolled as the research objects between October 2022 and October 2023. According to random number table method, they were divided into study group and control group, 75 cases in each group. On basis of FESS, control group was given normal saline, while study group was given dexamethasone for nasal irrigation. The improvement of clinical symptoms, inflammatory response before and after treatment, and the effects on sIgE and EOS were compared between the two groups. Results After treatment, clinical control rate of study group was higher than that of control group (97.33% vs 89.33%, P<0.05). After treatment, scores of nasal congestion, head/facial pain, olfactory disturbance and runny nose were decreased in both groups, which were lower in study group than control group (P<0.05). After treatment, levels of IL-5, IL-6 and IL-12 were decreased in both groups, which were lower in study group than control group. After treatment, levels of sIgE and EOS were decreased in both groups, which were lower in study group than control group. The incidence of postoperative complications in study group was lower than that in control group (13.33%% vs 29.33%, but there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion Dexamethasone nasal irrigation can improve clinical symptoms, effectively relieve inflammatory response, reduce sIgE, EOS and postoperative complications in patients with sinusitis after FESS.
关键词
慢性鼻窦炎 /
功能性鼻内窥镜手术 /
地塞米松 /
炎症反应 /
特异性免疫球蛋白 /
嗜酸粒细胞水平
Key words
chronic sinusitis /
functional endoscopic sinus surgery /
dexamethasone /
inflammatory response /
specific immunoglobulin /
eosinophil level
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参考文献
[1] 朱谦, 马婕, 石崧. 鼻内镜手术联合糖皮质激素浸润对慢性鼻窦炎伴鼻息肉患者远期疗效及鼻功能的影响[J]. 贵州医药, 2023, 47(2): 213-214.
[2] 杨润琴, 陈福权. 慢性鼻窦炎与嗅觉功能障碍[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28 (3) : 224-225+229.
[3] 王旭平, 刘金梅, 杨培培, 等. 功能性鼻内镜手术治疗鼻-鼻窦炎的疗效及对生活质量的影响[J]. 湖南师范大学学报 (医学版) , 2020, 17(2) : 181-183.
[4] KIM SW, KIM RB, KANG H, et al.Influence of a medialized middle turbinate on olfactory function: a prospective randomized double-blind study[J]. Int Forum Allergy Rhinol, 2019, 9(5) : 473-478.
[5] ROUYAR A, CLASSE M, GORSKI R, et al.Type 2/Th2-driven inflammation impairs olfactory sensory neurogenesis in mouse chronic rhinosinusitis model[J]. Allergy, 2019, 74(3) : 549-559.
[6] 张霞. 功能性鼻内镜手术联合糖皮质激素鼻腔冲洗对慢性鼻窦炎患者鼻黏膜纤毛功能及鼻腔微生态的影响[J]. 中国耳鼻咽喉头颈外科, 2022, 29(9) : 602-603.
[7] 钱志美, 李超群, 李泽卿. 鼻腔冲洗在慢性鼻窦炎鼻内镜术后治疗中的应用研究[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(4) : 35-40.
[8] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南 (2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2) : 81-100.
[9] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 慢性鼻-鼻窦炎诊断和治疗指南 (2012年, 昆明)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(2) : 92-94.
[10] BEACHLER DC, ENGELS EA.Chronic sinusitis and risk of head and neck cancer in the us elderly population[J]. JAMA Otolaryngol Head Neck Surg, 2017, 143(1) : 25-31.
[11] 李俊娟, 王青海, 谢添慧. 明胶海绵+地塞米松填塞在慢性鼻窦炎伴鼻息肉患者鼻内镜手术治疗中的应用价值[J]. 中国医学文摘 (耳鼻咽喉科学) , 2024, 39(01) : 66-69.
[12] 刘冬冬. 鼻内镜联合地塞米松治疗真菌性鼻窦炎的临床研究[J]. 中外医学研究, 2021, 19(32) : 146-148.
[13] 陆智芸, 许水森, 叶海雯, 等. 盐酸氨溴索和地塞米松在慢性鼻窦炎鼻内镜术后的应用[J]. 深圳中西医结合杂志, 2020, 30(07) : 129-130.
[14] 陆赛男, 盛菊萍. 鼻窦炎患者鼻内镜术后应用地塞米松行鼻腔冲洗的疗效评价[J]. 中国继续医学教育, 2016, 8(21) : 147-148.
[15] 罗茜, 黄定强. 免疫炎性标志物水平预测慢性鼻窦炎合并鼻息肉患者术后复发风险的价值[J]. 湖南师范大学学报 (医学版) , 2021, 18(3) : 106-109.
[16] 王萌, 顾兆伟, 赵鹤, 等. 抗IL-4、抗IL-5及抗IgE单克隆抗体在嗜酸粒细胞型慢性鼻窦炎伴鼻息肉治疗中的应用及疗效评价[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(11) : 1148-1152.
[17] 侯薇, 徐璐, 苏涛. IL-12、TGF-β1在CRSwNP组织中的表达水平及其临床意义[J]. 海南医学, 2022, 33(19) : 2460-2463.
[18] 王宏新, 石宝玉, 安娜. 鼻内镜下鼻中隔矫正对OSAHS伴慢性鼻-鼻窦炎患者血清ECP、TIgE、IL-6水平的影响[J]. 分子诊断与治疗杂志, 2023, 15 (6) : 994-997+1002.
[19] SEIBERLING KA, KIDD SC, KIM GH, et al.Efficacy of dexamethasone versus fluticasone nasal sprays in postoperative patients with chronic rhinosinusitis with nasal polyps[J]. Am J Rhinol Allergy, 2019, 33(5) : 478-482.
[20] 汤海, 刘志军. 止血愈合海绵加地塞米松填塞在慢性鼻-鼻窦炎鼻内镜手术效果观察[J]. 中国中西医结合耳鼻咽喉科杂志, 2019, 27 (05) : 360-362+339.
[21] 张治成, 杨晓, 杨晓刚. 鼻窦内窥镜治疗慢性鼻窦炎术后应用盐酸氨溴索和地塞米松雾化吸入对疗效、血清IL-5和IL-12水平的影响[J]. 重庆医学, 2017, 46(17) : 2372-2374.
[22] JANG TY, JUNG AY, KWON S, et al.Hypergravity enhances the therapeutic effect of dexamethasone in allergic asthma and rhinitis animal model[J]. PLoS One, 2018, 13(5) : e0197594.
[23] 徐蓉, 刘甜甜, 陈晓宇. 外周血EOS、IL-21、CCL4与慢性鼻-鼻窦炎伴鼻息肉患者术后复发的相关性[J]. 分子诊断与治疗杂志, 2024, 16 (4) : 683-686+691.
[24] 连刚, 涂静, 雷小平. 外周血EOS、NLR联合检测诊断慢性鼻-鼻窦炎价值分析[J]. 中国实验诊断学, 2021, 25(7) : 962-965.
[25] 房红娟, 马辉娟, 李晓瑞, 等. 血清变应原特异性IgE和外周血嗜酸粒细胞在霉菌性鼻窦炎中的表达及临床意义[J]. 川北医学院学报, 2021, 36(4) : 429-432.
[26] 胡焱, 陈剑波. 鼻窦CT评分联合特异性免疫球蛋白E和白细胞介素6预测嗜酸粒细胞型慢性鼻窦炎伴鼻息肉患者术后复发风险的价值[J]. 中国耳鼻咽喉头颈外科, 2023, 30(8) : 529-532.
基金
东莞市社会发展科技项目“慢性鼻一鼻窦炎伴鼻息肉患者细胞间黏附分子-1与II型固有淋巴细胞的表达及临床意义研究”（20211800903732）;广东省基础与应用基础研究基金区域联合基金项目（地区培育项目）“CSF1/CCL22反馈环介导鼻咽癌细胞与TAMs相互作用促鼻咽癌转移的分子机制”（2021B1515140070）
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