摘要
目的观察糠酸莫米松喷雾剂联合克拉霉素对功能性鼻内镜术后慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者血清白细胞介素(IL)-17、中性粒细胞/淋巴细胞比值(NLR)及鼻黏膜功能的影响。方法前瞻性选取于2021年1~12月南京医科大学第四附属医院收治的CRSwNP患者100例,采用简单随机数字表法分为对照组和观察组,每组各50例。两组患者均给予功能性鼻内镜手术治疗,对照组术后给予克拉霉素联合0.9%氯化钠溶液鼻腔冲洗干预,而观察组在对照组基础上联合糠酸莫米松喷雾剂干预,连续治疗3个月。比较两组黏膜上皮化时长、不良反应情况及治疗前和治疗3个月后血清IL-17、IL-1β、NLR、鼻黏膜功能、鼻气道阻力、Lund-Kenedy评分、鼻窦炎疾病特异性生存质量量表(SNOT-20)评分、鼻窦CT评分的差异。结果观察组黏膜上皮化时长为(7.84±1.07)周,明显短于对照组[(8.75±1.33)周],而鼻腔充血、鼻腔干燥及鼻黏膜增生等不良反应发生率为4.00%(2/50),明显低于对照组[16.00%(8/50)],差异均有统计学意义(P<0.05)。治疗后,两组血清IL-17、IL-1β、NLR及鼻气道阻力明显较治疗前下降,而鼻黏液纤毛清除率、鼻黏液纤毛清除速度明显较治疗前升高,且观察组IL-17、IL-1β、NLR、鼻气道阻力为(27.36±6.72)pg/mL、(13.56±2.45)pg/mL、2.64±0.51、(1.21±0.31)kPa/(s·L),均明显低于对照组[(43.89±8.59)pg/mL、(18.52±4.11)pg/mL、3.47±0.56、(1.69±0.36)kPa/(s·L)],鼻黏液纤毛清除率、鼻黏液纤毛清除速度为(69.45±5.88)×10^(-2)、(6.29±0.91)mm/min,均明显高于对照组[(61.89±6.01)×10^(-2)、(5.34±0.83)mm/min],差异均有统计学意义(P<0.05)。治疗后,两组Lund-Kenedy评分、SNOT-20评分及鼻窦CT评分明显较治疗前下降,且观察组Lund-Kenedy评分、SNOT-20评分及鼻窦CT评分为(1.82±0.53)、(7.15±1.92)、(3.68±1.23)分,均明显低于对照组[(2.91±0.67)、(11.23±2.13)、(4.47±1.96)分],差异均有统计学意义(P<0.05)。结论糠酸莫米松喷雾剂联合克拉霉素可减小功能性鼻内镜术后患者鼻气道阻力,促进鼻黏膜功能的恢复,提高生活质量,机制可能与降低血清IL-17、IL-1β、NLR有关。
Objective To observe the effect of mometasone furoate spray combined with clarithromycin on serum interleukin-17(IL-17),neutrophils/lymphocytes in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)after functional nasal endoscopy ratio(NLR)and the effect of nasal mucosal function.Methods A total of 100 patients with CRSwNP admitted to the Fourth Affiliated Hospital of Nanjing Medical University from January to December 2021 were prospectively selected and randomly divided into control group and observation group,each group 50 cases.Both groups were given functional endoscopic surgery,the control group was given clarithromycin combined with saline nasal irrigation after operation,and the observation group was given mometasone furoate spray intervention on the basis of the control group.The duration of mucosal epithelialization,adverse reaction rate,serum IL-17,interleukin-1β(IL-1β),NLR,nasal mucosal function,nasal airway resistance,Lund-Kenedy score,and sinusitis disease-specific survival quality scale(SNOT-20)scores and sinus CT scores were compared between the two groups.Results The duration of mucosal epithelialization in the observation group was(7.84±1.07)weeks,which was significantly shorter than that in the control group[(8.75±1.33)weeks],and the adverse reaction rates such as nasal congestion,nasal dryness and nasal mucosal hyperplasia was 4.00%(2/50),which was significantly lower than that in the control group[16.00%(8/50)],the differences were statistically significant(P<0.05).After treatment,the levels of serum IL-17,IL-1β,NLR and nasal airway resistance in the two groups were significantly lower than those before treatment,while the clearance rate of nasal mucociliary and the clearance rate of nasal mucociliary were significantly higher than those before treatment,and the IL-17,IL-1β,NLR and nasal airway resistance in the observation group were(27.36±6.72)pg/mL,(13.56±2.45)pg/mL,2.64±0.51,(1.21±0.31)kPa/(s·L),which were significantly lower than those in the control group[(43.89±8.59)pg/mL,(18.52±4.11)pg/mL,3.47±0.56,(1.69±0.36)kPa/(s·L)],the nasal mucociliary clearance rate and the nasal mucociliary clearance rate were(69.45±5.88)×10^(-2),(6.29±0.91)mm/min,which were significantly higher than those in the control group[(61.89±6.01)×10^(-2),(5.34±0.83)mm/min],the differences were statistically significant(P<0.05).After treatment,the Lund-Kenedy score,SNOT-20 score and sinus CT score in the two groups were significantly decreased compared with those before treatment,and the Lund-Kenedy score,SNOT-20 score and sinus CT score in the observation group were(1.82±0.53),and(7.15±1.92),(3.68±1.23)pionts,which were significantly lower than the control group[(2.91±0.67),(11.23±2.13),(4.47±1.96)points],the differences were statistically significant(P<0.05).Conclusion Mometasone furoate spray combined with clarithromycin can reduce nasal airway resistance,promote the recovery of nasal mucosa function,and improve quality of life in patients after functional nasal endoscopy.The mechanism may be related to the reduction of serum IL-17,IL-1β,and NLR related.
作者
程炜良
杨益艳
张宁
CHENG Wei-liang;YANG Yi-yan;ZHANG Ning(Department of Pharmacy,Nanjing Pukou Hospital/The Fourth Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210000,China.)
出处
《临床和实验医学杂志》
2022年第20期2193-2197,共5页
Journal of Clinical and Experimental Medicine
基金
江苏省青年医学重点人才培养项目(编号:QNRC2016833)。
关键词
糠酸莫米松喷雾剂
克拉霉素
鼻内镜
慢性鼻-鼻窦炎伴鼻息肉
鼻黏膜功能
Mometasone furoate spray
Clarithromycin
Nasal endoscopy
Chronic rhinosinusitis with nasal polyps
Nasal mucosal function
