摘要
探讨慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps, CRSwNP)经手术治疗后,中成药鼻炎宁颗粒对糖皮质激素鼻喷雾剂治疗6个月内的局部症状缓解及全身免疫功能的影响。选取山西白求恩医院耳鼻咽喉头颈外科接受治疗的CRSwNP患者237例,且均实施鼻内镜手术治疗,随机数字表法分为激素组、中药组、联合组,每组各79例。激素组为术后单纯使用鼻用激素(布地奈德鼻喷雾剂),中药组术后单纯给予中药制剂(鼻炎宁颗粒),联合组术后给予鼻用激素和中药制剂联合治疗,3组均治疗3个月,随访时间为出院当日至术后12个月,观察临床疗效。采用视觉模拟量表(visual analogue scale, VAS)评分、鼻腔鼻窦结局测试-20(SNOT-20)量表评分评估患者主观症状及生活质量改善情况;采用鼻内镜Lund-Kennedy评分及日本T&T标准嗅觉测试法评估患者客观疗效;检测外周血IL-21、CD4^(+)CD25^(+)Foxp3^(+)Treg、CD4^(+)Th17水平变化,记录并发症发生率、复发率以及治疗期间不良反应发生情况。治疗后总有效率,联合组明显优于激素组和中药组(P<0.05);VAS评分、SNOT-20量表评分评估主、客观症状改善情况,3组治疗后均优于治疗前,联合组均显著优于激素组和中药组(P<0.05);Lund-Kennedy评分及T&T标准嗅觉测试法评价病变局部客观改善情况,联合组均显著优于激素组和中药组(P<0.05);患者血清IL-21、CD4^(+)Th17水平,3组治疗后均低于治疗前,联合组低于激素组和中药组,激素组低于中药组(P<0.05);而患者血清CD4^(+)CD25^(+)Foxp3^(+)Treg水平,3组治疗后高于治疗前,联合组高于激素组和中药组,中药组高于激素组(P<0.05)。治疗过程中,均未出现严重不良反应,3组并发症的发生率、复发率比较差异无统计学意义。鼻炎宁颗粒在糖皮质激素治疗CRSwNP过程中,减轻糖皮质激素副作用的同时,协助其缓解患者症状,显著提高疗效,调节免疫失衡,加快促进免疫功能恢复正常,减轻炎性反应,降低复发率,提高生活质量。中西结合治疗比单纯使用糖皮质激素获益更大,值得进一步临床大样本研究。
This study discusses the effect of Biyanning Granules on local symptoms and systemic immune function of patients with chronic rhinosinusitis with nasal polyps(CRSwNP) within the 6 months of treatment by glucocorticoid nasal spray after surgical treatment. To be specific, a total of 237 CRSwNP patients, treated in Otorhinolaryngology Head and Neck Surgery in Shanxi Bethune Hospital, were enrolled. All patients were treated by nasal endoscopy and classified into hormone group(Budesonide Nasal Spray after surgery), Chinese medicine group(Biyanning Granules after surgery), and combination group(Budesonide Nasal Spray+Biyanning Granules after surgery) with random number table method, 79 cases in each group, and the treatment lasted 3 months. The follow-up was performed from the day of discharge to 12 months after the surgery. The clinical effect was observed. The visual analogue scale(VAS) scores and sino-nasal outcome test-20(SNOT-20) scale scores were used to assess patient′s subjective symptoms and quality of life. Lund-Kennedy endoscopic score(LKES), Japanese T&T olfactometry, and standard olfactory test were used to evaluate the objective curative effect on patients. The levels of interleukin(IL)-21, CD4^(+)CD25^(+)Foxp3Treg, and CD4^(+)Th17 in peripheral blood were analyzed. The incidence of complications, recurrence rate, and adverse reactions during treatment were also recorded. The total effective rate after treatment in the combination group was higher than that in the hormone group and Chinese medicine group(P<0.05). VAS scores and SNOT-20 scale scores were lower in the three groups after treatment than before treatment and lower in the combination group than in the other two groups(P<0.05). The improvement in LKES and T&T standard olfactometry test was better in the combination group than in the other two groups(P<0.05). Serum levels of IL-21 and CD4^(+)Th17 in the three groups were lower than before treatment. The levels in the combination group were lower than those in the other two groups and lower in the hormone group than in the Chinese medicine group(P<0.05). Serum CD4^(+)CD25^(+)Foxp3Treg level was higher in the three groups after treatment than before, higher in the combination group than in the other two groups, and higher in the Chinese medicine group than in the hormone group(P<0.05). During the treatment, no serious adverse reactions were observed. After treatment, the combination group showed no significant difference in the incidence and recurrence rate of complications from the hormone group and Chinese medicine group. In the treatment of CRSwNP with glucocorticoid, Biyanning Granules reduced the side effects of glucocorticoid and assisted glucocorticoid in alleviating the symptoms of patients. It significantly improved the curative effect, regulated immune imbalance, accele-rated the recovery of immune function, reduced the recurrence rate of inflammatory reaction, and improved the quality of life. The combination of Chinese and western treatment is more effective than glucocorticoid alone and warrants further clinical study in large sample size.
作者
高颖
王瑞
温树信
文开学
赵惠芳
戎建荣
曹烨
公志华
郭继强
GAO Ying;WANG Rui;WEN Shu-xin;WEN Kai-xue;ZHAO Hui-fang;RONG Jian-rong;CAO Ye;CONG Zhi-hua;GUO Ji-qjang(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences Tongji Shanxi Hospital,Third Hospital of Shanxi Medical Uniersity,Taiyuan 030032,China;Tongji Hospital,Tongji Medical Cllege,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中国中药杂志》
CAS
CSCD
北大核心
2022年第17期4789-4798,共10页
China Journal of Chinese Materia Medica
基金
山西省医疗器械智能准确检测项目(2020SYS14)
山西省卫生厅项目(2021146)。
关键词
慢性鼻窦炎伴鼻息肉
鼻炎宁颗粒
糖皮质激素
免疫平衡
症状缓解
chronic rhinosinusitis with nasal polyps
Biyanning Granules
glucocorticoid
immune balance
symptom relief
