摘要
目的观察不同疗程布地奈德鼻喷雾剂对复发性慢性鼻窦炎伴鼻息肉(CRSwNP)患者术后症状改善及炎症控制的影响。方法回顾性分析2021年6月到2024年6月郑州市第一人民医院收治的74例CRSwNP患者,按照内镜鼻窦手术后给予布地奈德鼻喷雾剂的疗程分为三月组(38例)和六月组(36例)。比较两组CRSwNP患者临床疗效、鼻内镜息肉评分和总体症状评级[使用鼻-鼻窦结局测试-22量表(SNOT-22)进行评估]在治疗前后的变化,并检测白介素-5(IL-5)、干扰素-γ(IFN-γ)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平变化,评估其变化与患者症状改善的相关性,同时记录不良反应发生情况。结果术后3个月和术后6个月,三月组患者治疗有效率与六月组比较差异均无统计学意义(P>0.05)。术后6个月,两组患者Lund-Kennedy评分及SNOT-22评级均较入院后降低,差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05)。术后6个月,两组IL-5、IFN-γ、hs-CRP、TNF-α水平均较治疗前降低,且六月组IL-5水平低于三月组,差异有统计学意义(P<0.05);术后6个月两组IFN-γ、hs-CRP、TNF-α水平比较,差异无统计学意义(P>0.05)。治疗和随访期间,三月组患者不良反应发生率为15.79%,六月组为11.11%,组间比较,差异无统计学意义(P>0.05)。相关性分析显示,IL-5降低幅度与患者鼻内镜息肉总评分、总体症状总评级的下降程度均处于明显正相关关系,其余指标相关性不明显(P>0.05)。结论术后应用布地奈德鼻喷雾剂3个月和6个月均能有效改善复发性慢性鼻窦炎伴鼻息肉患者的症状,且安全性良好。相较而言,将疗程延长至6个月在控制患者IL-5水平方面更具优势,对相关炎症的持续控制或许更加理想。临床建议结合患者具体病情变化,选择适当疗程治疗以帮助患者更充分地控制炎症反应。
Objective To investigate the impact of different treatment durations of budesonide nasal spray on postoperative symptom improvement and inflammation control in patients with recurrent chronic rhinosinusitis with nasal polyps(CRSwNP).Methods A retrospective analysis was conducted on 74 patients with recurrent CRSwNP who were admitted to The First People’s Hospital of Zhengzhou from June 2021 to June 2024.According to the duration of budesonide nasal spray administration after endoscopic sinus surgery,patients were divided into a 3-month group(n=38)and a 6-month group(n=36).Changes in clinical efficacy,nasal endoscopic polyp scores,and overall symptom ratings[assessed using the 22-item Sinonasal Outcome Test(SNOT-22)]before and after treatment were compared between the two groups.Serum levels of interleukin-5(IL-5),interferon-γ(IFN-γ),high-sensitivity C-reactive protein(hs-CRP),and tumor necrosis factor-α(TNF-α)were measured,and the relationships between their changes and symptom improvement were evaluated.Adverse events occurring during treatment and follow-up were recorded.Results At 3 months and 6 months after surgery,there were no statistically significant differences in treatment response rates between the 3-month group and the 6-month group(P>0.05).At 6 months after surgery,Lund–Kennedy scores and SNOT-22 ratings in both groups were significantly lower than those at admission(P<0.05),while there were no statistically significant differences between the two groups(P>0.05).At 6 months after surgery,IL-5,IFN-γ,hs-CRP,and TNF-αlevels in both groups were lower than those before treatment;moreover,the IL-5 level in the 6-month group was significantly lower than that in the 3-month group(P<0.05),whereas IFN-γ,hs-CRP,and TNF-αlevels did not differ significantly between the groups(P>0.05).During treatment and follow-up,the incidence of adverse reactions was 15.79%in the 3-month group and 11.11%in the 6-month group,with no statistically significant difference between the groups(P>0.05).Correlation analysis showed that the magnitude of IL-5 reduction was positively correlated with the degree of decrease in the total nasal endoscopic polyp score and the total overall symptom rating,whereas no significant correlations were observed for the other indices(P>0.05).Conclusion Postoperative application of budesonide nasal spray for either 3 months or 6 months can effectively improve symptoms in patients with recurrent CRSwNP,with good safety.Comparatively,extending the treatment duration to 6 months confers a greater advantage in reducing IL-5 levels and may be more favorable for sustained control of inflammation.Clinically,it is recommended that the treatment duration be selected according to individual disease progression to help patients achieve more complete control of the inflammatory response.
作者
陈丽丽
杨娜
沙晓铮
CHEN Lili;YANG Na;SHA Xiaozheng(Department of Otorhinolaryngology,The First People’s Hospital of Zhengzhou,Henan,Zhengzhou 450000,China)
出处
《临床研究》
2025年第12期65-69,共5页
Clinical Research
关键词
复发性慢性鼻窦炎伴鼻息肉
布地奈德鼻喷雾剂
疗程
白介素-5
炎症因子
recurrent chronic rhinosinusitis with nasal polyps
budesonide nasal spray
treatment duration
interleukin-5
inflammatory factors
