肾上腺糖皮质激素在慢性鼻窦炎和鼻息肉围手术期应用的不良反应

目的：探讨肾上腺糖皮质激素在慢性鼻窦炎和鼻息肉围手术期的临床应用范围，疗效及不良反应。方法：1997年1月－2000年7月对慢性鼻窦炎，鼻息肉患者施行鼻内镜手术期间，应用糖皮质激素治疗的704例中26例出现不良反应患者进行回顾性分析。结果：血象异常15例，血压升高5例，两者兼而有之2例，消化道出血2例，结核病灶扩散2例。结论：术前详询病史，完善检查，严格适应证，规范用药是避免不良反应发生的重要措施。     

口服糖皮质激素治疗慢性鼻-鼻窦炎伴鼻息肉

慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps,CRSwNP）是严重影响患者健康及生活质量的慢性疾病。有多项临床研究报道了口服糖皮质激素（glucocorticoids,GC）治疗CRSwNP具有一定的疗效。但临床证据质量不高,疗效难以维持以及可能产生的不良反应,目前对口服GC的治疗还存在争议。因此,本文对GC治疗CRSwNP的作用机制,短期和术前口服GC治疗CRSwNP的疗效及药物不良反应进行综述。     

鼻内镜手术治疗慢性鼻窦炎及鼻息肉135例疗效分析

目的 回顾分析鼻内镜手术治疗慢性鼻窦炎、鼻息肉的临床疗效.方法 对135例慢性鼻窦炎、鼻息肉行鼻内镜手术.术后随访1年.结果 治愈率76.3％,好转率20％,无效3.7％,总有效率96.3％.结论 鼻内镜手术治疗慢性鼻窦炎、鼻息肉具有良好的临床疗效,术后复发率低,值得临床推广应用.     

鼻内镜术后局部应用糖皮质激素治疗慢性鼻窦炎鼻息肉的效果观察

目的 评估慢性鼻窦炎鼻息肉患者经鼻内镜术后再采用糖皮质激素进行局部治疗的有效性。方法 本次医学研究以慢性鼻窦炎鼻息肉为对象,自愿参与研究的患者有90例,研究时段为2020年3月-2022年3月,将入选患者随机划分至两个独立的小组单元,对照组患者数量：观察组患者数量=45:45,予对照组鼻内镜术方案,予观察组鼻内镜术结合糖皮质激素方案。对比效果。结果 观察组和对照组比较治疗后的鼻腔通气功能、鼻黏液纤毛清除功能、治疗效果、并发症等指标,结果显示前者均较优（P<0.05）。结论 慢性鼻窦炎鼻息肉患者采用鼻内镜术结合局部应用糖皮质激素疗法后,鼻腔通气以及鼻黏液纤毛功能均得以改善,症状得到明显缓解,疗效显著,且并发症较少。     

慢性鼻-鼻窦炎-鼻息肉伴哮喘患者鼻内镜围手术期药物治疗

目的 探讨慢性鼻-鼻窦炎-鼻息肉(CRSwNP)伴支气管哮喘患者鼻内镜围手术期药物治疗原则及效果。方法 收集2010年6月至2013年12月山东大学齐鲁医院耳鼻咽喉科收治的109例CRSwNP伴支气管哮喘患者行鼻内镜手术(ESS)的临床资料。术前均对哮喘进行全面评估, 哮喘完全控制6个月后行ESS手术治疗, 围手术期采用雾化吸入及全身糖皮质激素等药物治疗。结果 围手术期无哮喘急性发作, 仅1例患者术后第2天因口服镇痛剂出现喘息;术后随访1~3年, 采用鼻内镜检查并行ESS临床疗效评估, 病情完全控制者5例(4.59%), 病情部分控制者94例(86.24%), 病情未控制10例(9.17%);仅1例术后13个月因股骨头坏死行手术治疗。结论 全面细致的哮喘病情评估和ESS围手术期药物治疗有利于防止围手术期哮喘发作及控制术后CRSwNP患者鼻息肉复发, 有利于提高手术疗效。     

加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用

目的 探讨加速康复外科(ERAS)在慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)手术患者围手术期的应用效果。 方法 选取CRSwNP患者136例,随机分为ERAS组70例,对照组66例,两组均接受鼻内镜下鼻息肉切除加鼻窦开放手术,ERAS组患者行术前宣教、围手术期气道评估干预、缩短禁食时间、术中控制性低血压、按时镇痛等一系列优化措施;对照组行传统的围术期处理。比较两组术前肺功能异常可耐受手术率、术后疼痛评分、术后24 h鼻腔出血量、术后住院时间、总住院时间。 结果 ERAS组、对照组术前肺功能异常患者可耐受手术率分别为93.3%、75.0%,两组比较差异无统计学意义(χ2=1.924, P=0.165); ERAS组患者术后鼻部疼痛、鼻塞、头痛、眼部胀痛、流泪、耳闷和睡眠困难的VAS评分均低于对照组(P均<0.001); ERAS组术后24 h内出血量为5.7(3.0,10.3)mL,对照组为7.2(5.0,13.2)mL,两组比较差异无统计学意义(U=-0.913, P=0.361)。平均住院日ERAS组、对照组分别为(4.6±0.8)、(7.5±1.1)d,两组比较差异有统计学意义(t=17.79, P<0.001);术后住院日ERAS组与对照组分别为(2.1±0.5)、(3.8±0.3)d,两组比较差异有统计学意义(t=23.94, P<0.001)。 结论 将ERAS理念贯穿于CRSwNP患者围手术期将有效减轻患者心理和生理的创伤应激反应,缩短住院时间。     

126例慢性鼻窦炎鼻息肉鼻内镜手术的临床分析

自2000年7月至2002年3月开展鼻内镜下治疗慢性鼻窦炎鼻息肉手术共126例，术后随访1年多，取得一些临床经验和体会，兹报告如下。     

糖皮质激素受体 mRNA在慢性鼻窦炎鼻息肉组织中的表达

目的通过检测糖皮质激素受体(glucocorticoid receptor, GR)-α及β mRNA在接受鼻腔糖皮质激素治疗后不同疗效的两组患者鼻息肉黏膜的定量表达,探讨在不同组慢性鼻窦炎鼻息肉组织中GR-α和GR-β的表达意义.方法采用荧光定量反转录聚合酶链反应(FQ-RT-PCR)方法检测40例患者鼻息肉组织中GR-α mRNA和GR-β mRNA的定量表达.结果通过随访80例门诊患者后筛查出40例患者,其中激素敏感组26例,激素不敏感组14例.在激素不敏感鼻息肉组织中GR-β mRNA 表达[(5.72±0.58)×102 拷贝/μg]均高于激素敏感组[(4.82±0.28)×102拷贝/μg,t=-6.65,P<0.01]和正常鼻黏膜组[(4.44±0.35)×102拷贝/μg,t=-9.19, P<0.01],并在该两组之间差异均有统计学意义.GR-α mRNA与GR-β mRNA的比值在激素敏感组(829.42±67.36)与激素不敏感组(535.70±89.00)间差异有统计学意义(t=11.74, P<0.01).结论慢性鼻-鼻窦炎患者中的GR-β mRNA高表达,GR-α mRNA表达下调提示激素不敏感的存在,GR-β在评价鼻息肉患者对激素治疗疗效上有一定作用.     

青少年慢性鼻窦炎和鼻息肉鼻内镜手术综合治疗的疗效观察

目的评估青少年慢性鼻窦炎和/或鼻息肉的鼻内镜手术综合治疗的疗效.方法回顾性分析1994年12月～2002年12月间149例(298侧)青少年慢性鼻窦炎、鼻息肉或两者兼有者的鼻内镜手术综合治疗情况和近期随访结果.结果随访6月～1年,Ⅰ～Ⅲ型总有效率为96.0%(143/149).93.7%的患者术后获得嗅觉的恢复或改善.结论鼻内镜手术综合治疗青少年慢性鼻窦炎和/或鼻息肉,可以获得较好的疗效,有利于青少年鼻及鼻窦生理功能的维护和改善.     

Effect of oral steroids on olfactory function in chronic rhinosinusitis with nasal polyps

AimsThe present study aimed to investigate the effects of oral steroids on olfactory disturbances in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Material and methodsThis is a prospective randomized non-blinded study. Selected CRSwNP patients (n = 140), with hyposmia, were devided into two groups; group A received a 7-day course of oral steroids with a 12-weeks course of nasal steroids and douching; group B received a 12-weeks course of nasal steroids and douching. Assessment included Sniffin’ Sticks scores, visual analogue scale score for olfaction and discomfort (VASsmell, VASdis), the Sinonasal Outcome Test-22, Greek-version (SNOT22-Gr) and the endoscopic appearance (EAS).ObjectivesThe main objective was to compare the olfactory effect of the different therapy in group A and group B, at 2, 12 and 24 weeks. Accessory objectives included the comparison of EAS, VASdis and SNOT22-Gr between groups, the evaluation of the therapeutic outcome duration, and, the investigation of potential correlation between the evaluated parameters.ResultsThe 2-weeks evaluation showed a significant statistical difference (P < 0.001) for all parameters except VASdis. Olfactory outcomes (Sniffin’ Sticks and VASsmell scale scores) were found significantly better in group A at the 24-weeks evaluation (P < 0.001). Within groups, the therapeutic result remained stable between the 12-weeks and 24-weeks evaluation (P > 0.05). Sniffin’ Sticks score was strongly correlated at 12-weeks evaluation with EAS (rho = 0.58, P < 0.001).ConclusionOur results suggest that a combination treatment of oral and nasal steroids in well-selected patients with CRSwNP may result in early olfaction restoration with a possible long-term effect.     

半乳糖凝集素10与慢性鼻窦炎伴鼻息肉

半乳糖凝集素10(Galectin-10)被发现已有很长的历史,但是探索其病理作用的研究很少。近几年,半乳糖凝集素10受到越来越多的关注,特别是其在气道嗜酸性粒细胞疾病中研究越来越多。综述了Galectin-10历史回顾及其在慢性鼻窦炎中的相关研究,Galectin-10/CLC蛋白不仅仅可作为以2型免疫反应为特征的CRSwNP的生物标志物,而且可能在其发病机制中发挥一定作用,并且很有希望作为以2型免疫反应为特征的CRSwNP的药物靶点。     

变应性因素在慢性鼻窦炎鼻息肉发病中的作用

目的探讨变应性因素与慢性鼻窦炎鼻息肉的临床表现和病理生理改变的关系。方法回顾性分析81例慢性鼻窦炎鼻息肉患者,根据是否存在变应性因素,将其分为为菲变应性因素组和变应性因素组,比较两组症状VAS评分、鼻息肉主观评分、鼻窦CT Lund-MacKay评分、嗅觉功能、鼻阻力等指标问的差异。结果81例患者中,非变应性因素组45例,变应性因素组36例。两组问症状VAS评分和鼻息肉主观评分无显著性差异（t=0．87,P=0．40：t=0．58,P=0.64）。鼻窦CT的Lund—MacKay评分,变应性因素组的前组筛窦病变程度较非变应性因素组严重,存在显著性差异（f=2．11,P=0．03）,而其余各鼻窦及OMC区均无显著性差异。两组间嗅觉功能以及双侧鼻腔总阻力亦无显著性差异（t=0．15,P=0.88：t=0．57,P=0．61）。结论变应性因素在慢性鼻窦炎鼻息肉的发病中不起主导作用,对临床症状、鼻息肉大小、嗅觉功能和鼻阻力等方面没有显著影响,但可能与前组筛窦的病变程度存在一定相关性。     

BRF2在慢性鼻-鼻窦炎伴鼻息肉发病过程中的作用研究

目的 研究BRF2在慢性鼻-鼻窦炎伴鼻息肉中的表达及意义。 方法 收集山东大学第二医院耳鼻咽喉头颈外科2016至2017年慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)手术标本37例及单纯鼻中隔偏曲手术标本18例,采用免疫荧光染色检测BRF2在慢性鼻-鼻窦炎伴鼻息肉组织中的表达及定位;脂多糖(LPS)刺激体外培养人鼻黏膜上皮细胞后,采用免疫荧光检测BRF2在细胞中的表达及定位,Western bloting及实时荧光定量PCR检测BRF2和内质网应激相关蛋白GRP78在细胞中的表达。 结果 BRF2在慢性鼻-鼻窦炎伴鼻息肉组织中表达量上调并在胞浆中的分布增多;在体外,LPS刺激可诱导鼻黏膜上皮细胞中BRF2表达上调并在胞浆中的分布增多,并发现内质网应激相关蛋白GRP78表达上升。 结论 BRF2可能介导了内质网应激,从而参与了慢性鼻-鼻窦炎伴鼻息肉的发病过程。     

The role of superantigens in chronic rhinosinusitis with nasal polyps

Recent reports suggest that staphylococcal exotoxins, acting as superantigens, activate T cells with subsequent massive proliferation, thereby contributing to the etiology of chronic rhinosinusitis with nasal polyps (CRSwNP). The objectives of this study are (1) to demonstrate directly the presence of staphylococcal exotoxins in nasal mucosa and sinonasal polyp tissue, and (2) provide indirect evidence of the effect of superantigens on the T cells expressing the target of superantigen, i.e., the beta variable chain receptor (TCRBV) in polyp tissue and peripheral blood of patients with CRSwNP. Sinonasal polyp tissue and peripheral blood specimens were obtained from 37 patients with chronic rhinosinusitis (22 patients with bilateral nasal polyps, 15 without nasal polyps) and 12 normal subjects for comparative negative controls. Tissue specimens were assayed by enzyme-linked immunosorbent assay (ELISA) for the most common staphylococcal exotoxins (A-D) and toxic shock syndrome toxin type 1. Fresh tissue and blood samples were analyzed by flow cytometry to determine the expression of TCRBV. In the CRSwNP subjects 12 of 22 samples (54.54%) demonstrated reactivity for at least 1 staphylococcal exotoxin, while 2 of the 12 were positive for 2 toxins. There were no positive results in the CRS without nasal polyps or control groups. There was a clear trend of increased TCRBV expression in the ELISA-positive group both for tissue and blood specimens. Staphylococcal superantigens were present in the nasal cavity of patients with CRSwNP with a high percentage of TCRBV, which suggests the possibility of superantigens as etiological agents of CRSwNP.     

Epithelial genes in chronic rhinosinusitis with and without nasal polyps

BACKGROUND: Genetic studies on chronic inflammatory diseases have resulted in an emphasis on the epithelial interface with the environment and the genes that influence this interaction. This study examines the expression of key epithelial genes implicated in the pathogenesis of other inflammatory disorders for their role in chronic rhinosinusitis (CRS). METHODS: Epithelial cells were collected from the inferior turbinate, middle turbinate, and/or uncinate from 62 subjects undergoing sinonasal surgery. Patient groups included 21 CRS patients with nasal polyposis, 23 CRS patients without nasal polyposis, and 18 controls. Samples were analyzed for S100A7, S100A8, S100A9, SLC9A3R1, G-protein-coupled receptor for asthma, and serine protease inhibitor kazal type 5 (SPINK5) by quantitative real-time polymerase chain reaction. Immunohistochemistry (IHC) was performed to analyze expression of SPINK5 lympho epithelial kazal-type inhibitor (LEKTI) in sinonasal samples. RESULTS: Expression of S100A7 and S100A8 was significantly decreased in CRS with and without nasal polyps when compared with controls. S100A9 expression was significantly decreased in CRS without nasal polyps, and SPINK5 expression was significantly decreased in CRS with nasal polyps. SPINK5 (LEKTI) protein was detected in sinonasal tissue and was significantly decreased in polyp samples using IHC. CONCLUSION: This study shows marked reductions in the level of expression of several genes involved in epithelial barrier maintenance and repair in the inflammatory state of CRS.