鼻声反射在射频治疗鼻阻塞中的价值

目的：探讨鼻声反射在射频治疗鼻阻塞中的价值。方法：根据鼻声反射测试结果定位,应用射频治疗46例鼻阻塞患者。结果：射频治疗前,鼻腔最小横截面积、下鼻甲前端截面积、鼻腔容积和鼻阻力分别为（0．37±0．16）cm^2、（1．10±0．17）cm^2、（5、76±2．81）cm^3和（5．96±2．24）kPa·s／L;射频治疗后分别为（0．68±0．18）cm^2、（1．76±0．19）cm^2、（9．10±2．10）cm^3和（2．42±0．86）kPa·s／L。射频治疗前后对比差异有统计学意义（P〈0．05）。46例患者中,治愈27例,好转19例,有效率为100％。结论：鼻声反射指导射频治疗鼻阻塞有助于鼻阻塞的定位及提高疗效。     

度普利尤单抗治疗慢性鼻窦炎伴鼻息肉的疗效分析

目的 分析临床中IL-4Rα单克隆抗体(度普利尤单抗)治疗慢性鼻窦炎伴鼻息肉(CRSwNP)的疗效。方法 回顾性分析2020年8月—2021年4月使用度普利尤单抗治疗4例CRSwNP患者前后的临床疗效、实验室数据、主观及客观评分以及不良事件等情况,初步评价度普利尤单抗治疗CRSwNP的效果。结果 对4例CRSwNP患者随访4个月。在接受度普利尤单抗治疗前,4例患者慢性鼻-鼻窦炎急性加重次数平均为(3.25±1.50)次/年,在随访期间4例患者均未出现慢性鼻-鼻窦炎急性加重,其中3例患者的鼻窦炎症状得到完全控制。度普利尤单抗治疗前4例患者平均鼻腔鼻窦结局测试-22 (SNOT-22)、宾夕法尼亚大学的嗅觉测试(UPSIT)及副鼻窦CT扫描Lund-Mackay评分分别为52.00±9.42、7.25±1.26、14.50±5.45;治疗4个月后上述评分分别为8.25±5.74、29.25±6.34,7.00±6.38,治疗前后对比差异均具有统计学意义(P<0.05)。使用单抗治疗后4例患者平均口服糖皮质激素(OCS)量为(5.00±7.07)mg/d,对比治疗前(18.75±4.79) mg/d,差异具有统计学意义(P<0.05)。结论 通过特异性抑制白介素-4(IL-4)和白介素-13(IL-13)通路,度普利尤单抗可以显著改善CRSwNP患者鼻窦炎症状以及嗅觉水平,减少患者慢性鼻-鼻窦炎急性加重次数、鼻窦炎病变范围和全身糖皮质激素用量。     

应用Logistic回归分析鼻内镜下治疗慢性鼻-鼻窦炎效果影响因素

目的探讨鼻内镜下手术治疗慢性鼻-鼻窦炎患者的临床治疗效果及影响因素。方法选择我院2010年1月-2011年12月行鼻内镜手术的慢性鼻-鼻窦炎患者270例,其中不伴有鼻息肉慢性鼻-鼻窦炎患者146例,伴鼻息肉者124例。收集相关临床资料,对鼻内镜术后6个月进行疗效评定,并应用Logistic回归分析影响手术治疗效果的危险因素。结果鼻内镜下手术治疗270例慢性鼻-鼻窦炎患者,总体病情完全控制率达87．78％（237／270）;不伴鼻息肉组病情完全控制率达92．47％（135／146）明显高于伴鼻息肉组82．26％（102／124）（X^2=6．512,P=0．011）,不伴鼻息肉组手术疗效明显优于伴鼻息肉组（X^2=7．539,P=0．023）;Logistic回归分析显示临床类型、是否伴有变应性鼻炎、VAS评分、Lund-Mackay评分、Lund—Kennedy评分、是否复发、术后随访依从性是影响手术疗效的主要因素。结论Logistic回归分析显示鼻内镜下治疗慢性鼻一鼻窦炎疗效除与是否伴有鼻息肉有关外,还与其他多种因素相关。     

鼻部相关手术对治疗阻塞性睡眠呼吸暂停低通气综合征的有效性

目的：探讨鼻部相关手术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗的有效性。方法：回顾性分析94例OSAHS合并鼻部相关疾病的患者,均经PSG、鼻内镜、鼻咽纤维镜检查确诊,因种种原因只行鼻部相关手术而未行其他任何治疗。鼻部相关手术包括鼻中隔矫正术,双下鼻甲等离子射频消融术,鼻息肉、慢性鼻窦炎患者行功能性鼻内镜手术。术后2个月、1年复查PSG。结果：94例患者鼻部手术后有效19例,术前AHI11．7±5．2,最低SaO287．6±2．7,平均SaO287．8±5．4,术后2个月AHI5．5±5．0,最低SaO292．5±5．3,平均SaO294．5±3．7,术后1年AHI6．1±4．2,最低SaO291．8±4．2,平均SaO292．8±4．1,有效率20．21％（19／94）,均为轻度Ⅰ型患者,占轻度患者的38．00％（19／50）,经PSG随访1年无复发。其余75例无效。结论：伴有鼻部相关疾病的OSAHS患者,单纯鼻部手术仅对部分以鼻部阻塞为主的Ⅰ型患者有效。     

鼻渊汤治疗慢性鼻窦炎疗效观察

目的 观察鼻渊汤治疗慢性鼻窦炎的疗效。方法 124例慢性鼻窦炎患者随机分成两组，治疗组68例应用鼻渊汤治疗；对照组56例应用鼻窦炎口服液治疗，比较观察两组疗效。结果 治疗组有效率为97．06％，对照组为89．28％，两组疗效差异有显著性意义（P〈0．01）。结论 鼻渊汤治疗慢性鼻窦炎具有良好的临床疗效。     

慢性鼻窦炎非手术治疗175例疗效分析

目的探讨非手术综合治疗慢性鼻窦炎的方法和临床疗效。方法对175例符合纳入标准及不在排除标准之列的慢性鼻窦炎患者给予非手术综合治疗,包括丙酸氟替卡松鼻喷剂喷鼻、罗红霉素胶囊半量口服、桉柠蒎肠溶软胶囊口服以及鼻腔冲洗。应用上述治疗4～12周后进行各项疗效评估,包括症状视觉模拟量表（VAS）主观症状评估、Lund—Kennedy法鼻内镜评估、Lund—Mackay法鼻窦cT评估和鼻腔鼻窦结局测量20条（SNOT-20）生活质量评估。结果经过4—12周治疗后,患者主观症状、鼻内镜评分、鼻窦CT评分以及生活质量评分,均较治疗前明显改善,经比较差异均具有统计学意义（P〈0．05）。结论慢性鼻窦炎的非手术综合治疗疗效确切,并且避免了对鼻腔、鼻窦结构、生理的破坏,只有在充分的药物治疗无效后才考虑手术治疗。     

337例慢性鼻-鼻窦炎患者临床分析

目的：探讨慢性鼻-鼻窦炎患者的临床症状和体征情况,为临床治疗提供依据。方法：应用SPSS 18．0软件,采用Person X^2检验、Pearson相关分析和Kruskal—Wallis检验,对337例慢性鼻-鼻窦炎患者的临床资料进行统计学分析。结果：337例患者总VAS评分为（15．9±5．7）分,其中重度症状排名前三位的分别是：鼻塞56例（16．6％）、鼻分泌物或后鼻漏23例（6．8％）、头昏或头痛11例（3．3％）,各组间差异有统计学意义（X^2=430．923,P〈0．01）。鼻内镜检查评分发现患侧黏膜水肿和分泌物严重程度高于鼻息肉,三组间差异有统计学意义（X^2=128．684,P〈0．01）。CT检查评分发现全部阴影排名前三位的部位分别是：上颌窦314侧（46．6％）、窦口鼻道复合体135侧（20．0％）和前筛112侧（16．6％）,各组问差异有统计学意义（X^2=803．274,P〈0．01）。VAS评分与Lund Kennedy评分间具有相关性（r=0．516,P％0．05）;VAS评分与Lund-Mackay评分间不具有相关性（r=0．213,P〉0．05）。结论：临床医师应综合患者的症状、内镜检查及CT检查结果进行合理病情评估,制定个性化的综合治疗方案,严格把握手术适应证,从而提高慢性鼻窦炎的治愈率。     

变应性鼻炎患者外周血嗜酸粒细胞-骨髓干细胞通路指标检测在激素治疗评价中的意义

目的检测健康人及变应性鼻炎（AR）患者治疗前后外周血嗜酸粒细胞（eosinophils，EOS）-骨髓干细胞通路相关指标CD34^＋、白细胞介素5（IL-5）、EOS，探讨外周血一骨髓通路在变应性鼻炎发病机制中的作用以及糖皮质激素对此通路的影响。方法实验分2组：①试验组：常年性持续性变应性鼻炎患者44例，男24例，女20例，年龄7～68岁；给予糖皮质激素治疗4周；②健康对照组：健康体检者30例。分别检测试验组治疗前后和对照组外周血EOS计数，血清IL-5水平及CD34^＋细胞数，并分析各指标间的相关性。结果试验组治疗前血清IL-5含量、CD34^＋数分别为（88．25&#177;33．47）ng／L、（9．24&#177;2．15）个／10^5，显著高于治疗后[（44．34&#177;16．32）ng／L、（6．31&#177;1．83）个／10^5]及健康对照组[（31．24&#177;8．43）ng,／L、（3．47&#177;1．32）个／10^5]。试验组治疗前后血清IL-5水平与其cD0数呈显著正相关（r值分别为0．64、0．61，P值均〈0．01）。患者血清IL05水平与其EOS数呈显著正相关（r=0．64，P〈0．01）。结论外周血EOS、IL-5及CD34^＋细胞参与AR发病过程，提示AR患者病变局部组织和骨髓造血之间有相关通路存在。通过检测外周血IL-5及CD34^＋可评价治疗效果。     

类固醇受体与变应性鼻炎患者类固醇抵抗的关系

目的探讨变应性鼻炎（allergic rhinitis，AR）患者外周血单个核细胞（peripheral blood mononuclear cell，PBMC）内两种皮质类固醇（corticostemids，cs）受体亚型——CS-α和CS-β表达水平与类固醇治疗效应之间的关系。方法采用半定量RT-PCR方法检测类固醇不同效应AR患者和健康对照组PBMC的CS-α、CS-β mRNA，采用免疫细胞化学方法检测CS-α和CS-β蛋白的表达。结果①类固醇敏感组、类固醇抵抗组及健康人体内均有CS-d、BmRNA的表达，但以CS-α为主，其CS-α/GAPDH（葡萄糖甘油醛脱氢酶）mRNA的比值（x^-±s，下同）分别为1．15±0．75，1．63±0．78，1．27±0．51；②类固醇抵抗组CS-β mRNA表达明显高于类固醇敏感组和健康对照（P〈0．05），3组CS-β／GAPDH mRNA的比值分别为1．42±0．73，0．82±0．59，0．80±0．68；③免疫细胞化学结果显示，类固醇抵抗组PBMC的CS-B表达阳性细胞比率明显高于类固醇敏感组及健康对照组（P〈0．01），分别为28．8％±9．9％，5．9％±3．2％，5．5％±6．8％。结论变应性鼻炎患者类固醇抵抗可能与CS-β的表达亢进有关。     

经口舌根梭形切除治疗阻塞性睡眠呼吸暂停低通气综合征的临床疗效

目的：探讨应用舌根梭形切除术治疗中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法：中重度OSAHS患者40例,X线动态睡眠摄影判断阻塞平面在软腭及舌根水平,全身麻醉下先行UPPP,同期行舌根梭形切除术。结果：OSAHS患者平均AHI由62．39±21．68减少至18．60±5．01（P〈0．01）,平均最低SaO2由（64．40±14．96）％升高到（88．39±9．21）％（P〈0．01）。综合疗效评价：显效29例（72．5％）,有效8例（20．0％）,无效3例（7．5％）,总有效率92．5％。结论：舌根梭形切除术治疗以舌根部肥大造成的气道狭窄之OSAHS很有效,无言语、味觉及吞咽功能障碍,可作为治疗OSAHS的手术方法之一。     

Clinical factors influencing the eosinophil infiltration of nasal polyps

AIMS AND METHODS: Our study, based on a retrospective chart analysis, was aimed 1) to describe the varying degree of eosinophil infiltration in a series of 263 adult patients operated on diffuse and bilateral nasal polyposis (NPS) after failure of medical treatment, in 15 cystic fibrosis patients with bilateral nasal polyps, and in 31 patients with chronic sinusitis without polyps (18 bilateral, 13 unilateral) 2) to search for clinical factors that might influence the degree of eosinophil infiltration. Eosinophil infiltration was expressed semi-quantativity as a percentage of inflammatory cells. RESULTS: Our study confirms that eosinophil infiltration is a striking feature of nasal polyposis. All patients with chronic sinusitis showed less than 10% eosinophils (mean +/- SEM = 2 +/- 2%) whereas 88% of patients with NPS showed more than 10% eosinophils (50 +/- 2%). Cystic fibrosis lied in between with 40% of patients showing more than 10% eosinophils. In idiopathic bilateral NPS the number of eosinophils was increased in patients with asthma (58 +/- 3%) and even more in Widal's triad (75 +/- 4%). Atopic patients did not have more eosinophils (52 +/- 5%). Patients treated with systemic steroids within two months before surgery showed decreased eosinophil infiltration (22 +/- 3% vs 50 +/- 2 for treated versus untreated) whereas patients treated with topical steroids did not (47 +/- 2%). CONCLUSIONS: Thus, a link might exist between clinical presentation and eosinophil infiltration. Chronic sinusitis and nasal polyps are probably not the same disease. Eosinophils appear as a link between nasal polyps, asthma and aspirin intolerance. Atopic status does not modify eosinophil infiltration of nasal polyps. Systemic steroids appear significantly more effective to reduce the eosinophil infiltrate than topical steroids in our selected group of operated patients.     

The effect of topical corticosteroid on basic fibroblast growth factor in nasal polyp tissue

BACKGROUND: The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid. METHODS: Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 microg/day. The bFGF levels were measured by competitive enzyme immunoassay method. RESULTS: The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 +/- 826 ng/mg protein (range, 416-3434 ng/mg) and 1340 +/- 749 ng/mg protein (range, 330-3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011). CONCLUSION: Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.     

慢性鼻窦炎合并哮喘患者CT Lund Mackay评分与VAS评分相关性分析

目的探讨慢性鼻窦炎合并哮喘患者术前CT Lund Mackay评分与术前及术后1年主观症状VAS评分的相关性。方法回顾性分析19例慢性鼻窦炎合并哮喘患者术前CT Lund Mackay评分和主观症状VAS评分及术后1年主观症状VAS评分,采用线性回归分析及配对t检验进行统计学分析。结果患者术前CT Lund Mackay评分中筛窦、窦口鼻道复合体、上颌窦评分较高,蝶窦最低。患者术前鼻塞、流涕VAS评分较高,头痛及嗅觉减退VAS评分较低。术后1年鼻塞、流涕VAS评分变化较大,头痛次之,嗅觉减退VAS评分变化相对较小（P＜0.05）。术前VAS评分（总分）及术后1年VAS评分（总分）与患者术前CT Lund Mackay评分呈正相关（r=0.465,P=0.045;r=0.522,P=0.022）。结论鼻塞、流涕是术前慢性鼻窦炎合并哮喘患者的主要鼻部症状,术后鼻塞、流涕、头痛、嗅觉减退均有改善,其中鼻塞、流涕改善最明显。术前VAS评分（总分）及术后1年VAS评分（总分）与术前患者CT Lund Mackay评分相关性良好。对于慢性鼻窦炎合并哮喘患者术前进行鼻窦CT客观评估,对于手术效果评估具有重要意义。     

The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis

OBJECTIVE: To determine the accuracy of computed tomography (CT) in the diagnosis of pediatric chronic rhinosinusitis (CRS). SETTING: Multi-institutional prospective dual cohort study. METHODS: Two cohorts of children undergoing CT of the paranasal sinuses were prospectively evaluated. The first cohort consisted of children undergoing CT in preparation for endoscopic sinus surgery (diseased group). The second cohort consisted of children undergoing CT for nonsinusitis reasons (nondiseased control group). Sinus CT scans were scored according to the Lund-MacKay system. Diagnostic accuracy was quantified with the receiver operating characteristic curve. Sensitivity, specificity, and predictive value analyses were conducted. RESULTS: A total of 66 pediatric patients (mean age, 8 years) were studied in the diseased group and exhibited a mean Lund score of 10.4 (95% confidence interval, 9.2-11.5); 192 control patients (mean age, 9 years) exhibited a mean Lund score of 2.8 (95% confidence interval, 2.4-3.2). The area under the curve for the receiver operating characteristic was 0.923 (P<.001), indicating excellent diagnostic accuracy. Adopting a Lund score cutoff of 5 to represent true disease, the CT scan demonstrated a sensitivity and specificity of 86% and 85%, respectively. Lund scores of 2 or less have an excellent negative predictive value, whereas Lund scores of 5 or greater have an excellent positive predictive value (ie, strongly indicate true disease). CONCLUSIONS: The sinus CT scan demonstrates excellent diagnostic accuracy for the diagnosis of pediatric CRS, with excellent sensitivity and specificity. However, its predictive value depends substantially on the base rate prevalence of CRS in the population being evaluated.     

通鼻消涕颗粒治疗慢性鼻窦炎的临床观察

目的 本课题拟对中药通鼻消涕颗粒与抗生素克拉霉素片治疗慢性鼻窦炎的临床疗效作一对比研究.方法 收集慢性鼻窦炎不伴鼻息肉患者.采用单盲的方法随机分为实验组(通鼻消涕颗粒组)36例与对照组(克拉霉素片组)36例.分别给予通鼻消涕颗粒和克拉霉素片口服治疗1个月.观察治疗前、治疗后2周及1个月的症状VAS积分及鼻内镜检查Lun...     

鼻窦炎口服液联合低剂量克拉霉素片治疗慢性鼻窦炎的临床疗效

目的 观察鼻窦炎口服液联合低剂量克拉霉素片治疗慢性鼻窦炎的临床疗效。方法 选择门诊慢性鼻窦炎患者86例, 采用随机对照分组试验的方法分为治疗组43例、对照组43例, 两组均口服克拉霉素片250 mg/d, 治疗组在此基础上加服鼻窦炎口服液10 mL/次, 每天3次, 连续3个月。比较两组用药前、用药3个月末主观、客观指标的变化。结果 治疗组患者视觉模拟量表评分、鼻内镜检查Lund-Kennedy评分及鼻窦CT扫描Lund-Mackay评分均明显下降(t=21.23, 30.23, 25.81, P均<0.05), 与对照组比较(t=10.21, 12.79, 9.58, P均<0.05)差异有统计学意义。治疗组有效率为83.72%, 对照组为65.12%, 差异有统计学意义(Mann-Whitney U=752.5 P<0.05), 两组均无严重不良反应。结论 鼻窦炎口服液联合低剂量克拉霉素片治疗慢性鼻窦炎疗效显著。     

ELISA for determination of immunoreactive free elastase and elastase in complex with alpha 1-antitrypsin in nasal secretions with sinusitis

Sensitive double antibody sandwich ELISA methods was developed in order to quantify immunoreactive neutrophil elastase (NE) levels in nasal secretions with chronic sinusitis (CS). Microwell plate as a solid phase was coated with anti-NE antibody. Two different horseradish peroxidase (HRP) labelled antibodies used as the second antibody were anti-NE-HRP for measuring total (free + complexed) NE level and anti-alpha 1-antitrypsin (AT)-HRP for complexed NE level. Mean value of total NE was 31.0 +/- 20.7 micrograms/ml in nasal secretions from adult patients with CS, and the percentage of complexed NE in total NE was 33.7 +/- 21.4%. This sandwich ELISA is a useful method for measuring both total and complexed NE levels in nasal secretions.     

Clinical outcomes after revision endoscopic sinus surgery

OBJECTIVE: To determine if patients undergoing revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis obtain significant symptomatic benefit from surgery. DESIGN: Prospective controlled clinical trial. METHODS: Adult patients undergoing revision ESS were evaluated preoperatively with a computed tomographic scan and the Rhinosinusitis Symptom Inventory. After the revision ESS, patients were reevaluated with the Rhinosinusitis Symptom Inventory. Data were analyzed for symptom score changes and effect sizes, changes in medication, and economic variables. Improvements in sinonasal symptom scores, medication use, and economic variables were compared with those of a contemporaneous control group of patients undergoing primary ESS and matched for age, sex, and Lund score. RESULTS: The 21 patients (mean age, 44.8 years) who completed evaluation after revision ESS had a mean follow-up of 12.4 months. Mean preoperative Lund score was 12.6. Large effect sizes indicating significant symptom improvements were noted for nasal obstruction (effect size, -1.9), hyposmia (-0.9), and headache (-0.6), as well as nasal (-1.1) and total symptom domains (-0.9; P<.05 in all cases). Nasal steroid and nonsedating antihistamine use did not decrease significantly after ESS, but oral antibiotic use showed a downward trend (net change, - 2.9 wk/y; P =.23). Improvements in clinical symptoms were statistically similar to corresponding improvements in the matched cohort of patients undergoing primary ESS. CONCLUSIONS: The symptomatic relief that revision ESS can provide for patients with refractory chronic rhinosinusitis is similar to that following a primary ESS. However, many patients undergoing revision ESS require continued intense medical management of their chronic rhinosinusitis.     

Clinical symptomatology and paranasal sinus involvement with nasal septal perforation

OBJECTIVE: Determine the symptom manifestations, clinical impact, and incidence of chronic rhinosinusitis (CRS) in patients with newly diagnosed nasal septal perforation. METHODS: A consecutive series of adult patients with nasal septal perforation were prospectively studied at the time of endoscopic diagnosis with the rhinosinusitis symptom inventory (RSI) and sinus computed tomography (CT). Patients' symptoms in the RSI symptom domains were computed. From the CT scan, septal perforation size and Lund scores were obtained. A separate (control) cohort of patients with CRS without septal perforation was matched to these patients for age, sex, and Lund score. RSI symptom domain comparisons were conducted between groups to determine the additional symptom burden conferred by septal perforation. RESULTS: Thirty-three patients with septal perforation were enrolled (mean age, 48.2 yr; 69.7% female). Mean perforation size was 1.9 (SD, 2.1) cm. The mean Lund score was 5.8 (SD, 5.3); 16 (57.1%) patients met radiographic criteria for a concurrent diagnoses of CRS. Patients with septal perforation reported significant nasal and facial symptom domain scores (56.8 and 47.0, respectively [range, 0-100]). Oropharyngeal and systemic symptoms were less severe (29.7 and 34.7, respectively). However, after comparison with the matched control patients, no statistically significant differences were identified in sinonasal symptoms between patients with and without septal perforation (all P > .131). CONCLUSIONS: Concurrent CRS may frequently accompany nasal septal perforation and may require appropriate treatment along with the perforation itself. The presence of septal perforation does not appear to significantly augment symptom severity in CRS.