鼻内联合用药改善持续性非变应性鼻炎鼻塞症状的临床研究

目的:评估鼻内联合应用鼻用抗组胺药氮卓斯汀鼻喷剂(AZENS)和鼻用激素丙酸氟替卡松鼻喷剂(FPNS)改善持续性非变应性鼻炎(NAR)鼻塞症状的有效性。方法:162例持续性NAR患者随机分为联合治疗组(AZENS+FPNS)和鼻用激素组(FPNS),比较2组患者在治疗前、治疗2周及6周时鼻塞症状的评分,并对治疗方案(包括方便性、不良反应、费用、疗效)进行总的满意度评价。结果:2组患者的鼻塞症状在治疗前、治疗2周和6周的3次评分均呈现逐次下降趋势,差异均有统计学意义(P<0.01);在治疗2周和6周时,联合治疗组患者鼻塞症状的改善明显优于鼻用激素组,差异均有统计学意义(P<0.01)。联合治疗组患者对治疗方案总的满意度评价优于鼻用激素组(P<0.05)。结论:鼻内联合用药能更快速有效地改善持续性NAR的鼻塞症状,同时具有良好的安全性和耐受性。     

变应性鼻炎与一氧化氮的关系探讨

目的;探讨变应性鼻炎（ＡＲ）与一氧化氮（ＮＯ）的关系。方法：采用硝酸还原酶比色法测定了５０例ＡＲ患者（ＡＲ组）和３０例正常人（对照组）血清ＮＯ水平。结果：ＡＲ组血清ＮＯ水平显著高于对照组（Ｐ〈０．０１）。结论：血清ＮＯ水平与ＡＲ有一定关系,提示ＮＯ在ＡＲ的发病过程中可能起着有害作用。     

加强变应性鼻炎研究促进临床规范治疗

国内外流行病学调查资料显示，变应性鼻炎患病率呈现逐渐上升趋势。世界卫生组织关于变应性鼻炎及其对哮喘的影响（allergic rhinitis and its impact on asthma,ARIA）的文件指出，世界范围内的患病率大约在15％～20％，我国目前缺乏全国性、多中心的流行病学观察数据，部分中心城市的初步观察结果显示其患病率大约在5％～10％，估计全国的患病人数超过五千万。众所周知，变应性鼻炎所引起的鼻部症状、眼部症状及相关器官症状给患者健康和生活质量带来严重影响，患者的睡眠、体力活动以及情绪等各项指标都有明显改变。研究表明，变应性鼻炎对体力活动的影响高于哮喘，对情绪的影响二者相似，对于体能和社会活动的影响不如哮喘，但同时也给患者及其家庭带来了巨大的经济负担。尽管如此，在当今日益发达的信息化社会，变应性鼻炎并未引起患者、家属以及专科医生对生活质量影响的足够重视，患者的生活和临床诊疗尚存有不少亟待解决的问题。     

变应性鼻炎的发病机制与精准治疗

目的变应性鼻炎临床上以鼻痒、喷嚏和流涕为典型特征,是一种变应原特异性IgE介导的鼻黏膜慢性炎症,目前治疗包括变应原回避、药物治疗、免疫治疗和手术治疗。基于不同免疫表型的精准治疗代表了变应性鼻炎治疗的未来方向。     

中西医结合治疗常年性变应性鼻炎

目前有多种治疗常年位变应性鼻炎的方法，但总的疗效不回理想，用激素、抗组织胶类药、减充血药、包甘田钻、异丙阿托品之类，往往仅能当时缓解症状，而不错预防复发，单纯中药治疗因疗效评定标准不一致，疗效不够理想，复发串较高．基于常年性变应性鼻炎的发病，既有免疫学因素，也有非免疫学因素，所以合理的治方应是综合性的．已有大量文简报道，中医中药在调节机体内环境、调节目主神经平衡及免疫方面有其独到Z处。本文根据国内外有关资料，采用各家方剂所氏，结合临床实钱与经验，目拟中药组方，制剂成鼻炎冲剂，配合正劫免疫疗法，综…     

射频治疗常年性变应性鼻炎

我科于１９９７年１２月～１９９９年７月,应用射频治疗变应性鼻炎４７例,报告如下。１资料与方法１.１临床资料 本组４７例,男２６例,女２１例。年龄２１～４６岁,平均３１岁。病程２～６年。符合变应性鼻炎诊断标准及疗效评定标准［１］（１９９７年修订,海口）,其中１２例（经ＣＴ鼻窦冠状位扫描）伴有鼻息肉、筛窦炎、上颌窦炎;９例伴双下鼻甲肥大而常年鼻塞;６例伴有哮喘病;２例伴鼻中隔偏曲影响鼻呼吸;全组病例均经激素、抗组胺药物等治疗,效果不明显。１.２治疗方法 患者平卧位,１％地卡因肾上腺素棉片,作鼻腔粘膜表面…     

免疫疗法治疗变应性鼻炎1000例

为评价连续性稀释定量皮内试验在治疗变应性鼻炎中的有效性和安全性,该作者对1989年至1999年十年间采用免疫疗法治疗的1000例变应性鼻炎病人进行了回顾性分析。以往的皮肤点刺或接种存在不能量化试验及检测变应原的最低浓度的缺陷,而该方法通过对变应原1:5的稀释,根据能够引起阳性皮肤反应的最小浓度来检测出每种变应原的终末反应浓度,     

变应性鼻炎的外科治疗

本就变应性鼻炎外科治疗的理论基础、应用解剖、手术方法、疗效及并发症的献资料进行综述。     

变应性鼻炎治疗的进展

变应性鼻炎（allergic rhinitis,AR）是鼻炎中最为常见的类型。近年来,流行病学研究报道变应性鼻炎在世界范围内的患病率呈明显上升趋势,影响全球10％～25％的人群。本文就近年来针对变应性鼻炎的治疗进行综述,旨在探索更有效的治疗方法。     

鼻塞治疗萎缩性鼻炎62例临床研究

目的探讨萎缩性鼻炎的治疗方法.方法回顾分析1990至2001年应用作者研制的鼻塞治疗萎缩性鼻炎62例的临床资料.结果经2年以上的临床观察,总有效率达100%.治疗后鼻纤毛传输率较治疗前明显提高.结论鼻塞治疗萎缩性鼻炎方法简单,疗效肯定.     

Posture-induced nasal obstruction in patients with allergic rhinitis

Nasal resistance is affected by posture. In this study, the effects of supine and lateral recumbent positions were investigated in eight normal subjects and 31 patients with allergic rhinitis. Of the 31 patients with allergic rhinitis, five showed unilateral complete nasal obstruction and one patient showed bilateral complete obstruction during the change of posture. Total nasal resistance had a tendency to increase with repeating the change of posture (a paired t-test, P < 0.05). The supine and lateral recumbent positions did not induce variable changes in total nasal resistance in normal subjects. Posture induces complete nasal obstruction in the supine or lateral recumbent positions in some patients with allergic rhinitis.     

鼻用糖皮质激素对缓解非变应性持续性鼻炎鼻塞症状的疗效观察

力不集中、要擤鼻涕、鼻涕流向咽喉、夜间睡眠质量等症状显著改善(P值均＜0.01);⑤持续治疗12周症状和体征的改善情况比治疗4周更显著.结论 鼻用糖皮质激素治疗12周可显著改善PNAR患者的鼻塞症状、鼻充血状态、鼻腔阻力,以及由鼻塞引起的其他相关症状和整体生活质量.     

鼻用糖皮质激素对缓解非变应性持续性鼻炎鼻塞症状的疗效观察

力不集中、要擤鼻涕、鼻涕流向咽喉、夜间睡眠质量等症状显著改善(P值均＜0.01);⑤持续治疗12周症状和体征的改善情况比治疗4周更显著.结论 鼻用糖皮质激素治疗12周可显著改善PNAR患者的鼻塞症状、鼻充血状态、鼻腔阻力,以及由鼻塞引起的其他相关症状和整体生活质量.     

常年性持续性变应性鼻炎患者鼻黏膜组织中类固醇受体-β mRNA的表达

目的通过检测皮质类固醇（corticosteroids,CS）受体α及βmRNA在接受鼻腔CS治疗后不同疗效的两组常年性持续性变应性鼻炎（AR）患者鼻黏膜的定量表达,探讨在不同组AR鼻黏膜组织中CS-α和CS-β的表达意义。方法通过随访120例门诊AR患者后筛查出65例常年性持续性AR患者,其中CS敏感组36例,CS抵抗组29例。采用荧光定量反转录聚合酶链反应（FQ-RT-PCR）方法,检测65例常年性持续性AR患者鼻黏膜组织中CS-αmRNA和CS-βmRNA的定量表达。结果在CS抵抗组鼻黏膜组织中CS-βmRNA表达[（5.62±1.28）×102拷贝/μg]均高于CS敏感组[（4.62±0.48）×102拷贝/μg,t=-6.67,P〈0.01]和正常鼻黏膜组[（5.32±0.55）×102拷贝/μg,t=-8.29,P〈0.01],并在该两组之间差异均有统计学意义。CS-αmRNA与CS-βmRNA的比值在CS敏感组（658.32±65.16）与CS抵抗组（525.70±68.10）间差异有统计学意义（t=10.16,P〈0.01）。结论常年性持续性AR患者中的CS-βmRNA高表达、CS-αmRNA表达下调提示CS抵抗的存在,CS-β在评价AR患者对CS治疗疗效上有一定作用。     

A prospective study of bacterial flora in nasal cavity of patients with persistent allergic rhinitis

It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts. A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed. PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens. In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.     

Passive smoking, allergic rhinitis and nasal obstruction in children

Allergic rhinitis is a common cause of nasal obstruction in childhood. This prospective study looked at the effect of passive smoking on nasal obstruction in children with and without allergic rhinitis. Eighty-one children took part. Each child was asked to score his or her degree of nasal obstruction on a visual analogue scale. Exposure to passive smoking was determined subjectively using a parental questionnaire, and objectively by measuring the urinary cotinine/creatinine ratio. Results were tabulated using Microsoft Excel and analysed with SPSS statistical software. Nasal obstruction was significantly worse in children with a positive history of allergic rhinitis (p < 0.05). There was also a trend towards a higher nasal obstruction score in children without allergic rhinitis exposed to passive smoking compared to those who were not so exposed. As would be expected, nasal obstruction is worse in children with allergic rhinitis than in those without. Passive smoking tends to increase the symptom of nasal obstruction in children without allergic rhinitis.     

Electrophoretic evaluation of nasal discharge in patients with allergic rhinitis and vasomotor rhinitis

BACKGROUND: Allergic rhinitis and vasomotor rhinitis are two common diseases that have similar symptoms and physical findings. This study was designed to assess the efficacy of electrophoretic analysis of nasal discharge for the differential diagnosis of allergic rhinitis and vasomotor rhinitis. METHODS: Two different groups of patients with allergic rhinitis (n = 18) and with vasomotor rhinitis (n = 18) diagnosed by current methods and 10 healthy subjects as a control group were included in this study. Component analyses of proteins in nasal wash were made by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. RESULTS: The mean levels of total protein, 66-kDa proteins and 26-kDa proteins (277.2 +/- 9 microg/mL, 114.5 +/- 9 microg/mL, and 67.0 +/- 4 microg/mL, respectively), in nasal washing samples of patients with allergic rhinitis were found to be higher than in the samples, (222.0 +/- 6 microg/mL, 65.6 +/- 6 microg/mL, and 42.9 +/- 4 microg/mL respectively) obtained from patients with vasomotor rhinitis. The control group showed the lowest rate of these proteins (167.8 +/- 7 microg/mL 34.3 +/- 3 microg/mL, and 25.0 +/- 3 microg/mL, respectively). The differences between mean levels of these proteins in all groups were statistically significant (p < 0.05). CONCLUSIONS: These findings indicate that electrophoretic analysis of nasal discharge can be used for the diagnosis of allergic rhinitis and vasomotor rhinitis. However, further studies are needed to standardize the technique of nasal wash and to determine the range of proteins in nasal secretions that will confirm the diagnosis.     

Decongestant effects of nasal xylometazoline and mometasone furoate in persistent allergic rhinitis

Thirty-six persistent allergic rhinitis (PAR) sufferers were studied, to both compare and correlate 15 minute response to nasal xylometazoline (XYLO) with 28 day response to nasal mometasone furoate (MF). 0.1% XYLO (1 spray each nostril) response was measured on two occasions, then a randomised double blind cross-over comparison of MF (200 mcg daily) to placebo conducted. Outcomes were peak nasal inspiratoly flow (PNIF), nasal forced inspiratory volume in one second (nFIV1) and nasal blockage score (NBS) improvements. Thirty-one participants completed per protocol. Within subject standard deviation for percentage improvement to XYLO was 26.0 for PNIF and 25.2 for nFIV1. Median % improvement (95%CI) in PNIF for XYLO vs. MF was 20.0 (11.4 to 31.0) vs. 9.6 (3.2 to 15.8) and in nFIV1 was 17.8 (10.0 to 28.1) vs. 3.3 (-4.3 to 19.1). XYLO effects were greater than MF (p<0.05) for PNIF, nFIV1 and NBS. There was no significant correlation of MF to XYLO improvements in PNIF, nFIV1 or NBS. In conclusion, acute reversibility to XYLO showed poor repeatability and XYLO reversibility is not predictive of decongestant response to nasal corticosteroid. XYLO was a stronger decongestant than MF but rhinitis medicamentosa still precludes any preference for long term XYLO therapy at this time.     

盐酸氮卓斯汀鼻喷剂联合布地奈德鼻喷剂治疗持续性变应性鼻炎疗效观察

目的 观察盐酸氮卓斯汀鼻喷剂联合布地奈德鼻喷剂治疗持续性变应性鼻炎的临床疗效.方法 随机将120例持续性变应性鼻炎患者分为A组、B组及C组各40例,A组给予盐酸氮卓斯汀鼻喷剂联合布地奈德鼻喷剂喷鼻,B组只给予盐酸氮卓斯汀鼻喷剂喷鼻,C组只给予布地奈德鼻喷雾剂喷鼻.疗程4周.比较3组患者治疗4周后临床疗效.结果 ①视觉模拟量表评分:4周后A组患者鼻部症状视觉模拟量表评分均较B组及C组低,差异有统计学意义(P<0.05);②鼻-结膜炎相关生活质量问卷评分:4周后3组患者鼻-结膜炎相关生活质量问卷评分均比治疗前有显著改善,而A组在睡眠、非鼻-结膜炎症状、鼻部症状及情感反应等4方面的评分与B组、C组比较差异有统计学意义(P<0.05);③疗效:A组患者显效率50.00%及总有效率92.50%,分别与B组(30.00%,75.00%)及C组(27.50,77.50%)比较,差异均有统计学意义(P<0.05).结论 盐酸氮卓斯汀鼻喷剂联合布地奈德鼻喷剂治疗持续性变应性鼻炎可以迅速缓解鼻部症状,提高患者生活质量.     

根据变应性鼻炎患者鼻分泌物嗜酸粒细胞计数调整类固醇治疗的临床意义

目的:探讨根据常年性持续性变应性鼻炎(AR)患者鼻分泌物嗜酸粒细胞(EOS)相对计数调整类固醇治疗的临床意义。方法:选择近3个月内未接受类固醇治疗的常年性持续性AR患者42例,采用酶联免疫荧光法测定鼻分泌物EOS阳离子蛋白浓度,根据鼻分泌物EOS计数将患者分为EOS组23例(EOS≥3%)与非EOS组19例(EOS<3%),均进行AR症状、体征评分、鼻分泌物细胞分类计数。治疗2、4、6个月时进行随访和疗效评价。结果:EOS组鼻分泌物中EOS比值[中位数M(25分位数;75分位数),下同]、EOS阳离子蛋白水平(x珋±s,下同)基线值分别为0.086(0.065;0.176)、(326±145)μg/L,非EOS组分别为0.016(0.005;0.022)、(154±58)μg/L,2组比较差异有统计学意义(t值分别为4.40、3.32,均P<0.01)。治疗2、6个月后,EOS组的EOS比值、EOS阳离子蛋白水平分别为0.038(0.006;0.070)、0.019(0.010;0.060);(175±122)μg/L、(175±153)μg/L,与基线值比较差异均有统计学意义(F值分别为6.73、7.38,均P<0.05);非EOS组分别为0.014(0.004;0.032)、0.015(0.010;0.026);(118±60)μg/L、(112±60)μg/L,与基线值比较,EOS比值差异无统计学意义(F=0.82,P>0.05),而EOS阳离子蛋白水平差异有统计学意义(F=3.78,P<0.05)。平均症状、体征评分EOS组和非EOS组在基线及2、4、6个月时不同时间点比较,差异均无统计学意义。2组鼻用类固醇用量各时间点比较差异均无统计学意义(均P>0.05)。结论:对于鼻分泌物EOS增高的AR患者,采用类固醇治疗能够抑制EOS炎症,改善AR患者的症状和体征。非EOS增高的AR患者对类固醇治疗反应性差,症状、体征无改善。临床上可以根据EOS的相对计数决定是否采用类固醇治疗。