舌下粉尘螨滴剂治疗儿童支气管哮喘伴变应性鼻炎的有效性和安全性

目的 探讨舌下含服标准化粉尘螨变应原疫苗治疗儿童支气管哮喘伴变应性鼻炎的有效性和安全性.方法 采用前后自身对照,比较52例年龄4～14岁粉尘螨过敏的支气管哮喘伴变应性鼻炎患儿治疗前及免疫治疗1年、2年后的症状评分、药物评分以及不良反应发生率,评价其疗效和安全性.以SPSS 17.0软件对数据进行统计学分析.结果 治疗前患儿支气管哮喘日间、夜间的症状评分分别为(3.22±0.66)、(2.05±0.57)分,治疗后1年分别为(1.68±0.61)、(0.94±0.32)分,治疗后2年分别为(0.61±0.28)、(0.43±0.13)分,治疗后1年较治疗前明显降低,治疗后2年较治疗后1年明显降低.差异均有统计学意义(q值分别为15.25、13.78、10.29、6.07,P值均<0.01).治疗前患儿变应性鼻炎的症状评分及药物评分分别为(2.34±0.59)、(3.09±1.01)分,治疗后1年分别为(1.21±0.46)、(1.89±0.64)分,差异有统计学意义(q值分别为15.48、18.61,P值均<0.01);治疗后2年分别为(1.02±0.37)、(1.49±0.38)分,与治疗后1年相比筹异无统计学意义(q值分别为2.53、2.78,P值均>0.05).治疗过程中未发生严重不良事件,仅表现为口腔不适感.结论 标准化粉尘螨变应原疫苗舌下含服是一种治疗儿童粉尘螨支气管哮喘伴变应性鼻炎的安全有效方法.

Abstract：

Objective To study the clinical efficacy of sublingual immunotherapy using standardized dermatophagoides farinae extract for children with combined allergic rhinitis and asthma syndrome. Methods Fifty-two children, from 4 to 14 years of age, with mite-sensitive combined allergic rhinitis and asthma syndrome were treated sublingually with standardized dermatophagoides farinae extract. The clinical efficacy was evaluated by monthly follow-up visits. After treatment for 1 or 2 years using the standardized dermatophagoides farinae extract, the asthma and rhinitis symptom scores, medication scores and adverse reactions before and after treatment were evaluated. SPSS 17.0 software was used to analyze the data. Results The allergic asthma symptom scores before treatment during the day were 3. 22 ±0. 66 and at night 2.05 ±0. 57. After 1 year of treatment, the day and night scores ( 1. 68 ± 0. 61 , 0. 94 ± 0. 32) respectively, were decreased significantly (q values were 15. 25 and 13. 78 respectively, all P < 0. 01 ). After 2 years of treatment, the scores (0. 61 ± 0. 28, 0. 43 ±0. 13 ) were also decreased significantly ( q values were 10. 29 and 6. 07 respectively, all P < 0. 01 ). The allergic rhinitis symptom scores and medication scores were 2. 34 ± 0. 59 and 3. 09 ±1.01 respectively before treatment and 1.21 ± 0. 46 and 1. 89 ±0. 64 after 1 year of treatment. The differences were significant ( q values were 15. 48 and 18. 61 respectively, all P<0.01). The allergic rhinitis symptom scores and medication scores were 1.02 ±0.37 and 1.49 ± 0. 38 after 2 years of treatment. There was no significant difference between 2 years of treatment and 1 year of treatment(q values were 2.53 and 2.78 respectively, all P >0.05). There were no severe adverse events during the treatment, except for mild mouth cavity discomfort. Conclusions Suhlingual immunotherapy using standardized dermatophagoides farinae extract is safe and effective in the treatment ofchildren with combined allergic rhinitis and asthma syndrome.     

慢性鼻-鼻窦炎鼻息肉患者细菌生物膜的观察

目的 观察慢性鼻-鼻窦炎鼻息肉患者手术黏膜组织中细菌生物膜的形态特征,并分析其与临床因素、术后疗效的关系.方法 试验组获取72例慢性鼻-鼻窦炎鼻息肉患者手术中筛窦黏膜组织,对照组获取15例鼻中隔偏曲患者、10例鼻骨骨折患者钩突黏膜组织(患者均知情同意),所有组织标本均行扫描电镜检查.对两组患者进行术后随访,分别应用Lund-Kennedy鼻内镜检查、慢性鼻窦炎疗效评定标准(1997年,海口)评估患者病情改善程度.采用t检验分析细菌生物膜对术后Lund-Kennedy评分的影响;采用卡方检验分析细菌生物膜与内镜手术疗效的相关性,以P＜0.05为差异有统计学意义.结果 试验组72例慢性鼻-鼻窦炎鼻息肉患者中有3例患者失访,失访率为4.2%.69例慢性鼻-鼻窦炎鼻息肉患者的细菌生物膜阳性率71.0%(49/69),并且可以观察到黏膜组织纤毛不同程度的损伤.对照组未发现细菌生物膜,可以观察到黏膜纤毛较浓密,排列整齐.卡方检验结果显示,性别、慢性鼻-鼻窦炎鼻息肉类型、病程等因素在试验组细菌生物膜阴性组与阳性组间差异无统计学意义(P值均＞0.05).细菌生物膜阳性组患者术后6个月和12个月的Lund-Kennedy 评分(4.78 ±1.67;4.55 ±1.61)分别高于细菌生物膜阴性组患者(3.65 ±1.39;3.65 ±1.18),差异均有统计学意义(t=-2.654,P＜0.01;t=-2.264,P＜0.05);细菌生物膜阴性组术后6个月和12个月的疗效明显优于细菌生物膜阳性组,差异有统计学意义(x2值分别为18.014、22.063,P值均＜0.001).结论 慢性鼻.鼻窦炎鼻息肉患者手术黏膜组织中存在细菌生物膜的生命周期不同形态,细菌生物膜的存在与否,与慢性鼻-鼻窦炎鼻息肉的类型、性别、病程无明显相关.细菌生物膜可能对患者术后疗效产生不良的影响.

Abstract：

Objective To explore the presence of bacterial biofilms(BF) in patients with CRS and the effect of BF on clinical symptoms and postoperative outcomes.Methods Seventy-two patients with chronic sinusitis were enrolled in this study.The control group included 15 patients with deviation of the nasal septum and 10 patients had a fracture of the nasal bone.Mucosa of the uncinate process or ethmoid near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery.The specimens were subjected to scanning electron microscopy.Patients were followed for 1 year and observed by the LundKennedy endoscopy,and the Haikou standard classification (ESS-1997).Statistical analysis was performed by t-test or chi-square test Results Three patients were lost to follow-up.The scanning electron microscopy analysis showed bacterial biofilms in 49 of the 69 patients with chronic sinusitis.A marked destruction of the epithelium and cilia was observed in samples positive for bacterial biofilms.No bacterial biofilms were detected in the control group,and scanning electron microscopy showed normal epithelium and cilia in those specimens.There was no significant difference in gender,classification or duration of disease between the BF(-) and BF( + ) groups.At six months and one year postoperative,the Lund-Kennedy endoscopy scores for CRS patients with BF(4.78 ± 1.67 ;4.55 ± 1.61) were significantly higher than those without BF(3.65 ±1.39;3.65 ±1.18) (t =-2.654,P＜0.01;l =-2.264,P＜0.05).Based on the Haikou standard classification,there was a significantly difference between patients with BF and those without BF( x2 = 18.014,22.063 ,P ＜ 0.001,respectively).Conclusions Different life stages of bacterial biofilms were demonstrated to be present in CRS.Gender,classification or duration of disease did not affect the presence of bacterial biofilms in patients with CRS.There is a correlation between bacterial biofilms and an unfavorable outcome in patients with CRS after ESS.     

Epworth嗜睡量表简体中文版信度和效度评价

目的 探讨Epworth嗜睡量表(Epworth sleepiness scale,ESS)简体中文版的信度和效度.方法以585例疑似阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者及103例确诊并进行手术的OSAHS患者为研究对象,多道睡眠图(PSG)监测前填写ESS量表简体中文版,进行手术的患者术后6个月以上再次进行了PSG监测和填写ESS量表.从585例患者中选取2010年7至8月间的51例患者重新进行ESS量表评分(时间至少间隔1周).结果 ESS量表简体中文版总的Cronbach'α系数为0.814;ESS总分重测信度为0.679,表中各项条目信度为0.473～0.698(P<0.01);分半信度R=0.817(P<0.01).ESS量表效度分析中,区分效度用呼吸暂停低通气指数(AHI)指标来区分单纯鼾症和轻、中及重度OSAHS患者,单纯鼾症与不同病情程度的OSAHS患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).用最低血氧饱和度(LSaO2)指标来区分正常血氧饱和度、轻、中及重度低血氧饱和度患者,正常血氧饱和度与不同程度低氧血症患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).因素分析中有4个公因子,累积贡献率达74.270%,每项条目负荷大于0.4;各因子分值与ESS量表总分进行相关分析发现除开车等红绿灯或遇堵车停几分钟时与其他各因子的相关性较低外,其他因子之间及ESS总分之间相关性均较高(P<0.01).量表评估与临床诊断的一致率较差(Kappa值为0.099,P<0.01),预测效度差(r=0.138,P<0.01).手术前后ESS总分由15.0[10;20]分降到4[1;6]分(M[P25;P75]),手术治疗有效、无效患者在手术前后ESS总分的差异均有统计学意义(Z=-7.528,P<0.01;Z=-4.382,P<0.01).结论 Epworth嗜睡量表简体中文版具有较好的信度和效度,可以作为白天嗜睡程度自我评估工具.

Abstract：

Objective To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). Methods Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. Results The total Cronbach's Alpha of ESS was 0. 814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698 ( P ＜ 0.01 ). Split-half reliability was 0.817 ( P ＜ 0.01 ). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients( P ＜ 0.05 ), and this was also true in different degrees of lowest saturation of arterial oxygen ( LSaO2 ) patients and normal LSaO2 patients(P＜0.05). The factor analysis of construct validity showed that 4 factors were extracted.The cumulative proportion was 74.270%. The loading was higher than 0. 4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item.The ESS had low consistency with clinical diagnosis(κ =0.099,P ＜0.01 ) and the predictive validity was not good (r =0.138, P ＜0.01 ). As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] ( M[P25 ;P75] ) ,and improved to 4[1 ;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation ( Z = - 7.528,P＜0.01) ,so was the patients who got ineffective results(Z= -4.382, P＜0.01) . Conclusions The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.     

特异性免疫治疗对慢性鼻窦炎伴变应性鼻炎患者鼻内镜手术效果的影响

目的 探讨特异性免疫治疗对慢性鼻窦炎(CRS)伴变应性鼻炎患者功能性内镜鼻窦手术(FESS)效果的影响.方法 将确诊为CRS伴常年性变应性鼻炎的57例患者按照尘螨过敏与否分成两组,尘螨过敏者为治疗Ⅰ组,FESS术后采用皮下免疫治疗;非尘螨过敏者为治疗Ⅱ组,单纯行FESS.分别对两组患者术前、术后6个月、术后1年的症状及体征进行评分并对比,采用鼻腔鼻窦结局测试-20 (SNOT-20)量表及Lund-Kennedy鼻内镜评分法.结果 两组患者术后6个月和1年的SNOT-20及Lund-Kennedy评分较术前均有明显改善(P＜0.01),治疗Ⅰ组患者的疗效优于治疗Ⅱ组且组间差异有统计学意义(P＜0.05).结论 特异性免疫治疗可改善CRS伴变应性鼻炎患者的手术效果.     

舌骨甲状软骨悬吊联合悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征

目的 探讨舌骨甲状软骨悬吊联合悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)治疗重症阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的手术方法和效果.方法 对69例有舌咽平面和腭咽平面狭窄的重症OSAHS患者[呼吸暂停低通气指数(apnea hyponea index,AHI)＞30次/h]进行了舌骨甲状软骨悬吊联合悬雍垂腭咽成形术.61例完成术后6个月随访,48例完成术后12个月随访.比较手术前后睡眠呼吸监测结果和Epworth嗜睡量表评分.结果 69例患者手术后打鼾症状减轻或消失.术后6个月18例纤维喉镜观察发现,12例患者的腭咽平面和舌咽平面狭窄减轻,6例没有明显变化,但没有舌根后坠.1年后14例纤维喉镜观察未发现狭窄加重者.以AHI降低幅度≥50%为治疗有效的评定标准,术后6个月和12个月随访,有效率分别为78.7%(48/61)和75.0%(36/48);患者AHI平均值由44.8次/h降至15.1次/h和17.2次/h,最低动脉血氧饱和度平均值由0.512升至0.880和0.730,配对t检验,差异均有统计学意义(P值均＜0.01);Epworth嗜睡量表评分平均值分别为6.7和7.2分,均较术前的16.6分明显降低(P值均＜0.01).结论 舌骨甲状软骨悬吊联合悬雍垂腭咽成形术方法简单,时间短,花费少,手术效果满意,适用于腭咽平面和舌咽平面狭窄的OSAHS患者的治疗.

Abstract：

Objective To discuss the methodology and therapeutic effect of hyoid suspension in association with uvulopalatopharyngoplasty ( UPPP) in the treatment of severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Sixty-nine patients with severe OSAHS( apnea hyponea index,AHI ＞ 30) were treated with hyoid suspension and UPPP.Sixty-one patients were followed for 6 months (48 of them for 12 months).Polysomnogram (PSG) tests were performed and an Epworth sleepiness scale ( ESS) was recorded preoperatively and postoperatively in these patients.Results After the surgery,the snoring of the patients disappeared or was alleviated to varing degrees.Eighteen patients underwent fiberoptic nasopharyngolaryngoscopic examination.Twelve of them showed palatopharyngeal and glossopharyngeal stenosis was improved 6 months after surgery.Six patients showed no change,but had no glossoptosis.Fourteen patients underwent fiberoptic nasopharyngolaryngoscopic examination 1 year after surgery,with no recurrence of the stenosis being found.A decrease of 50% in the AHI was considered effective,and in patients the effective rate was 78.7% (48/61 ) 6 months after the operation and 75.0% (36/48) 1 year after the operation.The average AHI decreased from 44.8 to 15.1 and 17.2,and the minimum arterial oxygen saturation average increased from 0.512 to 0.880 and 0.730.Matching t tests were utilized and the results of follow-up indicated that there was a significant improvement in the indexes in those cases which could be followed up ( P ＜ 0.01 ).The average of the ESS was 6.7 six months after operation and 7.2 one year after operation,with a significant decrease compared to the preoperative ( 16.6) data (P ＜0.01).Conclusions Modified hyoid suspension in association with UPPP has the advantage of a simple operation,short hospitalization and less expense,and the effect of the operation was significant.Patients with palatopharyngeal and glossopharyngeal stenosis should be chosen for this operation.     

慢性鼻-鼻窦炎患者功能性内镜鼻窦手术前后的主客观评估及相关性分析

目的:探讨慢性鼻-鼻窦炎(CRS)患者功能性内镜鼻窦手术(FESS)前后的主客观评估及相关性。方法:对70例术前CRS患者进行主观症状调查[视觉模拟量表(VAS)],并进行客观检查及评分(Lund-Kennedy内镜评分系统及Lund-Mackay CT评分系统)。所有患者FESS术后随访1年,进行术后6个月和12个月的VAS评分及Lund-Kennedy内镜评分。分析各评价方法的相关性及比较手术前后的评价得分。结果:术前鼻塞、鼻分泌物和鼻后滴漏、头面部胀痛感较为突出,经FESS后6、12个月症状改善明显;嗅觉减退和全身不适感术后改善不明显。术前VAS评分与Lund-Mackay CT评分之间呈正相关(r=0.866,P<0.01);术前Lund-Kennedy内镜评分与Lund-Mackay CT评分之间呈正相关(r=0.803,P<0.01);术前VAS评分与Lund-Kennedy内镜评分之间呈正相关(r=0.912,P<0.01)。术后6、12个月VAS总分与术后内镜总分呈正相关(6个月r=0.798,12个月r=0.882);术后12个月的VAS评分中鼻塞、鼻分泌物和鼻后滴漏、头面部胀痛感与Lund...     

局部糖皮质激素治疗慢性鼻-鼻窦炎的疗效研究

目的 观察单独应用局部糖皮质激素治疗中国人慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)的疗效.方法 随机选取2010年11月至2011年12月就诊于中山大学附属第一医院耳鼻咽喉科,未经治疗的CRS伴或不伴鼻息肉患者34例.使用鼻腔局部喷布地奈德规律治疗3个月.以视觉模拟量表(visual analogue scale,VAS)评估治疗前及治疗后第1、2、3个月鼻部症状评分;以鼻腔鼻窦结局测试-20(sino-nasal outcome test-20,SNOT-20)评估治疗前后患者的生活质量;以Lund-Mackay CT评分评估治疗前后影像学的改变.采用SPSS 16.0软件进行统计学分析.结果 34例患者中,脱落4例.患者治疗前鼻塞、鼻漏、头痛、面部压迫感、总体症状的VAS评分分别为(4.84±3.15)、(6.03±2.93)、(1.68±2.66)、(2.04±2.97)、(6.00±2.75)分,治疗后第3个月分别为(2.26±2.27)、(1.96±2.23)、(0.42±0.95)、(0.58±1.42)、(2.71±1.90)分,差异有统计学意义(t值分别为4.386、6.740、2.445、2.980、6.989,P值均＜0.05);嗅觉下降或障碍治疗前后差异无统计学意义(t=0.902、P＞0.05).治疗后第1个月鼻塞、鼻漏、总体症状的VAS评分较治疗前差异有统计学意义(P值均＜0.05);而治疗后第1、2、3个月之间各种鼻部症状的VAS评分差异无统计学意义(P值均＞0.05).治疗后SNOT-20得分较治疗前差异有统计学意义(t=3.687,P＜0.01).从CT表现上评估总体治愈率为22.2％.结论 局部糖皮质激素治疗中国人CRS有明确疗效,22.2％的患者能达到CT的痊愈,症状改善出现在第1个月.     

儿童变应性鼻炎免疫治疗的临床疗效及免疫学机制研究

目的 评价标准化尘螨变应原疫苗治疗儿童变应性鼻炎的临床疗效并初步探索其免疫学机制.方法螨过敏变应性鼻炎儿童64例,随机分为免疫治疗组(32例)和药物治疗组(32例).通过症状评分和药物评分评价临床疗效,并检测治疗前后血清中总IgE、螨特异性IgE、特异性IgG4的水平.结果 经过1年的治疗,免疫治疗组患儿的症状评分(4[3;6]分)和药物评分(0.35[0.30;0.43]分)较治疗前(分别为10[9;11]分、0.76[0.61;0.90]分)均明显减少且差异有统计学意义(Z值分别为-4.80、-4.74,P值均<0.01),与药物治疗组(分别为7[5;9]分、0.72[0.60;0.92]分)相比差异亦有统计学意义(U值分别为155.00、139.50,P值均<0.01).总IgE和螨特异性IgE水平未见明显改变,但免疫治疗组患儿血清中螨特异性IgG4的水平明显升高(U=6.00,P<0.01).结论 标准化螨变应原免疫治疗能够有效改善变应性鼻炎患儿的症状,减少药物使用,变应原特异性IgG4的增高可作为预测免疫治疗疗效的免疫学参考指标.

Abstract：

Objective To evaluate the efficacy and immunological changes of children receiving subcutaneous immunotherapy with Dermatophagoides pteronyssinus. Methods Sixty-four children with allergic rhinitis to Dermawphagoides pteronyssinus (Der p) were randomly allocated to receive either specificimmunotherapy (n = 32) or medical treatment (n = 32 ). Symptom and medication scores were assessed toevaluate the clinical efficacy in the baseline and after one year treatment. Total IgE, Der p-specific IgE, and specific IgG4 were measured. Results Immunotherapy reduced the symptom ( the scores reduced from 10[9;11] to4[3;6]) and medication score (the scores reduced from 0.76[0.61; 0.90] to 0.35[0.30;0. 43] ) in children with arlergic rhinitis significantly ( Z value were - 4.80 and - 4.74, respectively, each P＜0.01 ). There was a significant difference in symptom and medication scores between both groups after one year treatment ( U value were 155. 00 and 139.50, respectively, each P ＜ 0.01 ). There were no differences in levels of serum total IgE, specific IgE before and after one year treatment, but the level of serum specific IgG4 increased significantly after one year treatment. Conclusions Immunotherapy with standardized extract is efficacious to treat children sensitive to Der p, allergen-specific IgG4 is significant as immunological marker to predict efficacy of immunotherapy.     

鼻腔结构重塑在慢性鼻-鼻窦炎治疗前后的主客观评估及相关性研究

目的探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者行鼻腔结构重塑前后的主客观评估及相关性研究。方法对70例CRS患者鼻内镜下行下鼻甲射频消融外移术、中鼻甲成形术及窦口鼻道复合体功能性切除术,同期行鼻中隔黏膜下矫正术。术前对所有患者作主观症状视觉模拟量表(visual analog scale,VAS)调查、客观检查及评分、Lund-Kennedy内镜评分和Lund-Mackay CT评分。术后随访1年,分别行以上3种评分,并作相关性分析。结果术前VAS评分总分与CT评分呈显著正相关(r=0.39,P<0.01),内镜评分与CT评分呈正相关(r=2.11,P<0.05),但嗅觉障碍的VAS评分与内镜、CT评分无相关性,差异无统计学意义。术前VAS与术后VAS评分差异具有统计学意义(t=39.51,P<0.01),术后VAS与术后内镜评分差异具有统计学意义(r=0.59,P<0.01),术前与术后Lund-Kennedy内镜评分比较差异具有统计学意义(t=39.30,P<0.01)。结论术前VAS评分、CT评分、内镜评分呈正相关,术后随访1年,手术后主观症状VAS总分与术前差异具有统计学意义,与术后Lund-Kennedy内镜评分呈正相关。术前及术后的鼻塞、头晕、面部疼痛、鼻漏症状与客观评估有相关性。手术需多方面评价,有利于个体化的手术。     

鼻黏膜诱发型一氧化氮合酶的表达与鼻内镜术后鼻黏膜转归关系的探讨

目的:观察慢性鼻窦炎(CRS)患者鼻黏膜中诱发型一氧化氮合酶(iNOS)的表达水平,探讨iNOS在CRS炎症中的作用以及与鼻内镜术后鼻黏膜转归的相关性.方法:根据血清总免疫球蛋白E(TIgE)水平将所有CRS病例分为TIgE水平高的A组(TIgE≥90 kU/L)和TIgE不高的B组(TIgE＜90 kU/L),2组皆于鼻内镜术(ESS)前取病变鼻黏膜检测iNOS的表达并参照Lund-Kennedy系统对鼻窦冠状位CT进行评分.追踪2组病例术后同侧术腔完成上皮化的时间.分析CT评分以及鼻黏膜iNOS表达与术腔上皮化时间的相关性.结果:A组的上皮化时间与鼻黏膜iNOS的表达之间呈正相关(P＜0.05);与鼻窦CT评分无明显相关.B组的上皮化时间与鼻窦CT评分呈正相关(P＜0.05),而与鼻黏膜iNOS的表达无相关.结论:iNOS对预测CRS术后术腔恢复有价值,TIgE高的情况下,iNOS的表达强度与术后完成上皮化的时间呈正相关.伴变应性因素的CRS患者,术前鼻黏膜高强度的iNOS表达,很可能预示着术后上皮化需要较长的过程.     

鼻内镜手术对成人慢性鼻-鼻窦炎伴哮喘患者疗效的影响

目的　分析并探讨鼻内镜手术对成人慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）伴哮喘患者疗效的影响。方法　采用前瞻性对照分组设计,对我院诊断为CRS并接受鼻内镜手术治疗的325例患者依入组标准选择92例患者进行跟踪随访,于术前、术后评估所有患者鼻部和哮喘各指标变化情况。结果　共92例完成3个月随访,90例完成12个月随访。鼻内镜手术后鼻部总体症状和鼻塞、流涕的视觉模拟量表评分以及鼻内镜Lund-Kennedy评分均明显改善,喷嚏、嗅功能、头面部疼痛视觉模拟量表评分结果也有不同程度改善。伴哮喘患者鼻内镜手术后哮喘控制测试评分在术后明显升高,而肺功能各指标变化无统计学差异。结论　以鼻内镜手术为中心的综合治疗对成人CRS伴哮喘患者的鼻部症状改善和减少用药量有显著作用;短期内鼻内镜手术对提高哮喘患者哮喘控制水平和减少哮喘用药量有积极作用。     

咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察

目的 探讨碱性等渗盐水鼻腔冲洗对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后的临床疗效。 方法 80例咽喉反流症状或体征评分阳性的慢性鼻窦炎患者使用随机数字生成器分为2组,其中鼻内镜手术后接受碱性等渗盐水冲洗患者40例为研究组,鼻内镜术后接受生理盐水冲洗患者40例为对照组。根据外周血嗜酸粒细胞占白细胞百分比是否超过4.27%对研究组和对照组分层。在鼻内镜手术后2周、6周进行随访评估。评估包括反流症状指数评分量表、反流体征评分量表、鼻腔鼻窦结局20量表、视觉模拟量表、鼻阻塞症状评估量表、Lund-Kennedy评分以及不良反应记录。 结果 在2周时,研究组视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［1.5(0.0,3.0)分］(P=0.016<0.05);在6周时,研究组鼻腔鼻窦结局20评分的变化量［(13.4±10.3)分］以及视觉模拟量表评分的变化量［3.0(2.0,4.0)分］>对照组［(8.7±6.1)、1.0(0.0,2.2分)］(P=0.001<0.05)。分层后,使用碱性等渗盐水冲洗的患者中外周血嗜酸粒细胞占白细胞百分比≤4.27%的亚组在鼻内镜手术后2周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［13.0(8.0,19.0)、(3.2±1.9)分］更大(P=0.024<0.05,P=0.030<0.05)且在术后6周的鼻腔鼻窦结局20和视觉模拟量表评分变化量［(15.7±9.5)、2.0(2.0,4.0)分］更大(P=0.002<0.05,P=0.005<0.05)。2组患者均未出现严重不良反应。 结论 对于伴有咽喉反流症状或体征评分阳性的慢性鼻窦炎患者,在鼻内镜手术后早期护理阶段使用碱性等渗盐水进行鼻腔冲洗具有一定的临床疗效,尤其是在外周血嗜酸粒细胞占白细胞百分比低于4.27%的患者中。     

功能性鼻内镜鼻窦手术后换药应用布地奈德混悬液的效果分析

目的 探讨在慢性鼻-鼻窦炎患者术后应用布地奈德混悬液（普米克令舒）的效果。方法 分析280例慢性鼻-鼻窦炎行鼻内镜手术的患者,随机分为2组,A组常规换药,术后常规使用布地奈德鼻喷剂喷鼻;B组对有囊泡及水肿明显者在术后换药过程中清理后予以明胶海绵浸润布地奈德混悬液置于囊泡及水肿部位,每周1~2次,观察术后1个月、3个月及6个月的疗效,包括VAS视觉量表主观评估及鼻内镜Lund-Kennedy客观评估。结果 A、B组术后1、3、6个月VAS评分分别为4.48±1.33,2.16±0.81,2.04±0.96;3.85±1.09,1.90±0.88,1.93±0.74。A、B组术后1、3、6个月Lund-Kennedy评分分别为11.44±1.73,4.51±1.05,3.94±0.86;6.82±2.08,4.26±1.17,2.17±0.79。两组患者的VAS评分在术后三个时间点差异均有统计学意义（P<0.05）;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,差异无统计学意义。两组间Lund-Kennedy 客观评估比较,在术后1个月和6个月两个时间点差异有统计学意义（P<0.05）,而在术后3个月,两组比较差异无统计学意义;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,A组在两个时间点差异有统计学意义,B组在两个时间点差异无统计学意义。结论 慢性鼻-鼻窦炎鼻内镜术后应用布地奈德混悬液能更好地减少术后囊泡形成、减轻水肿,促进黏膜上皮化。     

鼻内镜术后中药鼻腔雾化吸入辅佐治疗慢性鼻-鼻窦炎的主客观评估

目的 评价慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者在鼻内镜术(endoscopic sinus surgery, ESS)后用中药进行鼻腔超声雾化吸入辅佐治疗的疗效。方法 63例CRS患者随机分为治疗组(33例)和对照组(30例),ESS术后第3天行鼻腔超声雾化吸入。治疗组雾化用药为鼻窦炎口服液,每天早晚各1次,每次8mL,连续5d,后改为每周1次,连续3个月。对照组使用生理盐水鼻腔雾化吸入,方法相同。雾化前(术后第2天)、雾化5d和3个月后分别采用视觉模拟量表、Lund Kennedy评分系统、Lund Mackay评分法进行相关评估。结果 通过对主观症状、鼻内镜及鼻窦CT扫描进行检查评估,治疗组与对照组在雾化前后及组间比较差异均有统计学意义。结论 CRS患者ESS术后中药雾化吸入能明显提高手术疗效。     

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。     

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

ObjectivesLatest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS).MethodsWe performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund–Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery.ResultsNasal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003).ConclusionOur study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS.     

Failures of Adenoidectomy for Chronic Rhinosinusitis in Children: For Whom and When Do They Fail?

OBJECTIVES: To determine which children who are treated with adenoidectomy for chronic rhinosinusitis (CRS) will ultimately undergo endoscopic sinus surgery (ESS) and the length of time between adenoidectomy and ESS. STUDY DESIGN: Retrospective chart review of prospectively collected data in a tertiary pediatric otolaryngology service. METHODS: One hundred forty-three children had adenoidectomy for CRS over a 10-year period. Follow-up was available on 121 children. Sixty-one children failed the procedure. Data were available on 55 children who underwent ESS after failing adenoidectomy for the treatment of CRS. Mean time from adenoidectomy to ESS was determined. Factors such as age, allergic rhinitis, asthma, computed tomography (CT) score, and sex were evaluated for effects on this time. RESULTS: With use of Cox regression analysis, the mean time from adenoidectomy to ESS was 24 months, ranging from 4 to 77 months. The presence of asthma (P < .04) and age less than 7 years (P < .01) were predictors of earlier failure. Allergic rhinitis (P < .3), CT score (P < .9), and sex (P < .3) showed no effect. CONCLUSIONS: Those who fail adenoidectomy for CRS who require ESS are mainly children who are younger than 7 years of age and have asthma. They appear to require a salvage ESS at a mean of 24 months after the adenoidectomy.     

大环内酯类药物治疗内镜鼻窦手术后黏膜迁延性炎性反应的临床观察

目的 观察小剂量服用大环内酯类药物对内镜鼻窦手术后鼻窦黏膜长期迁延性炎性反应患者治疗的临床效果。方法 病例来源于2004-2006年中山大学附属第一医院耳鼻咽喉科医院首次经内镜鼻窦手术治疗后2年以上、长期迁延性鼻窦炎性反应、疗效评估未愈的慢性鼻窦炎患者13例。治疗方案采用克拉霉素250 mg/d,连续口服超12 ～ 28周,同时保留原有基本治疗（鼻用糖皮质激素、黏液促排剂、鼻腔盥洗）。在治疗结束时与结束后3、6个月采用症状视觉模拟量表和内镜黏膜形态评估（Lund-Kennedy评分法）对临床疗效进行主客观综合评价。以SPSS 16.0统计软件进行t检验或非参数检验。结果 13例患者中1例经20周治疗无效中断治疗,其他12例均达到预定的停药标准。全部患者停药时间分别为：12周4例,16周2例,20周5例,24周1例,28周1例。综合评价结果：非常好6例,好4例,比较好2例,不好1例。治疗前后症状视觉模拟量表及内镜Lund-Kennedy评分（中位数[25分位数;75分位数]）分别为8.00[7.50;8.50]与1.00[0.25;1.00];7.00[6.50;8.00]与1.00[0.00;1.00],治疗前后差异均有统计学意义(Z分别为-3.201、-3.194,P均＜0.01)。停药后3～6个月未发现鼻窦炎复发。13例患者未发生药物不良反应,肝肾功能均未受到影响。结论 小剂量（250 mg/d）、长期（12 ～28周）使用大环内酯类药物治疗内镜鼻窦手术后顽固的持续性迁延性炎性反应临床疗效显著、稳定。大环内酯类药物临床安全性和患者耐受性较好。