鼻用糖皮质激素治疗变应性鼻炎专家共识（2021，上海）

本文系中国鼻病研究协作组召集国内青年鼻科专家,基于临床经验和循证医学证据制订的鼻用糖皮质激素治疗变应性鼻炎的专家共识。本共识从鼻用糖皮质激素的作用原理、药理特点和临床应用等方面系统总结了鼻用糖皮质激素在治疗变应性鼻炎中的作用、临床应用要旨和注意事项,旨在进一步规范变应性鼻炎的诊疗,指导医师进行合理的用药,以提高变应性鼻炎的治疗疗效和患者的就医满意度。     

组胺受体及抗组胺药的分类及其在变应性鼻炎中的应用

组胺是体内一种重要的化学介质,可通过活化H1、H2、H3、H4等类型受体参与多种病理生理过程.在变应性鼻炎(AR)的速发相中,肥大细胞脱颗粒释放组胺等炎性介质,组胺与鼻黏膜中H1受体结合触发喷嚏、鼻痒和流涕等症状,应用H1受体拮抗剂(H1RAs)可显著缓解上述症状.新近研究发现鼻黏膜中除H1受体外还存在H2、H3和H4...     

联合应用白三烯受体拮抗剂治疗小儿变应性 鼻炎的临床观察

目的探讨联合应用白三烯受体拮抗剂治疗小儿中、重度变应性鼻炎(allergic rhinitis, AR)的临床疗效。方法随机将62例中、重度AR患儿分为常规治疗组和联合治疗组,每组患者各31例,常规治疗组用第二代抗组胺药口服、鼻用糖皮质激素喷鼻治疗;联合治疗组在常规治疗组的基础上加用孟鲁司特钠咀嚼片口服,两组患者疗程均为4周。对两组患儿在治疗前、治疗4周结束时及治疗结束后3个月鼻部症状视觉模拟量表(VAS)评分及总有效率进行比较。 结果①鼻部症状VAS评分每组患者治疗前与治疗4周结束时、治疗结束后3个月分别比较差异均具有统计学意义(P均<0.05);治疗4周结束时、治疗结束后3个月,联合治疗组和常规治疗组分别比较,差异均有统计学意义(P均<0.05);②总有效率:治疗4周结束时、治疗结束后3个月,联合治疗组（总有效率为96.67%、90.00%）和常规治疗组（总有效率83.33%、73.33%）分别比较,差异均有统计学意义(P均<0.05);常规治疗组治疗4周结束时和治疗结束后3个月总有效率比较,差异具有统计学意义(P<0.05),而联合治疗组差异则无统计学意义 (P>0.05)。结论白三烯受体拮抗剂联合鼻用糖皮质激素和第二代抗组胺药治疗小儿中、重度AR可以增强和巩固疗效。     

鼻喷剂治疗老年性变应性鼻炎的临床体会

变应性鼻炎(allergic rhinitis,AR)是耳鼻咽喉科的常见病之一。随着机体的老化,老年人全身各系统的生理功能逐渐下降,特别是免疫系统的老化现象尤为明显,机体对外来特异性抗原的免疫应答能力下降,变应性疾病发病减少。老年性变应性鼻炎的症状多不典型,且     

咪唑斯汀治疗季节性变应性鼻炎的临床试验

目的：观察咪唑斯汀治疗季节性变应性鼻炎的疗效和安全性。方法：将符合入选标准的72例患者随机分为咪唑斯汀组和氯雷他定组，两组给药方法相同，口服10mg／d，连续服药14d，根据症状积分下降指数进行疗效评估。通过对患者的询问、体检以及血、尿常规，肝、肾功能和心电图检查来发现不良事件。结果：试验过程中剔除5例，实际完成试验67例，其中咪唑斯汀组34例，氯雷他定组33例。咪唑斯汀组总有效率为82．4％，其中显效20．6％；氯雷他定组总有效率为66．7％，其中显效6．1％。两组均未发现严重不良反应。咪唑斯汀组与氯雷他定组的副作用发生率分别为38．2％和33．3％，咪唑斯汀主要副作用为困倦(26．5％)和口干(8．8％)；氯雷他定的主要副作用亦为困倦(18．2％)和口干(9．0％)。两组治疗前后的血、尿常规，肝、肾功能和心电图检查均无明显改变。结论：咪唑斯汀治疗季节性变应性鼻炎疗效好，不良反应发生率低，疗效和副作用与氯雷他定相似     

高渗盐水鼻腔冲洗治疗血管运动性鼻炎的初步研究

要：目的血管运动性鼻炎（vasomotor rhinitis, VMR）常表现为鼻塞和流涕,其发病机制尚不清楚,目前尚缺乏长期治疗VMR的有效方法。方法将患有VMR的49例患者随机分为两组：高渗盐水组25例,男14例,女11例;年龄19~66岁,平均年龄43.88岁;生理盐水组24例,男13例,女11例;年龄19～61岁,平均年龄为40.75岁。高渗盐水组以3%的盐水（温度为40℃）行鼻腔冲洗治疗,生理盐水组以生理盐水（温度为40℃）行鼻腔冲洗治疗,干预期为3个月,用视觉模拟量表（visual analog scale, VAS）评估患者鼻塞和流涕症状,用SF 12v2评估患者生活质量,该项研究还对两组患者干预前和干预3个月末时的鼻腔冲洗液（nasal lavage fluid, NLF）中黏蛋白（mucin, MUC）5B和P物质（substance P, SP）进行检测。结果43例VMR患者完成了研究,干预3个月末时,高渗盐水组患者鼻塞和流涕VAS评分均降低,SF 12v2评分升高,NLF中MUC5B降低,但SP含量与干预前相比差异无统计学意义（P>0.05）;生理盐水组患者干预前后鼻塞VAS评分、SF 12v2评分和NLF中SP比较,差异无统计学意义（P>0.05）,但流涕VAS评分和NLF中MUC5B含量却出现显著降低;高渗盐水组和生理盐水组之间相比,鼻塞VAS评分和SF 12v2评分间差异具有统计学意义（P<0.05）,流涕VAS评分、NLF中MUC5B和SP浓度无明显差异（P>0.05）。结论高渗盐水鼻腔冲洗是长期治疗VMR的有效手段。     

抗组胺药在变应性鼻炎中的作用机制及应用进展

变应性鼻炎(AR)是一种鼻黏膜的慢性非感染性炎症,主要是由机体接触致敏变应原后诱发的由特异性免疫球蛋白E(IgE)介导的、多种炎性细胞(如肥大细胞、嗜碱性粒细胞等)参与的鼻黏膜的高敏反应.组胺在AR发病中发挥重要作用,是引起鼻痒、喷嚏、流涕等临床症状的核心介质.抗组胺药物通常通过拮抗组胺相关受体来阻断组胺与受体结合,从...     

变应性鼻炎的药物治疗策略

变应性鼻炎(allergic rhinitis,AR)是耳鼻咽喉科常见的疾病,也是重要的变态反应性疾病之一.全球AR患者超过5亿,我国大陆地区AR的患病率为4％～38％[1].AR在给患者生活质量造成严重影响的同时,亦给社会带来沉重的经济负担[2].     

婴幼儿鼻腔错构瘤的诊断及鼻内镜手术治疗

目的探讨婴幼儿鼻腔错构瘤的临床特点及诊疗措施。方法回顾性分析诊治的5例婴幼儿鼻腔错构瘤患者,分析其临床症状、局部体征、影像学表现及病理组织学特点,探讨其诊断、鉴别诊断及治疗策略。结果5例患儿均表现为单侧鼻腔阻塞,伴有不同程度的吃奶时呛咳、夜眠时打鼾憋气等现象。1例肿块在2个月内呈渐进性生长,4例肿块在病程中无明显增大。5例中有1例伴有同侧后鼻孔狭窄。影像学清晰显示鼻腔占位情况,2例位于单侧鼻腔、筛窦,3例累及单侧鼻腔、筛窦及鼻咽部;颅底骨质缺损3例,同侧眶壁骨质破坏2例;3例肿块内见斑点状、条状高密度钙化影,伴周围骨壁膨胀性改变;5例均有鼻中隔明显受压向对侧偏移。5例均采用鼻内镜下手术切除,4例完全切除,1例分3次切除,术后病理及免疫组化均提示鼻软骨间叶性错构瘤,随访至今均未复发。结论婴幼儿鼻腔错构瘤是一种非常罕见呈局限生长的瘤样增生,常以鼻塞为主要症状就诊。治疗以手术切除为主,鼻内镜手术一般可以完全切除大多数病变,并且具有视野清楚、创伤小、并发症少、术后恢复快等优点。     

款冬Ze339治疗间歇性过敏性鼻炎的研究

款冬为原产于欧洲、北美和西南亚的菊科蜂斗菜属草本植物，其根和叶子含有一种具有药用价值混合物。款冬Ze339是从款冬植物叶子中提取出的一种特殊物质，主要成分为蜂斗精，在先前的研究中，我们已经证实款冬Ze339在治疗季节性过敏性鼻炎的效果优于抗组胺药，特别在鼻塞症状的改善方面。而且一些抗组胺药有镇静、嗜睡等不良反应。     

变应性鼻炎的外科手术治疗专家共识（2022，上海）

变应性鼻炎（AR）是一种变应原致敏和激发引起的、有神经介质参与的特异性IgE介导的、Th2类型鼻黏膜慢性炎症。AR的外科手术作为二线治疗手段,能够有效改善顽固性鼻塞和鼻黏膜高分泌及高敏感性反应,临床上推荐酌情使用。但目前AR的外科手术还存在一些争议性问题,诸如适应证的选择、并发症规避及疗效评价等。有鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,基于临床经验和循证医学证据制订了AR的外科手术治疗专家共识。本共识从AR手术治疗历史、相关解剖与生理病理学原理等角度出发,系统总结了AR手术治疗中的相关机制、手术方式与适应证选择,以及并发症处理与注意事项等,旨在指导并规范临床医师开展AR外科手术治疗,以期进一步拓展AR的治疗方式并提高相应的治疗疗效。     

鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识(2022，北京)

鼻用减充血剂可以快速缓解鼻塞,但长期过量使用可导致药物性鼻炎。目前临床上对鼻用减充血剂的使用和药物性鼻炎的治疗还存在很多误区。鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,基于临床经验和循证医学证据制订了鼻用减充血剂的临床应用暨药物性鼻炎的诊治专家共识。本共识系统总结了临床应用鼻用减充血剂治疗鼻塞的注意事项及药物性鼻炎的治疗原则,旨在指导并规范临床应用鼻用减充血剂,并正确有效地治疗药物性鼻炎。     

治疗变应性鼻炎对小气道功能的影响

目的　针对伴有小气道功能异常的变应性鼻炎患者,给予正规鼻用糖皮质激素治疗,观察其对小气道功能的影响。方法　筛选具有小气道功能异常的变应性鼻炎患者,给予鼻用糖皮质激素喷鼻治疗12周。治疗前予鼻部症状视觉模拟量表评分及鼻结膜炎相关生活质量问卷评分、肺通气功能检查;治疗后4、8、12周再次评估鼻部症状评分,4、12周时复查肺功能指标,观察肺功能的变化。结果　经过12周治疗,患者主观症状均有显著改善（P <0.01）,肺功能指标：第1秒用力呼气容积占预计值百分比（FEV1pred%）、第1秒用力呼气容积占肺活量比值（FEV1/FVC%）、最大呼气中段流量占预计值百分比（MMEFpred%）、用力呼出75%肺活量的呼气流量占预计值百分比（MEF75pred%）、用力呼出50%肺活量的呼气流量占预计值百分比（MEF50pred%）、用力呼出25%肺活量的呼气流量占预计值百分比（MEF25pred%）均较 治疗前明显提高（P <0.05）,其中代表小气道功能的指标MMEFpred%、MEF75pred%、MEF50pred%的改善具有统计学非常显著性差异（P <0.01）。结论　鼻用糖皮质激素治疗小气道损伤的变应性鼻炎患者可以明显改善其小气道功能,这对于预防变应性鼻炎发展为哮喘具有积极的意义。     

局部糖皮质激素对慢性鼻炎患者鼻腔菌群及pH值的影响

目的观察糖皮质激素鼻喷剂对慢性单纯性和慢性肥厚性鼻炎患者鼻腔菌群(需氧菌及真菌)及酸碱度的影响。同时评价其临床疗效。方法对42例慢性单纯性和慢性肥厚性鼻炎患者单纯接受局部糖皮质激素鼻喷剂(布地奈德,BUDESONIDE,商品名:雷诺考特)治疗8周(256ΜG/D),检测其治疗前后鼻腔菌群(需氧菌及真菌)分布情况、PH值及症状体征分级记分。结果①鼻炎组42例标本中,治疗前细菌检出率为88%,共检出需氧菌53株,分别归7属9种;治疗后检出率为90·47%,检出需氧菌46株,分别归8属10种;需氧菌群总体分布结果和同种细菌配对样本的统计结果显示,治疗前后差异无统计学意义(Χ2=0·416,P>0·05);②治疗前后的真菌培养均为阴性;③鼻炎组治疗后鼻腔黏液PH值(X-±S)为7·70±0·23,与治疗前的7·90±0·39相比,明显下降(T=2·72,P<0·05);④症状评分中治疗后与治疗前相比较差异均有统计学意义,而体征评分治疗前后对比则无明显变化。结论糖皮质激素鼻喷剂局部应用8周是比较安全的,一般不会引起鼻腔需氧菌群的改变和真菌生长,可以部分纠正慢性单纯性和慢性肥厚性鼻炎患者鼻腔黏液PH值,改善患者的临床症状。     

变应性鼻炎联合用药及鼻用激素维持治疗的疗效

目的评估变应性鼻炎（AR）患者联合用药、单独鼻用激素维持治疗的疗效及生活质量。方法 24例中重度持续性AR患者,使用布地奈德鼻喷雾剂和口服氯雷他定1周治疗。18例显效患者随机分为布地奈德维持用药实验组（11例）和停止用药对照组（7例）。通过临床症状、视觉模拟评分（visual analogue scale,VAS）及鼻结膜炎相关生活质量问卷（rhinoconjunctivitis quality of Life questionnaire,RQLQ）进行评估。结果联合用药1周,临床症状及生活质量均得到显著性改善（P〈0.01）,治疗总有效率为91.7%（22/24）。在维持治疗1个月后,实验组与对照组症状评分较联合治疗结束时显著性升高（P〈0.01）;VAS及RQLQ评分亦升高,但差异无显著性。结论对中重度持续性AR联合用药可有效控制症状,症状控制后鼻用激素维持治疗可改善生活质量。     

Nasal carriage of Staphylococcus aureus in children with allergic rhinitis and the effect of intranasal fluticasone propionate treatment on carriage status

OBJECTIVE: The aim of this study is to determine the rate of nasal carriage of Staphylococcus aureus (NCSA) in children with allergic rhinitis (AR) and to determine the effect of intranasal fluticasone propionate spray on the NCSA. PATIENTS AND METHODS: Nasal swabs were taken from the children admitted to general pediatrics and pediatric pulmonology clinics. Patients were divided into two groups according to the presence or absence of AR. Diagnosis of AR was based on the patient's symptoms. Nasal swabs were taken from AR patients before and after the treatment with intranasal fluticasone propionate, and from the control group at the beginning and after 2 months. RESULTS: Whole NCSA rate was 17.9%; it was 21.4% for AR patients and 15.9% for control group, respectively (p>0.05). Treatment with intranasal fluticasone propionate spray did not influence NCSA in AR patients. CONCLUSION: It seemed that NCSA was not increased in children with AR and treatment with intranasal fluticasone propionate spray did not change NCSA in AR patients. It is obvious that better understanding of the factors affecting the acquisition and loss of NCSA might increase our knowledge about the relationship between NCSA, allergic airway diseases and their treatments.     

白介素12基因治疗对变应性鼻炎小鼠嗜酸粒细胞及白介素5的影响

目的 探讨经鼻局部给予脂质体包裹的白细胞介素(interleukin,IL)12基因治疗对变应性鼻炎(allergic rhinitis,AR)小鼠模型鼻黏膜、外周血和骨髓中嗜酸粒细胞(eosinophils,EOS)的调节作用及相关因子IL-5的影响.方法 采用6～8周雄性BALB/C小鼠,随机分成AR组、基因治疗组和健康对照组,每组12只.卵清蛋白(ovalbumin,OVA)致敏激发建立AR模型,治疗组激发前经鼻给予脂质体包裹的pGEG.m IL-12,对照组用生理盐水代替.三组分别用HE染色计数鼻黏膜中EOS的数量,用瑞氏染色计数骨髓涂片中EOS数,以流式细胞仪检测外周血中的EOS数;免疫组化染色检测鼻黏膜和骨髓中IL-5的表达,以ELISA方法检测血清中的IL-5含量.采用单因素方差分析进行统计学处理.结果 三组小鼠中,各检测指标在各组之间的差异均有统计学意义(P值均<0.01).两两比较发现,基因治疗组鼻黏膜EOS数为(4.6±2.6)个/高倍镜视野,低于AR组的(26.5±9.8)个/高倍镜视野,差异有统计学意义(P<0.05);IL-5阳性细胞数[(3.0±1.3)个/高倍镜视野]也低于AR组[(17.6±6.4)个/高倍镜视野],差异有统计学意义(P<0.05);骨髓涂片中EOS(0.040±0.029)低于AR组(0.086±0.014),差异有统计学意义(P<0.05),IL-5阳性细胞数(0.035±0.012)也低于AR组(0.083±0.025),差异有统计学意义(P<0.05).基因治疗组外周血中EOS(0.124±0.031)低于AR组(0.184±0.079),差异有统计学意义(P<0.05),IL-5[(29.51±6.68)pg/ml]也低于AR组[(56.58±16.80)pg/ml],差异有统计学意义(P<0.05).结论 经鼻局部给予脂质体包裹的pGEG.m IL-12能够通过降低骨髓、外周血和鼻黏膜中IL-5的表达,进而减少骨髓、外周血和鼻黏膜中EOS的数量,IL-12基因治疗可能为呼吸道变应性炎症开辟一种新的治疗途径.     

A community based questionnaire study on the association between symptoms suggestive of otitis media with effusion, rhinitis and asthma in primary school children

OBJECTIVES: To evaluate the association between symptoms suggestive of otitis media with effusion (OME), rhinitis and asthma in an unselected population of primary school children and investigate whether our previous observation of such an association in a secondary care setting was valid in the community. METHODOLOGY: A specifically designed questionnaire was administered to 332 new entrant primary school children across 11 state and independent primary schools in the East Berkshire district between March and June 1996. It had six sections, to ascertain symptoms suggestive of OME, rhinitis, asthma, other atopic features, treatment for any of these, and a possible family history of atopy. Within the first three sections, each question was scored and weighted depending on the importance of each in establishing the possible diagnoses, with three scoring bands: '0' indicating the absence; '1-5' the possibility and '> or =6' a strong likelihood that the above conditions were present. The outcome measures were the number of children with or without symptoms suggestive of OME, rhinitis, asthma, and the correlation of these symptom scores with each other and OME with eczema, other atopic manifestations, family history of atopy and educational system. RESULTS: Thirty two point eight percent, thirty six point six percent and twenty four percent had symptoms suggestive of OME, rhinitis and asthma, respectively with scores of either 1-5 or > or =6. There was a highly significant correlation between otological (OME) and nasal scores (p=0.00000), particularly obstructive nasal symptoms (p=0.00000) and > or =6 upper respiratory tract infections/year (p=0.00000); otological and chest scores suggestive of asthma (p=0.00001), and a family history of asthma (p=0.00178). No association was found between scores for OME and eczema, urticaria, food or drug allergies. No differences were noted between the sexes or educational systems. CONCLUSION: The highly significant association between the symptom scores suggestive of OME and rhinitis in this unselected population, indicates the importance of enquiring about nasal symptoms in children with chronic OME, as appropriate treatment of rhinitis may improve the child's quality of life, reduce health care utilisation and possibly reduce the need for OME surgery.     

A comparison of the effects of an alpha-agonist,an anti-muscarinic agent and placebo on intranasal histamine challenge in allergic rhinitis

Autonomic receptors play a part in the physiology and pathology of the nasal mucosa. The effect of an α-agonist and an anti-muscarinic agent on histamine-challenge was examined on patients with perennial allergic rhinitis. Nine patients received saline, oxitropium bromide 0.075%, or xylometazoline hydrochloride 0.1 % in a double-blind fashion. Sequential challenge with increasing doses of histamine were given and resistance changes, sneezes and volume and content of secretion measured. Histamine challenge produced dose-related increases in nasal resistance (P < 0.0001), lavage fluid volume (P < 0.01) and total protein (P < 0.01). Following xylometazoline, histamine produced little increase in resistance compared with saline and oxitropium bromide (P < 0.0001). The latter reduced the dose-related increase in resistance (P < 0.01) and nasal lavage fluid volume (P= 0.0007) and total protein (P= 0.023) seen with saline. These results confirm the importance of α-adrenergic and muscarinic receptors in the human nasal mucosa and suggest mechanisms of action for these drugs in perennial allergic rhinitis.