短期、高剂量克拉霉素治疗过敏性慢性鼻窦炎的疗效及对IL-5、IL-8表达的抑制作用

目的:观察短期、高剂量克拉霉素治疗过敏性慢性鼻窦炎(CRS)的疗效及对IL-5、IL-8表达的抑制作用。方法:对23例合并过敏的、不伴鼻息肉的CRS患者采用短期、高剂量克拉霉素强化治疗(500 mg/d,2次/d,为期1周;然后250 mg/d,2次/d,为期1周),比较治疗前后单项鼻部症状(鼻塞、流涕、鼻涕后漏和嗅觉障碍)和总体症状评分(VAS评分)、鼻内镜评分(Lund-Kennedy评分)的变化情况及鼻腔分泌物中IL-5和IL-8的浓度改变。结果:短期、高剂量克拉霉素强化治疗后2周,CRS患者单项鼻部症状(鼻塞、流涕、鼻涕后漏和嗅觉障碍)和总体症状评分以及鼻内镜评分均出现减少,相应的鼻分泌物中IL-5和IL-8浓度降低,差异有统计学意义(P<0.05)。结论:短期、高剂量克拉霉素强化对过敏性CRS有显著的临床疗效,可能与高剂量克拉霉素抑制IL-5和IL-8的表达有关。

Clinical efficacy of short-term and high-dose clarithromycin in the treatment of patients with allergic chronic rhinosinusitis and effect on IL-5 and IL-8 production

Objective:To determine the clinical efficacy of short-term,high-dose clarithromycin in the treatment of patients with allergic chronic rhinosinusitis(CRS),and evaluate the effect on IL-5 and IL-8 production.Method:Twenty-three CRS patients with atopy were enrolled to accept the intensive treatment of clarithromycin(500 mg,twice daily for consecutive 7 days,followed by 250 mg,twice daily for consecutive 7 days).Individual nasal symptoms including nasal congestion,rhinorrhea,postnasal drip,loss of smell and total nasal symptom were scored by visual analogue scale(VAS) at different time-point(before treatment and 2 weeks after treatment,respectively).Similarly,Lund-Kennedy score under endoscopic inspection was recorded and IL-5 and IL-8 concentration in nasal secretions was tested,accordingly.Result:After treatment with high-dose clarithromycin for 2 weeks,individual nasal symptom scores and total nasal symptom score were significantly decreased compared with baseline values(P<0.05).Lund-Kennedy score and IL-5 and IL-8 concentration in nasal secretions were also significantly decreased compared with baseline values(P<0.05).Conclusion:Short-term and high-dose clarithromycin is effective to treat CRS patients with aptoy,which might be involved with inhibition of IL-5 and IL-8 production.