鼻用糖皮质激素治疗慢性鼻窦炎的鼻窦CT观察

目的采用影像学方法评价鼻用糖皮质激素治疗慢性鼻窦炎（不合并鼻息肉）的疗效。方法慢性鼻窦炎患者24例（42侧），其中青少年患者11例（20侧），平均（x^-±s，下同）年龄（11．8±3．2）岁；成年患者13例（22侧），平均（36．7±11．0）岁。患者接受鼻用糖皮质激素（布地奈德鼻喷雾剂）治疗，成年和青少年患者的药物剂量分别为256μg／d和128μg／d，平均疗程分别为（7．5±3．2）周和（7．0±3．4）周。采用Lund-Mackay评分方法，在治疗前后分别对患者鼻窦CT进行评分（Lund得分），同时记录患者主诉鼻部症状改善情况。结果①治疗后，成年患者的平均Lund得分为6．5±7．5，显著低于治疗前（12．2±5．7，t=3．82，P〈0．01）；青少年患者的平均Lund得分治疗后为2．6±3．7，显著低于治疗前（10．3±5．7，t=5．08，P〈0．01）。成年患者中5例（38％）达到影像学治愈标准，好转7例（54％），无效1例（8％）；青少年患者中8例（73％）达到影像学治愈标准，好转3例（27％），两组疗效差异无统计学意义（P〉0．05）。②鼻用糖皮质激素对成年慢性前组筛窦炎治愈率最高（47％），对慢性后组筛窦炎治愈率最低（38％）；药物对青少年慢性前、后组筛窦炎和慢性蝶窦炎的疗效优于成年患者。③成年患者的主观疗效与治疗前Lund得分呈正相关关系（r=0．676．P〈0．05），即治疗前Lund得分越高，主观疗效越差。青少年患者的主观疗效，与治疗前Lund得分无相关关系（P〉0．05）。结论鼻用糖皮质激素可有效治疗慢性鼻窦炎，部分患者可以达到影像学上的治愈标准。

CT evolution of nasal steroid management of chronic rhinosinusitis

OBJECTIVE: To evaluate the efficacy of topical steroid treatment of nonpolypoid chronic sinusitis. METHODS: Two cohorts of adult and children with nonpolypoid chronic sinusitis were investigated. The first cohort consisted of 11 pediatric patients [mean age, (11.8 +/- 3.2) years] with a mean Lund score of 10.3 +/- 5.7 (x +/- s). The second cohort consisted of 13 adult patients [mean age, (36.7 +/- 11.0) years] with a mean Lund score of 12.2 +/- 5.7. The mean duration of the nasal budesonide (Rhinocort) treatment was (7.5 +/- 3.2) weeks for adult patients (256 microg/d) and (7.0 +/- 3.4) weeks for pediatric patients (128 microg/d). Each Lund score and the patient's assessment of nasal symptoms were evaluated after treatment. RESULTS: The average Lund score was significantly decreased to 6.5 -/+ 7.5 (t = 3.82, P < 0.01) in adult patients and to 2.6 +/- 3.7 (t = 5.08, P < 0.01) in pediatric patients after treatment. Thirty-eight percent of the adult patients and 73% of the pediatric patients were cured on CT images. The patient's self-assessment of efficacy was positively correlated with pretreatment Lund score in adult patients (r = 0.676, P < 0.05), but not so in pediatric patients. CONCLUSIONS: These findings demonstrate that most of patients with nonpolypoid chronic sinus did well with topical steroid treatment. Therefore, surgery was required in few patients.