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。

Macrolide therapy on nasal mucosal persistent refractory inflammation after endoscopic sinus surgery

Objective To examine the clinical effect of low-dose (250 mg/d), long-term ( 12 -28 weeks) macrolide Klacid on the persistent refractory inflammation of paranasal sinus mucosa following endoscopic sinus surgery (ESS). Methods Thirteen patients from a consecutive series of 141 patients undergoing ESS for chronic rhinosinusitis ( CRS ) during 2004 - 2006 for the first time were recruited for persistent refractory inflammation over 2 years postoperatively. All patients were given Klacid 250 mg/d orally for 12 - 28 weeks and simultaneously maintained the usual treatment including intranasal corticosteroid, mucolytics, and nasal douche. At the end of treatment and the sequential 3 and 6 months,13 patients were evaluated by symptoms of visual analogue scale and nasal endoscopy by Lund-Kennedy scoring system, respectively. Results Among the 13 patients, 1 patient stopped therapy for no obvious benefit 5 months after treatment, 12 patients finished the planned treatment till achieving.the stopping therapy standard. Ultimately both symptom (8. O0 [ 7.50, 8.50]and 1.00 [ 0.25, 1. 00], Z = - 3.201, P ＜0.01) and endoscopic evaluation (7.00[6.50, 8.00]and 1.00[0.00, 1.00], Z= -3. 194, P＜O. 01 ) showed total remarkable improvement after therapy in 13 patients. The comprehensive assessment showed very good outcomes in 6 cases, good in 6 cases, and no good outcomes in 1 case, respectively.During the sequential 3 months and 6 months, no recurrent sinusitis and side effect happened in any patients. Conclusions It is effective to treat chronic refractory sinusitis with a low-dose (250 mg/d), long-term ( 12 -28 weeks) Klacid on nasal mucosal persistent refractory inflammation after ESS. Klacid is well tolerated and safe to CRS patients during the use of 12 -28 weeks.