大环内酯类药物治疗慢性鼻-鼻窦炎的疗效观察

目的　探讨大环内酯类药物治疗慢性鼻-鼻窦炎不伴鼻息肉（chronic rhinosinusitis without nasal polyp，CRSsNP）的临床疗效。方法　对82例成人CRSsNP患者按照鼻窦CT评分严重情况随机分成治疗组和对照组两组，每组各41例。治疗组给予布地奈德喷鼻，2次/d，克拉霉素250 mg口服，1次/d，连续3个月；对照组予布地奈德喷鼻，2次/d。所有患者均每1个月进行1次肝肾功能评估，观察比较两组用药前、后主观客观指标的变化（视觉模拟量表评分，鼻内镜检查Lund-Kennedy评分，鼻窦CT扫描评分）。结果　治疗组所有患者视觉模拟量表评分、鼻内镜检查Lund-Kennedy评分及鼻窦CT扫描评分均明显下降（t =23.79、31.69、26.06，P 均<0.05），与对照组比较（t =10.42、13.28、10.17，P 均<0.05）差异有统计学意义。结论　大环内酯类药物能有效控制CRSsNP的症状，特别对于激素治疗不敏感的患者，不适于手术的患者更是一种有效的治疗手段。

Observation of the effect of Macrolide on patients with chronic rhinosinusitis without nasal polyps

OBJECTIVE To discuss the clinical effect of macrolide on chronic rhinosinusitis without nasal polyps（CRSsNP）.METHODS 82 adult patients with CRSsNP were randomly divided into the treatment group and the control group according to their CT score.There was 41 cases in each group.The patients in the treatment group were given budesonide nasal spray,twice a day,and orally clarithromycin,250 mg once daily.The treatment lasted for 3 consecutive months.And patients in the control group was treated only with budesonide nasal spray,twice a day.The liver and kidney function of all patients were evaluated every month.Changes of subjective and objective indexes（Visual Analogue Score,Nasal endoscopy LundKennedy score,Paranasal sinus CT scanning score）before and after treatment were compared between the two groups.RESULTS The clinical study showed that the VAS score,nasal endoscopy and sinus CT scan score of the treatment group were significantly decreased（t=23.19,31.69,26.06,P 0.05）,compared with the control group,and the difference was statistically significant（t=10.42,13.28,10.17,P 0.05）.CONCLUSION Macrolide could effectively control symptoms of CRSsNP.It is an effective treatment especially for patients who are not sensitive to hormone therapy,or not suitable for surgery.