短期布地奈德混悬液经鼻雾化治疗慢性鼻窦炎伴鼻息肉的疗效和安全性研究

目的:评价布地奈德混悬液短疗程经鼻雾化吸入治疗鼻息肉的疗效和安全性。方法:将30例嗜酸粒细胞性慢性鼻窦炎伴鼻息肉患者随机分为雾化吸入组(n=15)和喷鼻对照组(n=15)。雾化吸入组接受吸入用布地奈德混悬液1mg/2ml经鼻雾化吸入,每日2次;喷鼻对照组使用布地奈德鼻喷剂256μg喷鼻,每日2次,疗程为1周。治疗前后评价鼻塞、流涕、嗅觉损失、头/面痛4个症状的视觉模拟评分,内镜Kennedy评分和晨起血清皮质醇测定。结果:经过1周治疗,雾化吸入组的4个鼻部症状评分均明显减少,其中以鼻塞的改善最为明显(用药前:8.4±0.7,用药后:4.0±0.8,P<0.01);内镜下息肉评分亦有明显减少(用药前:4.9±0.7,用药后:4.1±0.4,P<0.01);雾化吸入组鼻部症状评分和息肉评分均低于喷鼻对照组。雾化吸入组的晨起血清皮质醇浓度在治疗后降低[用药前:(17.6±2.4)μg/dl,用药后:(14.8±2.6)μg/dl,P<0.01],均在正常值范围内(5～25μg/dl)。结论:短疗程使用布地奈德混悬液经鼻雾化吸入治疗鼻息肉,可迅速改善鼻部症状、减小息肉体积,且对肾上腺皮质功能无明显影响。可作为嗜酸粒细胞性慢性鼻窦炎伴鼻息肉患者内镜术前的治疗手段。

The efficacy and safety of a short course of budesonide inhalation suspension via transnasal nebulization in chronic rhinosinusitis with nasal polyps

Objective:To evaluate the efficacy and safety of a short course of nebulized budesonide via transnasal inhalation in chronic rhinosinusitis with nasal polyps.Method:Thirty patients with severe eosinophilic nasal polyps were randomized into experimental group(n=15) and control group(n=15).The experimental group received nebulised budesonide suspension(1 mg twice daily) via transnasal inhalation for one week and control groupreceived budesonide nasal spray(256 μg twice daily).Visual analogue scales(VAS)of nasal symptoms(including nasal obstruction,nasal discharge,loss of smell,and headache/facial pain) and endoscopic polyp scores(Kennedy scores) and morning serum cortisol concentration were performed to both groups before and after the treatment.Result:Nebulized budesonide inhalation caused a significant improvement in all nasal symptoms especially nasalobstruction(baseline: 8.4±0.7;after treatment: 4.0±0.8,P<0.01) and reduced polyp size compared with before treatment.Additionally,the patients treated with nebulized budesonide showed more obvious improvement in nasal symptoms and polyp size than control group.The morning serum cortisol concentration was mild decreased after one week treatment in nebulized steroid group [baseline:(17.6±2.4)μg/dl,after treatment:(14.8±2.6)μg/dl,P<0.01],but all values still were located in normal range(normal range: 5-25 μg/dl).Conclusion:A short course of nebulized budesonide transnasal inhalation can rapidly improve nasal symptoms,reduce polyp size,and does not cause obvious HPA axis suppression.Based on these,it is recommend that transnasal inhalation with nebulized budesonide suspension should be performed as a pre-operative routine in patients with nasal polyp.