两性霉素B冲洗对难治性鼻窦炎鼻内镜术后嗜酸性粒细胞、上皮化时间的影响

目的 研究两性霉素B冲洗方法对难治性鼻窦炎 (difficult-to-treat rhinosinusitis, DTRS) 患者鼻内镜术后嗜酸性粒细胞 (Eosinophils, Eos) 及上皮化时间产生的影响。方法 根据随机数字表法将2016年1月至2017年1月锦州市中心医院耳鼻咽喉头颈外科收治的86例接受鼻内镜手术治疗的DTRS病例分为2组, 各43例, 对照组术后予以常规治疗, 研究组术后在常规治疗基础上使用两性霉素B冲洗, 比较2组各时间段T淋巴细胞亚群 (CD3+、CD4+、CD8+及CD4+/CD8+) 、Eos计数、炎性因子白细胞介素2 (IL-2) 、白细胞介素4 (IL-4) 、白细胞介素5 (IL-5) 、血清干扰素γ (IFN-γ) ]、上皮化时间、术后复发率、肿痛程度及疗效。结果 研究组术后疗效总有效率为95.35%, 显著高于对照组81.40% (P<0.05) ;研究组术后1月CD3+、CD4+、CD8+与CD4+/CD8+值显著高于对照组 (P<0.05) , Eos计数、IL-2、IL-4、IL-5、IFN-γ水平显著低于对照组 (P<0.05) ;研究组术后7 d VAS评分、重度肿胀率明显低于对照组 (P<0.05) ;研究组上皮化时间明显短于对照组 (P<0.05) , 复发率明显低于对照组 (P<0.05) 。结论 在难治性鼻窦炎鼻内镜术后应用两性霉素B冲洗, 可有效增强机体免疫功能, 改善炎症, 缓解肿痛程度, 减少Eos, 缩短上皮化时间, 降低术后复发率。

Effect of Amphotericin B Irrigation on Eosinophils and Epithelization Time in Patients with Refractory Rhinosinusitis after Nasal Endoscopic Surgery

Objective To study the effects of amphotericin B irrigation on eosinophils (Eos) and epithelization time in patients with refractory rhinosinusitis after nasal endoscopic surgery. Methods The random number table method was performed to divided the 86 patients with refractory rhinosinusitis undergoing nasal endoscopic surgery in Otolaryngology&Head and Neck Surgery, Jinzhou Central Hospital, into two groups, 43 cases in each group. The control group was given routine treatment after surgery, while the study group was treated with amphotericin B irrigation on the basis of routine treatment. The T lymphocyte subsets (CD3+, CD4+, CD8+and CD4+/CD8+) , Eos count, inflammatory factors interleukin 2 (IL-2) , interleukin 4 (IL-4) , interleukin5 (IL-5) , serum interferon γ (IFN-γ) ], epithelization time, postoperative recurrence rate, swelling degree and curative effect were compared between the two groups. Results The total response rate of postoperative curative effect in the study group was significantly higher than that in the control group (95.35% vs 81.40%) (P <0.05) . At 1 month after surgery, CD3+, CD4+, CD8+and CD4+/CD8+in the study group were significantly higher than those in the control group (P < 0.05) , while Eos count, levels of IL-2, IL-4, IL-5 and IFN-γ were significant lower than those in the control group (P < 0.05) . At 7 days after surgery, the VAS score and severe swelling rate in the study group were significantly lower than those in the control group (P < 0.05) . The epithelization time was shorter than that in the control group (P < 0.05) . The recurrence rate in the study group was significantly lower than that in the control group (P < 0.05) . Conclusion The application of amphotericin B irrigation in patients with refractory rhinosinusitis after nasal endoscopic surgery can effectively enhance the immune function, improve inflammation, relieve degree of swelling and pain, reduce Eos, shorten the epithelization time, and reduce the postoperative recurrence rate.