鼻用糖皮质激素治疗慢性鼻窦炎的鼻窦CT观察  

CT evolution of nasal steroid management of chronic rhinosinusitis

作　　者：张罗[1] 王成硕[1] 韩德民[2] 周兵[1] 王向东[1] 葛文彤[1] 李银川[1] 王彤[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京市耳鼻咽喉科研究所100730 [2]北京市耳鼻咽喉科研究所

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第9期673-678,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：科技部"十五"国家科技攻关计划课题资助(2004BA720A19-01)

摘　　要：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(±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,f=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。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 μg/d）and （7.0 ±3.4 ） weeks for pediatric patients （128 μg/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.

关 键 词：鼻窦炎 糖皮质激素类 体层摄影术 X线计算机 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]