大环内酯类药物治疗慢性鼻-鼻窦炎的临床观察  

Clinical Observation of Macrolide Therapy in the Treatment of Chronic Rhinosinusitis

作　　者：周浩[1] 陈兵[1] 

机构地区：[1]宜宾市第二人民医院耳鼻咽喉科,四川宜宾644000

出　　处：《华西医学》2013年第1期48-51,共4页West China Medical Journal

摘　　要：目的观察小剂量服用大环内酯类药物治疗慢性鼻-鼻窦炎(CRS)的临床效果。方法选择2009年7月-2011年12月诊断为CRS的患者56例,其中不伴息肉36例,伴有鼻息肉20例,诊断标准采用《慢性鼻-鼻窦炎诊断和治疗指南(2008年南昌)》。治疗方案采用克拉霉素250 mg/d,连续至少口服12周,治疗前、治疗结束时与结束后3个月采用症状视觉模拟量表(VAS)、内镜黏膜形态评估(Lund-Kennedy评分法)和Lund-Mackey鼻窦CT评分对临床疗效进行主客观综合评价。结果治疗后不伴鼻息肉的CRS患者VAS评分、Lund-Kennedy评分、Lund-Mackay鼻窦CT评分分别为(2.56±1.09)、(2.08±1.03)、(2.43±1.81)分,均显著低于治疗前(7.63±2.16)、(6.10±1.98)、(6.86±2.32)分(P值均<0.01)。停药后3个月未发现鼻窦炎复发。伴有鼻息肉的CRS患者治疗后VAS评分为(4.13±1.86)分,低于治疗前的(8.22±2.67)分(P<0.05),而Lund-Kennedy评分、Lund-Mackay CT评分治疗后与治疗前比较,差异无统计学意义[(8.56±2.54)、6.88±2.38)分,P>0.05(;14.28±3.43)、(13.46±3.82)分,P>0.05]。56例患者均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周)使用大环内酯类药物治疗不伴鼻息肉的CRS临床疗效显著、稳定;而单独用于治疗伴有鼻息肉的CRS疗效不明显。大环内酯类药物临床安全性和患者耐受性较好。Objective To examine the clinical effect of low-dose macrolide on the treatment of chronic rhinosinusitis（CRS）.Methods Fifty-six patients diagnosed to have CRS between July 2009 and December 2011 were recruited.Among these patients,20 were accompanied with polyps,while the other 36 were not.The diagnosis criteria was Diagnosis and Therapy Guideline for CRP（Nanchang,2008）.All patients were given Klacid at 250 mg/d orally for at least 12 weeks.The clinical efficacy was subjectively and objectively evaluated with visual analogue scale（VAS）,nasal endoscopy by Lund-Kennedy scoring system,and Lund-Mackay CT scoring system before treatment,at the end of treatment,and three months after the treatment.Results For CRS patients without polyps,the VAS score,Lund-Kennedy score and Lund-Mackay CT score at the end of treatment were 2.56±1.09,2.08±1.03,and 2.43 ± 1.81,respectively,which were all significantly lower than those before treatment： 7.63 ± 2.16（P0.01）,6.10 ± 1.98（P0.01）,and 6.86 ± 2.32（P0.01）.During the three months after treatment,no recurrent sinusitis happened.For CRS patients with polyps,the VAS score at the end of treatment was 4.13 ± 1.86,significantly lower than that before treatment： 8.22 ± 2.67（P0.05）.However,Lund-Kennedy score and Lund-Mackay CT score in these patients were not significantly different from those before treatment（8.56 ± 2.54 and 6.88 ± 2.38,P0.05;14.28 ± 3.43 and 13.46 ± 3.82,P0.05）.No side effect occurred in any patients.Kidney function of all patients were not influenced either.Conclusions It is effective to treat CRS patients without polyps by a low-dose（250 mg/d）,long-term（12 weeks） Klacid.However,simple Klacid therapy on CRP patients with polyps is unsatisfied.Klacid is well tolerated and safe to CRS patients.

关 键 词：大环内酯类 鼻窦炎 鼻息肉 药物治疗 

分 类 号：R765[医药卫生—耳鼻咽喉科]