细菌溶解产物治疗慢性鼻窦炎的疗效分析  

Efficacy analysis of bacterial lysates in the treatment of chronic rhinosinusitis

作　　者：李欣[1] 何健[1,2] 李聪[1] 张玥钰 刘雪峰 吕芸 LI Xin;HE Jian;LI Cong;ZHANG Yueyu;LIU Xuefeng;LYU Yun(the First Clinical College of Medicine,Gansu University of Chinese Medicine,Lanzhou,Gansu,730000,China;Department of Otolaryngology Head and Neck Surgery,Gansu Provincial People's Hospital,Lanzhou,Gansu,730030,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]甘肃省人民医院耳鼻咽喉头颈外科,甘肃兰州730030

出　　处：《中国耳鼻咽喉头颈外科》2024年第11期722-726,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：甘肃省人民医院科技计划项目(20JR10RA391)。

摘　　要：目的观察手术患者应用细菌溶解产物(bacterial lysates,BLs)联合鼻用激素治疗慢性鼻窦炎(CRS)的疗效。方法收集甘肃省人民医院耳鼻咽喉头颈外科诊断为慢性鼻窦炎伴鼻息肉(CRSwNP)和慢性鼻窦炎不伴鼻息肉(CRSsNP)病例,分为四组,CRSwNP应用BLs组、CRSwNP对照组、CRSsNP应用BLs组和CRSsNP对照组。所有患者均接受手术治疗,对照组术后采用鼻用激素治疗,BLs组术后给予鼻用激素+BLs口服治疗。应用视觉模拟量表(VAS)、鼻腔鼻窦结局测试-20(SNOT-20)、Lund-Kennedy评分、Lund-Mackay评分、嗜酸细胞(Eos)、IL-4、IgG、IgA、IgM和总IgE水平对四组患者术前、术后1个月、术后3个月进行评估。结果CRSwNP应用BLs组和CRSsNP应用BLs组间IgG、IgA、IL-4、Eos水平比较,差异有统计学意义(P<0.05);治疗后1个月、3个月CRSwNP应用BLs组和CRSsNP应用BLs组间VAS及SNOT-20差异均有统计学意义(P<0.05);治疗后1个月、3个月CRSwNP应用BLs组和CRSsNP应用BLs组间Lund-Kennedy评分及Lund-Mackey评分差异均有统计学意义(P<0.05)。四组患者治疗后疾病控制有效率均具有统计学意义(P<0.05)。无与治疗直接相关严重并发症。结论应用BLs对CRS患者术后鼻漏、持续性炎症反应、黏膜恢复情况均有改善,可提高机体IgG、IgA水平,降低Eos及IL-4水平,不良反应少,安全性高,可提高CRS的治疗效果。OBJECTIVE To observe the curative effect of bacterial lysates(BLs)combined with intranasal corticosteroids(INCS)in the treatment of chronic rhinosinusitis(CRS).METHODS Cases diagnosed as CRS with nasal polyps(CRSwNP)and CRS without nasal polyps(CRSsNP)were collected and divided into four groups:CRSwNP with BLs group,CRSwNP control group,CRSsNP with BLS group and CRSsNP control group.All patients received surgical treatment,the control group received postoperative INCS therapy,and the BLs group received postoperative INCS+BLs oral therapy.Visual analogue scale(VAS),sino-nasal outcome test-20(SNOT-20),Lund-Kennedy score,Lund-Mackay score,eosinophilic(Eos)cell,IL-4,IgG,IgA,IgM and total IgE levels were evaluated before,1 month and 3 months after surgery.RESULTS Significant differences in IgG,IgA,IL-4 and Eos levels between CRSwNP and CRSsNP with BLs groups(P<0.05).There were significant differences in VAS and SNOT-20 between CRSwNP group and CRSsNP with BLs group at 1 and 3 months after treatment(P<0.05).At 1 month and 3 months after treatment,there were statistically significant differences in Lund-Kennedy score and Lund-Mackey score between the CRSwNP group and the CRSsNP with BLs group(P<0.05).The effective rate of disease control in the four groups after treatment was statistically significant(P<0.05).There were no serious complications directly related to the treatment.CONCLUSION The application of BLs can improve postoperative rhinorrhea,persistent inflammatory and mucosal recovery in patients with CRS,increase IgG and IgA levels,reduce Eos and IL-4 levels,reduce adverse reactions,and improve the therapeutic effect of CRS with high safety.

关 键 词：鼻窦炎 鼻息肉 慢性鼻窦炎伴鼻息肉 慢性鼻窦炎不伴鼻息肉 细菌溶解产物 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]