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
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摘要
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。
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.
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.
引文
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[4]孙丽芳,付笑迎,杨方华,等.深圳地区493例儿童变应性鼻炎过敏原检测结果分析[J].分子诊断与治疗杂志,2017,9(3):181-185.
[5]陈仁物,王德云.欧洲鼻窦炎和鼻息肉诊疗意见书2012版:鼻窦炎诊治更新与精要[J].解放军医学杂志,2013,38(2):87-93.
[6]邓世明,刘铁陵,刘军,等.鼻内镜鼻窦开放术治疗真菌性鼻窦炎临床疗效观察[J].西部医学,2015,27(4):538-540.
[7]李昕蓉,刘洋,王盼盼,等.小青龙汤治疗肺气虚寒型变应性鼻炎的疗效分析[J].成都医学院学报,2015,10(6):696-699.
[8]李志,韩亮,尤权杰,等.外周血嗜酸粒细胞诊断嗜酸粒细胞性慢性鼻-鼻窦炎的分析评价[J].中华耳鼻咽喉头颈外科杂志,2016,51(7):528-532.
[9]罗嘉龙,赵晓明,汪志伟.血清嗜酸性粒细胞阳离子蛋白与变应性鼻炎及气道高反应疾病相关性研究进展[J].中国眼耳鼻喉科杂志,2015,15(4):298-300.
[10]杨德英.鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎45例临床分析[J].医学临床研究,2015,32(2):364-365.
[11]南海静,崔春莲,张萌,等.构巢曲霉菌引起侵袭性真菌性鼻窦炎1例[J].临床耳鼻咽喉头颈外科杂志,2016,30(18):1486-1487.
[12]吴喜福,张革化,赵耕,等.两性霉素B鼻内应用改善慢性鼻-鼻窦炎预后的Meta分析[J].中国耳鼻咽喉头颈外科,2014,21(4):169-173.
[13]郎涛,聂玉玲,古再丽,等.两性霉素B治疗恶性血液病合并侵袭性真菌感染的临床观察[J].临床内科杂志,2016,33(1):57-58.
[14]刘飞,刘军.鼻息肉与变应性鼻炎患者鼻黏膜IL-17水平及嗜酸性粒细胞计数变化及其相关性[J].山东医药,2016,56(29):73-75.
[15]武大伟,王建亭,张敏,等.变应性气道疾病对嗜酸性鼻息肉炎性亚型界定的影响[J].中国耳鼻咽喉头颈外科,2016,23(1):36-40.
[16]王成硕,娄鸿飞,孟一帆,等.组织嗜酸粒细胞增多对慢性鼻-鼻窦炎伴鼻息肉复发的预测价值研究[J].中华耳鼻咽喉头颈外科杂志,2016,51(4):268-272.
[17]赵松花,孙绍辉,陈娜,等.嗜酸细胞性慢性鼻-鼻窦炎嗅觉障碍与嗜酸性粒细胞的关系[J].武警医学,2015,26(4):350-352.
[18]侯小兵,夏晶晶,王君,等.难治性鼻窦炎鼻内镜手术联合中药"苍耳子散"应用78例疗效观察[J].中国中西医结合耳鼻咽喉科杂志,2017,25(2):150-152.
[19]李四军,常艺琼,潘庆春,等.鼻内镜联合改良柯陆手术治疗难治性鼻-鼻窦炎的临床效果对比研究[J].中国耳鼻咽喉头颈外科,2017,24(8):431-432.
[20]麦伟良,张敏森,陈荣强,等.右美托咪定联合氟比洛芬酯辅助全麻对难治性鼻窦炎鼻内镜手术的影响[J].海南医学,2017,28(13):2107-2109.
[21]黄昌胜,沈关心. IL-35在机体对HBV感染免疫应答中的调节作用[J].医学分子生物学杂志,2017,14(4):246-248.
[22]徐静逍,程馨缘,郭施余,等.清热润燥口服液对BALB/c小鼠免疫功能的影响[J].昆明医科大学学报,2017,38(09):17-20.
[23]杨绿原,黄江菊.两性霉素B联合内镜手术对真菌性鼻-鼻窦炎患者炎症反应及免疫功能的影响[J].中国临床药理学杂志,2016,32(2):102-104.
[24]李月光.两性霉素B鼻窦内冲洗联合鼻内镜手术治疗真菌性鼻窦炎的效果观察[J].河北医科大学学报,2014,35(12):1404-1406.
[2]王旭,郭清华,朱晓朴,等.鼻内镜手术治疗真菌球型鼻窦病变的效果[J].昆明医科大学学报,2016,37(12):47-50.
[3]郝海波,刘天,姚梦雷,等.2012-2016年荆州市重症手足口病病例流行病学特征分析[J].预防医学情报杂志,2018,34(6):737-740.
[4]孙丽芳,付笑迎,杨方华,等.深圳地区493例儿童变应性鼻炎过敏原检测结果分析[J].分子诊断与治疗杂志,2017,9(3):181-185.
[5]陈仁物,王德云.欧洲鼻窦炎和鼻息肉诊疗意见书2012版:鼻窦炎诊治更新与精要[J].解放军医学杂志,2013,38(2):87-93.
[6]邓世明,刘铁陵,刘军,等.鼻内镜鼻窦开放术治疗真菌性鼻窦炎临床疗效观察[J].西部医学,2015,27(4):538-540.
[7]李昕蓉,刘洋,王盼盼,等.小青龙汤治疗肺气虚寒型变应性鼻炎的疗效分析[J].成都医学院学报,2015,10(6):696-699.
[8]李志,韩亮,尤权杰,等.外周血嗜酸粒细胞诊断嗜酸粒细胞性慢性鼻-鼻窦炎的分析评价[J].中华耳鼻咽喉头颈外科杂志,2016,51(7):528-532.
[9]罗嘉龙,赵晓明,汪志伟.血清嗜酸性粒细胞阳离子蛋白与变应性鼻炎及气道高反应疾病相关性研究进展[J].中国眼耳鼻喉科杂志,2015,15(4):298-300.
[10]杨德英.鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎45例临床分析[J].医学临床研究,2015,32(2):364-365.
[11]南海静,崔春莲,张萌,等.构巢曲霉菌引起侵袭性真菌性鼻窦炎1例[J].临床耳鼻咽喉头颈外科杂志,2016,30(18):1486-1487.
[12]吴喜福,张革化,赵耕,等.两性霉素B鼻内应用改善慢性鼻-鼻窦炎预后的Meta分析[J].中国耳鼻咽喉头颈外科,2014,21(4):169-173.
[13]郎涛,聂玉玲,古再丽,等.两性霉素B治疗恶性血液病合并侵袭性真菌感染的临床观察[J].临床内科杂志,2016,33(1):57-58.
[14]刘飞,刘军.鼻息肉与变应性鼻炎患者鼻黏膜IL-17水平及嗜酸性粒细胞计数变化及其相关性[J].山东医药,2016,56(29):73-75.
[15]武大伟,王建亭,张敏,等.变应性气道疾病对嗜酸性鼻息肉炎性亚型界定的影响[J].中国耳鼻咽喉头颈外科,2016,23(1):36-40.
[16]王成硕,娄鸿飞,孟一帆,等.组织嗜酸粒细胞增多对慢性鼻-鼻窦炎伴鼻息肉复发的预测价值研究[J].中华耳鼻咽喉头颈外科杂志,2016,51(4):268-272.
[17]赵松花,孙绍辉,陈娜,等.嗜酸细胞性慢性鼻-鼻窦炎嗅觉障碍与嗜酸性粒细胞的关系[J].武警医学,2015,26(4):350-352.
[18]侯小兵,夏晶晶,王君,等.难治性鼻窦炎鼻内镜手术联合中药"苍耳子散"应用78例疗效观察[J].中国中西医结合耳鼻咽喉科杂志,2017,25(2):150-152.
[19]李四军,常艺琼,潘庆春,等.鼻内镜联合改良柯陆手术治疗难治性鼻-鼻窦炎的临床效果对比研究[J].中国耳鼻咽喉头颈外科,2017,24(8):431-432.
[20]麦伟良,张敏森,陈荣强,等.右美托咪定联合氟比洛芬酯辅助全麻对难治性鼻窦炎鼻内镜手术的影响[J].海南医学,2017,28(13):2107-2109.
[21]黄昌胜,沈关心. IL-35在机体对HBV感染免疫应答中的调节作用[J].医学分子生物学杂志,2017,14(4):246-248.
[22]徐静逍,程馨缘,郭施余,等.清热润燥口服液对BALB/c小鼠免疫功能的影响[J].昆明医科大学学报,2017,38(09):17-20.
[23]杨绿原,黄江菊.两性霉素B联合内镜手术对真菌性鼻-鼻窦炎患者炎症反应及免疫功能的影响[J].中国临床药理学杂志,2016,32(2):102-104.
[24]李月光.两性霉素B鼻窦内冲洗联合鼻内镜手术治疗真菌性鼻窦炎的效果观察[J].河北医科大学学报,2014,35(12):1404-1406.