摘要
鼻窦炎是鼻窦黏膜的一种炎症症状,因其常与鼻炎并发,故现广泛认为“鼻鼻窦炎”的名称更为合适。鼻鼻窦炎以包括鼻塞、嗅觉丧失、流涕及面部压迫感在内的临床常见症状为特征。其病因复杂,临床上的综合治疗是十分必要的。
糠酸莫米松作为一种具有局部抗炎作用的糖皮质激素,最初用于治疗皮肤疾患和哮喘;而近年来,它的鼻喷剂型(内舒拿)被越来越多的用于变应性鼻炎。此药物具有对持续性哮喘疗效显著,且耐受性良好,可以在提高肺功能的同时减弱过敏源引起的速发性和迟发性哮喘反应,降低气道高反应性及过敏源引起的痰液嗜酸粒细胞增多。近来有研究显示,糠酸莫米松局部应用(糠酸莫米松鼻喷剂),可以提高粘膜纤毛系统的功能,同时影响局部及全身免疫,并能促进内镜术后气道粘膜的恢复。
应用糖皮质激素时,不仅要看重它的效能,安全性也不应忽视。对于局部应用的糖皮质激素,局部的高抗炎作用应与低全身暴露相一致。因此,从局部到全身的延迟再分布和快速完全的肝脏代谢——且代谢产物无活性,是很有利的。对糠酸莫米松而言,已有相关报道称,它具有极低全身生物利用度,并对人糖皮质激素受体有极高亲和力。但同时,糠酸莫米松不良的全身副反应,如下丘脑-垂体-肾上腺轴抑制,也提上日程。
无论如何,所有的研究结果都不能盖棺定论,尚需进一步研究。本文汇集多方论点进行综述,以期对进一步的临床工作有所助益。
Sinusitis is a symptomatic inflammation of the mucosa of paranasal sinuses. Because of it usually appears with nasal symptems, it is now widely suggested that the denomination of“rhinosinusitis”may be more rational. The most common symptoms, including nasal obstruction, smell loss, rhinorrhea, and facial pressure, have been well characterized. As the complexity of its etiology, clinical combined therapy is essential.
Mometasone furoate (MF) is a corticosteroid, which originally developed as a topical anti-inflammatory agent to treat dermatologic disorders, asthma, and more recently as a nasal spray for allergic rhinitis (Nasonex). It has been shown to be efficacious and well tolerated by patients with persistent asthma; improving lung function while reducing the magnitude of allergen-induced early and late asthmatic responses, allergen-induced airway hyperresponsive- ness, and allergen-induced increases in sputum eosinophilia. New researches show that MF which is applied as a local corticosteroid(mometasone furoate nasal spray, MFNS) could improve the function of mucocililary system, as well as effect the local/systemic immunity and promote the recovery of the airway mucosa before/after endoscope surgery.
Besides the efficacy of a corticosteroid, safety issues have to be taken into consideration. For topically applied glucocorticoids, the high local anti- inflammatory activity should be paralleled by a low systemic exposure. Therefore, it is favorable for a prolonged redistribution from local tissue into systemic circulation and a rapid and complete hepatic metabolism of the compounds to inactive derivatives. It has been reported that MF has a very low systemic bioavailability and very high affinity to the human glucocor- ticoid receptor has been reported. Meanwhile, the undesirable systemic side effects, such as the suppression of the hypothalamic-pituitary-adrenal(HPA) axis, have also been raised.
Anyway, all of the investigate has not reached the final conclusion. Further studies are essential. This overview article has gathered many standpoints of various aspects, intending to benefit the clinical work.
引文
1 Yamaguchi T, Watanabe Ishiiwa H, Suzuki S, et al. Incipient chordoma: a report of two cases of earlystage chordoma arising from benign notochordal cell tumors. Mod Pat hol, 2005, 18 (7): 1005-1010
2 Scheil S, Bruderlein S, Liehr T. Genome-wide analysis of sixteen ch- ordomas by comparative genomic hybridization and cytogenetics of the first human chordoma cell line U-CH1. Genes Chromosomes Cancer, 2001, 32 (3): 203-211
3 Tamborini E, Miselli F, Negri T, et al. Molecular and biochemical a- nalyses of Platelet-Derived Growth Factor Receptor (PDGFR) B, PDGFR A, and KIT Receptors in Chordomas. Clin Cancer Res, 2006, 12(23): 6920-6928
4 McMaster M L, Goldstein A M, Bromley C M, et al. Chordoma: in- cidence and survival patterns in the United States, 1973-1995. Cancer Causes Control, 2001, 12 (1): 1-11
5 Tirabosco R, Mangham DC, Rosenberg AE, et al. Brachyury express- ion in extra-axial skeletal and soft tissue chordomas: a marker that distin- guishes chordoma from mixed tumor/myoepithelioma/parachordoma in softtissue. Am J Surg Pathol, 2008, 32(4): 572-580
6 Naka T, Boltze C, Samii A, et al. Skull base and nonskull base ch- ordomas: clinicopathologic and immunohistochemical study with special reference to nuclear pleomorphism and proliferative ability. Cancer, 2003, 98(9): 1934-1941
7 Chugh R, Tawbi H, Lucas D R, et al. Chordoma: The Nonsarcoma P- rimary Bone Tumor. The Oncologist, 2007, 12(11): 1344-1350
8刘宁,闫庆娜. 29例脊索瘤的临床病理分析.大同医学专科学校学报,2006, 4: 9-10
9田秋红,云径平,吴秋良,等.脊索瘤的临床病理及免疫组织化学研究.中华肿瘤防治杂志,2006, 13 (8): 611-613
10王季,蔡郑东.脊柱脊索瘤的诊断及治疗进展.现代肿瘤医学, 2007, 15 (11): 1676-1678
11裴学菊,周宜兰,罗代珍,等.针吸细胞学诊断脊索瘤的探讨(附5例报告).肿瘤防治研究,2007, 34(10): 813-814
12唐谊海,冯新莉,唐岩.脊索瘤的临床病理、免疫组化和超微结构观察.辽宁医学杂志,1998, 12(4): 186-188
13 Almefty K, Pravdenkova S, Colli B O, et al. Chordoma and Chond- rosarcoma Similar, but Quite Different, Skull Base Tumors. Cancer, 2007, 110(11): 2457-2467
14 Radner H, Katenkamp D, Reifenberger G, et al. New developments in the pathology of skull base tumors. Virchow Arch, 2001, 438(4): 321-335
15 Kubota T, Sato K, Kabuto M, et al. Immunohistochemical and ultra- structural study of skull base chordomas. Noshuyo Byori, 1994, 11(1): 23-28
16 Gherardi G, Marveggio C, Cola C, et al. Decisive role of immuno- cytochemistry in aspiration cytology of chordoma of the clivus : a case report with review of the literature. J Laryngol Otol, 1994, 108(5): 426-430
17吴彦桥,杨伟炎,黄德亮.颅底脊索瘤治疗新趋势——多科合作的时代.中华耳鼻咽喉科杂志,2003, 38(5): 397-400
18 Mori K, Chano T, Kushima R, et al. Expression of E-cadherin in chordomas: diagnostic marker and possible role of tumor cell affinity. Virchows Arch, 2002, 440(2): 123-127
19 John H F, William D D, Sandra O J, et al. Steroid Hormone Recep- tor and COX-2 Expression in Chordoma. Am J Clin Pathol, 2007, 128(3): 375-381
20 Romeo S, Hogendoorn PC. Brachyury and chordoma: the chondr- oidchordoid dilemma resolved? J Pathol, 2006, 209(2): 143-146
21 Shalaby A AE, Presneau N, Idowu B D, et al. Analysis of the fibro- blastic growth factor receptor-RAS/RAF/MEK/ERK-ETS2/brachyury signalling pathway in chordomas. Modern Pathology, 2009, 22(8): 996-1005
22黎辉,詹娜,王则胜.颅底脊索瘤临床与病理分析.卒中与神经疾病, 2005, 12(4): 242-244
23 Tabaee A, Nyquist G, Anand V K, et al. Palliative endoscopic surge- ry in advanced sinonasal and anterior skull base neoplasms. Otolary- ngology-Head and Neck Surgery, 2010, 142(1): 126-128
24 Chen KW, Yang HL, Lu J, et al. Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord, 2010, 48: 166-171
25 Mizoe J, Hasegawa A, Takagi R, et al. Carbon Ion Radiotherapy for Skull Base Chordoma. Skull Base, 2009, 19(3): 219-224
26 Ferraresi V, Nuzzo C, Zoccali C, et al. Chordoma: clinical character- istics, management and prognosis of a case series of 25 patients. BMC Cancer, 2010, 10: 22
27 Schwab JH, Boland PJ, Agaram NP, et al. Chordoma and chondro- sarcoma gene profile: implications for immunotherapy. Cancer Immunol Immunother, 2009, 58(3): 339-349
28张晋煜,许建波,马翔.骶骨脊索瘤临床特征与治疗干预.临床肿瘤学杂志,2008, 13 (7): 666-669
29 Loehn B, Walvekar RR, Harton A, et al. Mandibular Metastasis fr- om a Skull Base Chordoma: Report of a Case with Review of Literature. Skull Base, 2009, 19(5): 363-368
30 Jawad MU, Scully SP. Surgery Significantly Improves Survival in P- atients With Chordoma. Spine, 2010, 35(1): 117-123
31 McPherson CM, Suki D, McCutcheon IE, et al. Metastatic disease from spinal chordoma: a 10-year experience. J Neurosurg Spine, 2006, 5(4): 277-280
32 Fischbein NJ, Kaplan MJ, Holliday RA, et al. Recurrence of clival chordoma along the surgical pathway. AJNR Am J Neuroradiol, 2000, 21(3): 578-583
33 Arnautovic KI, Al-Mefty Q. Surgical seeding of chordomas. J Neur- osurg, 2001, 95(5): 798-803
34 Naka T, Kuester D, Boltze C, et al. Expression of Hepatocyte Gro- wth Factor and c-MET in Skull Base Chordoma. Cancer, 2008, 112(1): 104-110
35 Naka T, Boltze C, Kuester D, et al. Expression of Matrix Metallop- roteinase(MMP)-1, MMP-2, MMP-9, Cathepsin B, and Urokinase Plasminogen Activator in Non–Skull Base Chordoma. Am J Clin Pathol, 2004, 122(6): 926-930
36 Naka T, Boltze C, Kuester D, et al. Intralesional Fibrous Septum in Chordoma. A Clinicopathologic and Immunohistochemical Study of 122 Lesions. Am J Clin Pathol, 2005, 124(2): 288-294
1张罗,韩德民.解读英国变态反应和临床免疫学会鼻鼻窦炎和鼻息肉诊治指南.中国耳鼻喉头颈外科,2009, 16(5): 287-291
2 Scadding GK, Durham SR, Mirakian R, et al. Bsaci guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy, 2008, 38(2): 260-275
3黄卓林,王秀英,阮亦劲.开瑞坦联合内舒拿喷鼻剂治疗变应性鼻炎疗效观察.国际医药卫生导报,2008, 14(13): 74-77
4 Karen K.Y, Edmund A.P, Beverly J.C, et al. Analysis of the Olfacto- ry Mucosa in Chronic Rhinosinusitis. DOI, 2009, 1170: 590-595
5刘月辉,陶泽璋.吸入糖皮质激素对变应性鼻炎大鼠黏膜病理改变的实验研究.中华耳鼻喉头颈外科杂志, 2009, 44(11): 935-940
6 Kim YM, Lee CH, Won TB, et al. Functional recovery of rabbit maxillary sinus mucosa in two different experimental injury models. Laryngocope, 2008, 118(3): 541-545
7 Ali MS, Hutton DA, Wilson JA, et al. Major secretory mucin expre- ssion in chronic sinusitis. Otolaryngol Head Neck Surg, 2005, 133 (3):4232-4281
8 Kim DH, Chu HS, Lee JY, et al. Upregulation of MUC5AC and M- UC5B mucin genes in chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg, 2004, 130 (6): 747-752
9纪琛琪,郭永清.粘蛋白在鼻息肉及变应性鼻炎中的基因表达水平的研究.临床耳鼻咽喉头颈外科杂志,2009,23(20): 923-925、929
10黄雪琨,李源.慢性鼻腔及鼻窦炎黏膜中的黏蛋白.国际耳鼻咽喉头颈外科杂志, 2007, 31(2): 65-67
11刘学兵,刘钢.变应性鼻炎与细胞因子免疫研究.天津医药, 2006, 34(2): 140-142
12 Peters AT, Kato AT, Carr T, et al. Analysis of the Th17 pathway i- n chronic rhinosinusitis. J Allergy Clin Immunol, 2009, 123: S145
13 Banwell ME, Robinson DS, Lloyd CM, et al. Adenoid-derived TH2 cells reactive to allergen and recall antigen express CC chemokine receptor 4. J Allergy Clin Immunol, 2003, 112 (6): 1155-1161
14 Sok JC, Ferquson BJ. Differential diagnosis of eosinophilic chronic rhinosinusitis. Curr Allergy Asthma Rep, 2006, 6(3): 203-214
15马艳红,刘国辉,贺广湘,等.鼻内镜术后不同疗效患者鼻黏膜T细胞亚群观察.中国煤炭工业医学杂志, 2006, 9(5): 438-439
16 Bernstein JM, Ballow M, Rich G, et al. Lymphocyte subpopulations and cytokines in nasal polyps: is there a local immune system in the nasal polyp? Otolaryngol Head Neck Surg, 2004, 130(5): 526-535
17 Shi J, Fan Y, Xu R, et al. Characterizing T-Cell Phenotypes in Nasal Polyposis in Chinese Patients. J Investig Allergol Clin Immunol, 2009, 19(4): 276-282
18 Lane AP, Truong-Tran QA, Schleimer RP. Altered expression of ge- nes associated with innate immunity and inflammation in recalcitrant rhinosinusitis with polyps. Am J Rhinol, 2006, 20(2): 138-144
19 Lorenzo G D, Pacorw M L, Pellitteri M E, et al. Randomized plac -ebocontrolled trial comparing fluticasone aqueous nasal spray in monotherapy, fluticasone plus cetirizine, fluticasone plus montelukast andcetirizine plus montelukast for seasonal allergic rhinitis. Clin Exp Allergy, 2004, 34(2): 259-267
20冯晓辉,钟启宝.局部糖皮质激素对慢性鼻窦炎的鼻-鼻窦黏膜功能的影响.医学临床研究, 2008, 25(7): 1217-1219
21 Albertien AC, Aukema MD, A Paul GH, et al. Treatment of nasal p- olyposis and chronic rhinosinusitis with fluticasone propionate nasal drops reduces need for sinus surgery. Allergy Cl in Immunol, 2005, 115(5): 1017-1023
22许庚.非变应性持续性鼻炎(慢性鼻炎)局部糖皮质激素治疗新概念.临床耳鼻咽喉头颈外科志, 2007, 21(14): 636-638
23夏贵华.糠酸莫米松鼻喷雾剂在功能性鼻内窥镜术后的疗效分析.中华医学会第十次全国耳鼻咽喉-头颈外科学术会议论文汇编书面交流, 649
24 Stjarne P, Mosges R, Jorissen M, et al. Trial of Mometasone Furoa- te Nasal Spray for the Treatment of Nasal Polyposis. Arch Otolaryngol Head Neck Surg, 2006, 132(2): 179-185
25 Ogawa M, Tsumuro T, Takubo M, et al. Effect of Mometasone Fu- roate on Nasal Congestion Model in Rats. Pharmacology, 2009, 84(2): 99-103
26左可军,许庚.鼻用糖皮质激素对缓解非变应性持续性鼻炎鼻塞症状的疗效观察.中华耳鼻咽喉头颈外科杂志,2009, 44(9): 739-745
27 Hofmann T, Gugatschga M, Koidl B, et al. Influence of Preservati- ves and Topical Steroids on Ciliary Beat Frequency In Vitro. Arch Otolaryngol Head Neck Surg, 2004, 130(4): 440-445
28 Berg OH, Lie K, Steinsvag SK. The effects of topical nasal steroi- ds on rat respiratory mucosa in vivo, with special reference to benzalk- onium chloride. Allergy, 1997, 52(6): 627-632
29 Minshall E, Ghaffar O, Cameron L, et al. Assessment by nasal bio- psy of longterm use of mometasone fuorate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis. Otolaryngol Head Neck Surg, 1998, 118(5): 648-654
30 Li HB, Wen WP, Cheng L, et al. Expression of Chloride Channel Protein CLC-3 in Patients With Allergic Rhinitis Effect of Topical Corticosteroid Treatment. Arch Otolaryngol Head Neck Surg, 2008, 134(3): 301-305
31吴文丽,甄宏韬,高敏.糖皮质激素对变应性鼻炎大鼠模型钙激活氯通道的影响.中华耳鼻咽喉头颈外科杂志, 2009, 44(3): 242-245
32锡琳,张罗,张伟. Foxp3基因与变应性鼻炎相关性探讨.临床耳鼻咽喉头颈外科杂志, 2009, 23(2): 92-96
33项济生.类固醇鼻喷剂的临床应用.临床耳鼻咽喉科学杂志,2004, 18(110): 641-642
34蔡克敏,李华斌,赵质彬,等.鼻内糖皮质激素对鼻息肉中Foxp3+调节性T细胞的影响.中国耳鼻咽喉头颈外科杂志, 2009, 16(5): 273-276
35 Atsuta J, Plitt J, Bochner BS, et al. Inhibition of VCAM-1 express- ion in human bronchial epithelial cells by glucocorticoids. Am. J. Respir.Cell Mol.Biol, 1999, 20(4): 643-650
36 Inman MD, Watson RM, Rerecich T, et al. Dose-dependent Effects of Inhaled Mometasone Furoate on Airway Function and Inflammation After Allergen Inhalation Challenge. Am J Respir Crit Care Med, 2001, 164(4): 569-574
37许庚,史剑波,文卫平.慢性鼻-鼻窦炎的定义及其分类和治疗.中华耳鼻咽喉头颈外科杂志, 2005, 40(10): 737
38张罗,韩德民,周兵,等.鼻息肉中嗜酸性粒细胞浸润和活化与白细胞介素5表达.中国耳鼻咽喉头颈外科杂志, 2005, 12(3): 171
39 Bousquet J, Jacot W, Vignola AM, et al. Allergic rhinitis: a disease remodeling the upper air ways. J Allergy Clin I mmunol, 2004, 113(1): 43-49
40 Vera-Cruz P, Ferreira M, Zagalo C, et al. Moderate leukocyte infiltration in the lower turbinate mucosa after a two-week intranasal administration of Mometasone Furoate, Azelastine or Salmon Calcitonin. Rev Laryngol Otol Rhinol, 2009, 130(2): 105-109
41王显红,龚树生.糖皮质激素对鼻息肉组织中细胞因子Eotaxin、E- otaxin-2表达的影响.临床耳鼻咽喉头颈外科杂志,2009, 23(5): 205-208
42 Zhang N, Holtappels G, Claeys C, et al. Pattern of in?ammation a- nd impact of Staphylococcus aureus enterotoxins in nasal polyps from southern China. Am J Rhinol, 2006, 20(4): 45-50
43罗鸿,严能兵,刘珺,等.变应性鼻炎患者鼻分泌物中嗜酸粒细胞计数与鼻用糖皮质激素治疗反应的关系.中华耳鼻咽喉头颈外科杂志, 2009, 44(3): 209-213
44 Gauvreau GM, Inman MD, Kelly M, et al. Increased levels of air- way neutrophlis reduce the inhibitory effects of inhaled glucocorti- costeroids on allergen-induced airway eosinophils. Can Respir J, 2002, 9(1): 26-32,30
45 Bacci E, Cianchetti M, Bartoil M, et al. Low sputum eosinophils p- redict the lack of response to beclomethasone in symptomatic asthmatic patients. Chest, 2006, 129(3): 565-572
46 Cho KN, Choi JY, Kim CH, et al. Prostaglandin E2 induces MUC8 gene expression via a mechanism involving ERKMARK/RSK1/cAMP response element binding protein activation in human air way epithelial cells. J Biol Chem, 2005, 280 (8): 6676-6681
47 Kook KJ, Hoon KC, Kim K, et al. Effects of prostaglandin E(2) o- n gel-forming mncin secretion in normal human nasal epithelial cells. Acta Otolaryngol, 2006, 126(2): 174-179
48 Issar M, Sahasranaman S, Buchwald P, et al. Differences in the gl- ucocorticoid to progesterone receptor selectivity of inhaled glucocorticoids. Eur Respir J, 2006, 27(3): 511-516
49 Neher A, Gst?ttner M, Scholtz A, et al. Antibacterial Activity of Mometasone Furoate. Arch Otolaryngol Head Neck Surg, 2008, 134(5): 519-521
50 Williamson I G, Rumsby K, Benqe S, et al. Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis: A Rand-omized Controlled Trial. JAMA, 2007, 298(21): 2487-2496
51 Klossek JM. Efficacy and safety of mometasone furoate nasal spray in the treatment of sinusitis or acute rhinosinusitis. Rev Laryngol Otol Rhinol (Bord), 2007, 128(3): 187-192
52许庚,李源,谢民强,等.功能性内窥镜鼻窦手术后术腔黏膜转归阶段的划分及处理原则.中华耳鼻咽喉科杂志, 1999, 34 (5): 302-305
53周健.功能性鼻窦内窥镜术后术腔黏膜转归的观察及处理198例分析.中国误诊学杂志,2008, 8(6): 1409-1410
54冼志,盖锡球,叶锦华,等.围手术后期处理对慢性鼻窦炎、鼻息肉术后鼻窦黏膜转归的影响.海南医学,2006, 17(3): 29-30
55于睿莉,朱冬冬,董震.慢性鼻-鼻窦炎鼻息肉内镜术后糖皮质激素对鼻黏膜重塑的影响.中华耳鼻咽喉头颈外科杂志,2006, 41(10): 773-776
56余文煜,董震.实验性变应性鼻炎鼻黏膜组织重塑的特点.中华耳鼻咽喉头颈外科杂志,2006, 41(1): 48-53
57 Schubert MS. Allergic fungal sinusitis: pathogenesis and manageme- nt strategies. Drugs, 2004, 64(4): 363-374
58刘红兵,刘建国,罗贵,等.布地奈德混悬液对慢性鼻-鼻窦炎鼻内镜术后窦腔黏膜上皮化的作用.中国新药与临床杂志,2008, 27(8): 595-597
59李清林.内窥镜鼻窦围手术期中丙酸氟替卡松鼻喷雾剂的应用.中国现代药物应用,2009, 3(1): 117-118
60项光早,廖志苏.影响慢性鼻-鼻窦炎手术预后的相关因素分析.临床耳鼻咽喉头颈外科杂志,2009, 23(17): 778-780
61 Schleimer RP, Kato A, Peters A, et al. Epithelium, Inflammation, a- nd Immunity in the Upper Airways of Humans Studies in Chronic Rhinosinusitis. The Proceedings of the American Thoracic Society, 2009, 6(3): 288-294
62虞一红,张建耀,胡建道,等.糠酸莫米松鼻喷剂治疗80例过敏性鼻炎的临床观察.华西药学杂志,2009, 24 (3): 329
63 Sahasranaman S, Issar M, Hochhaus G. Metabolism of mometasonefuroate and biological activity of the metabolites. Drug Metab Dispos, 2006, 34(2): 225-233
64 Lee D.K.C, Robb FM, Sims EJ, et al. Systemic bioactivity of intran- asal triamcinolone and mometasone in perennial allergic rhinitis. Blackwell Publishing Ltd Br J Clin Pharmacol, 2003, 55(3): 310-313
65 Demoly P. Safety of intranasal corticosteroids in acute rhinosinusitis. Am J Otolaryngol, 2008, 29(6): 403-413
66 Tayab ZR, Fardon TC, Lee D.K.C, et al. Pharmacokinetic/pharmaco- dynamic evaluation of urinary cortisol suppression after inhalation of fluticasone propionate and mometasone furoate. Br J Clin Pharmacol, 2007, 64(5): 698-705
67 Affrime MB, Cuss F, Padhi D, et al. Bioavailability and metabolism of mometasone furoate following administration by metered-dose and dry- powder inhalers in healthy human volunteers. Clin Pharmacol, 2000, 40(11): 1227-1236
68 Noonan M, Leflein J, Corren J, et al. Long-term safety of Mometa- sone Furoate administered via a dry powder inhaler in children: Results of an open-label study comparing Mometasone Furoate with Beclomethasone Dipropionate in children with persistent asthma. BMC Pediatrics, 2009, 9: 43
69 Galant SP, Melanmed IR, Nayak AS, et al. Lack of effect of flutic- asone propionate aqueous nasal sparay on the hypothalamic- pituitary-adrenal axis in 2-and 3-year-old patients. Pediatrics, 2003, 112(1Pt1): 96-100
70 Chrousos GP, Ghaly L, Shedden A, et al. Effects of Mometasone Furoate Dry Powder Inhaler and Beclomethasone Dipropionate Hydrofl- uoroalkane and Chlorofluorocarbon on the Hypothalamic-Pituitary- Adrenal Axis in Asthmatic Subjects. Chest, 2005, 128(1): 70-77
71 Affrime MB, Kosoglou T, Thonoor CM, et al. Mometasone Furoate has minimal effects on the Hypothalamic-Pituitary-Adrenal axis when delivered at high doses. CHEST, 2000, 118(6): 1538-1546
72 Fardon TC, Lee DK, Haggart K, et al. Adrenal suppression with d- ry powder formulations of fluticasone propionate and mometasone furoate. Am J Respir Crit Care Med, 2004, 170(9): 960-966
73 Hübner M, Hochhaus G, Derendorf H. Comparative pharmacology,b- ioavailability,pharmacokinetics,and pharmacodynamics of inhaled glu- cocorticosteroids. Immunol Allergy Clin North Am, 2005, 25(3): 469-488
74 Mortimer K.J, Tattersfeld A.E. Benefit versus risk for oral, in- haled, and nasal glucocorticosteroids. Immunol Allergy Clin North Am, 2005, 25 (3): 523-539
75 Rohatagi S, Luo Y, Shen L, et al. Protein binding and its potential for eliciting minimal systemic side effects with a novel inhaled corticosteroid, ciclesonide. Am J Ther, 2005, 12(3): 201-209
76 Valotis A, H?gger P. Significant receptor affinities of metabolites a- nd a degradation product of mometasone furoate. Respiratory Research, 2004, 5(1): 7
77 Edsbacker S, Johansson CJ. Airway selectivity: an update of pharm- caokinetic factors affecting local and systemic disposition of inhaled steroids. Basic Clin Pharmacol Toxicol, 2006, 98(6): 523-536
78 Austin R J, Maschera B, Walker A, et al. Mometasone furoate is a less specific glucocorticoid than ?uticasone propionate. Eur Respir J, 2002, 20(6): 1386-1392
79 Pujols L, Mullol J, Torrego A, et al. Glucocorticoid receptors in hu- man airways. Allergy, 2004, 59 (10): 1042-1052
80 Mccormark PL, Ploskerg L. Inhaled mometasone furoate: a review of its use in persistent asthma in adults and adolescents. Drugs, 2006, 66(8): 1151-1168
81 Ogawa M, Sakonjo H, Kamei C. Dissociation of local anti-infamm- atory effect and systemic efects of mometasone furoate in mice. Immunopharmacology and Immunotoxicology, 2009, 31(4): 601-606
82 Daley-Yates PT, Price AC, Sisson JR, et al. Beclomethasone dipr-opionate: Absolute bioavailability, pharmacokinetics and metabolism following intravenous, oral, intranasal and inhaled administration in man. Br J Clin Pharmacol, 2001, 51 (5): 400-409
83 Daley-Yates P.T., Kunka R.L., Yin Y., et al. Bioavailability of futic- asone propionate and mometasone furoate aqueous nasal sprays. Eur J Clin Pharmacol, 2004, 60(4): 265-268.
84 Boner A.L. Efects of intranasal corticosteroids on the hypothalamic- pituitary-adrenal axis in children. J Allergy Clin Immunol, 2001, 108 (1 Suppl.): S32-S39
85 Gevaert P, Holtappels G, Johansson SG, et al. Organization of seco- ndary lymphoid tissue and local IgE formation to Staphylococcus aureus enterotoxins in nasal polyp tissue. Allergy, 2005, 60(1): 71-79
86 Kato A, Peters A, Suh L, et al. Evidence of a role for B cell-acti- vating factor of the TNF family in the pathogenesis of chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol, 2008, 121(6): 1385-1392