目的 探討布地奈德聯(lián)合克拉霉素治療慢性鼻-鼻竇炎的臨床療效。方法 2013年1月—2014年2月首都醫(yī)科大學(xué)石景山教學(xué)醫(yī)院收治的慢性鼻-鼻竇炎患者160例, 隨機(jī)分為對(duì)照組和治療組, 每組80例。對(duì)照組口服克拉霉素分散片, 2片/次, 2次/d, 2周后改為2片/次, 1次/d。治療組在對(duì)照組基礎(chǔ)上加用布地奈德氣霧劑噴鼻, 2噴/鼻孔, 1次/d。兩組患者均連續(xù)治療16周。比較兩組主客觀臨床療效, 同時(shí)檢測(cè)兩組美國康涅狄格化學(xué)感覺臨床研究中心(Connecticut Chemosensory Clinical Research, CCCRC)評(píng)分, 鼻腔分泌物和血清毒性顆粒蛋白(ECP)的變化。結(jié)果 治療后兩組患者主、客觀癥狀均明顯改善, 同組評(píng)分與治療前相比差異具有統(tǒng)計(jì)學(xué)意義(P<0.01);且治療組各主、客觀評(píng)分降低程度更為明顯, 與對(duì)照組相比差異具有統(tǒng)計(jì)學(xué)意義(P<0.01)。治療后兩組患者CCCRC評(píng)分均明顯提高, 與治療前相比差異具有統(tǒng)計(jì)學(xué)意義(P<0.01);與對(duì)照組相比, 治療組改善更為顯著, 差異具有統(tǒng)計(jì)學(xué)意義(P<0.01)。治療后鼻腔和血清ECP均明顯降低, 與治療前相比差異具有統(tǒng)計(jì)學(xué)意義(P<0.01);且治療組降低程度更為明顯, 與對(duì)照組相比差異具有統(tǒng)計(jì)學(xué)意義(P<0.01)。結(jié)論 布地奈德聯(lián)合克拉霉素治療慢性鼻-鼻竇炎具有較好的臨床療效, 能降低鼻腔、血清ECP水平, 值得臨床推廣應(yīng)用。

Objective To investigate the clinical effect of budesonide combined with clarithromycin in treatment of chronic rhinosinusitis. Methods The patients with chronic rhinosinusitis (160 cases) of Shijingshan Teaching Hospital of Capital Medical University from January 2013 to February 2014 were randomly divided into control and treatment groups, and each group had 80 cases. The patients in the control group were po administered with Clarithromycin Dispersible Tablets, 2 tablets/time, twice daily for 2 weeks, and then 2 tablets/time, once daily. The patients in the treatment group were given Budesonide Aerosol to nasal spray on the basis of control group, 2 sprays/nostril, once daily. The patients in two groups were treated continuously for 16 weeks. The clinical efficacies of subject and object in two groups were compared, while CCCRC score, ECP of nasal secretions and serum in two groups was detected. Results After treatment, subjective and objective symptoms in two groups were significantly improved, and the differences were statistically significant in the same group (P < 0.01). The subjective and objective evaluation in the treatment group were more apparent, and there were differences between two groups (P < 0.01). After treatment, CCCRC scores in two groups were significantly improved, and the difference was statistically significant in the same group (P < 0.01). Compared with the control group, the treatment group improved more significantly, and the differences were statistically significant (P < 0.01). ECP of nasal secretions and serum in two groups were significantly lower, and the difference was statistically significant in the same group (P < 0.01). The extent of the treatment group was more obvious, and there were differences between the two groups (P < 0.01). Conclusion Budesonide combined with clarithromycin has the good clinical effect in treatment of chronic rhinosinusitis, and can reduce the level of ECP in nasal cavity and serum, which is worth clinical promotion.