目的 探讨布地奈德联合克拉霉素治疗慢性鼻-鼻窦炎的临床疗效。方法 2013年1月—2014年2月首都医科大学石景山教学医院收治的慢性鼻-鼻窦炎患者160例, 随机分为对照组和治疗组, 每组80例。对照组口服克拉霉素分散片, 2片/次, 2次/d, 2周后改为2片/次, 1次/d。治疗组在对照组基础上加用布地奈德气雾剂喷鼻, 2喷/鼻孔, 1次/d。两组患者均连续治疗16周。比较两组主客观临床疗效, 同时检测两组美国康涅狄格化学感觉临床研究中心(Connecticut Chemosensory Clinical Research, CCCRC)评分, 鼻腔分泌物和血清毒性颗粒蛋白(ECP)的变化。结果 治疗后两组患者主、客观症状均明显改善, 同组评分与治疗前相比差异具有统计学意义(P<0.01);且治疗组各主、客观评分降低程度更为明显, 与对照组相比差异具有统计学意义(P<0.01)。治疗后两组患者CCCRC评分均明显提高, 与治疗前相比差异具有统计学意义(P<0.01);与对照组相比, 治疗组改善更为显著, 差异具有统计学意义(P<0.01)。治疗后鼻腔和血清ECP均明显降低, 与治疗前相比差异具有统计学意义(P<0.01);且治疗组降低程度更为明显, 与对照组相比差异具有统计学意义(P<0.01)。结论 布地奈德联合克拉霉素治疗慢性鼻-鼻窦炎具有较好的临床疗效, 能降低鼻腔、血清ECP水平, 值得临床推广应用。

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.