目的 分析鼻用糖皮质激素丙酸氟替卡松喷雾剂联合鼻腔冲洗或内镜下鼻窦手术治疗儿童变应性鼻炎导致慢性鼻窦炎的临床效果，以及对患儿多种炎症因子表达的影响。方法 前瞻性选择2020年1月-2021年6月包头市第四医院收治的变应性鼻炎导致慢性鼻窦炎患儿共120例，采用随机数字法分为3组，每组40例，即单用丙酸氟替卡松喷雾剂（单用组）、丙酸氟替卡松喷雾剂联合鼻腔冲洗组（联合鼻腔冲洗组）、丙酸氟替卡松喷雾剂联合内镜下鼻窦手术组（联合鼻窦手术组）。单用组患儿采用丙酸氟替卡松鼻喷雾剂，每喷50 μg，每侧2喷，总量200 μg，每天1次；联合鼻腔冲洗组患儿每日清晨使用可调式鼻腔清洗器加入0.9%氯化钠注射液250 mL对两侧鼻腔充分冲洗，每天1次，冲洗完毕后应用丙酸氟替卡松鼻喷雾剂，用法用量同单用组；联合鼻窦手术组患儿进行内镜下鼻窦手术，在术后应用丙酸氟替卡松鼻喷雾剂，用法用量同单用组。3组均持续用药12周。比较各组患儿治疗前及治疗4、8、12周的视觉模拟量表（VAS）评分、鼻内镜检查评分和鼻-结膜炎生活质量问卷（RQLQ）评分，评估各组治疗12周的临床疗效；检测各组患儿鼻呼吸道一氧化氮（NO）浓度、血清中白细胞介素-17A（IL-17A）、肿瘤坏死因子-α（TNF-α）和免疫球蛋白E（IgE）水平。结果 随着治疗时间的延长，各组患儿VAS评分、鼻内镜检查评分和RQLQ评分均逐渐降低（P＜0.05），联合鼻腔冲洗组和联合鼻窦手术组治疗8、12周的VAS评分、鼻内镜检查评分和RQLQ评分均显著低于单用组（P＜0.05）。联合鼻腔冲洗和联合鼻窦手术组治疗12周的临床疗效优于单用组（P＜0.05）。联合鼻腔冲洗和联合鼻窦手术组治疗4、8、12周的鼻呼吸道NO浓度及血清IL-17A、TNF-α水平均显著低于单用组（P＜0.05）。上述各项指标联合鼻腔冲洗组和联合鼻窦手术组比较，差异不显著（P＞0.05）。结论 变应性鼻炎导致慢性鼻窦炎患儿单用丙酸氟替卡松喷雾剂疗效不理想，联合鼻腔冲洗或内镜下鼻窦手术，对改善患儿临床症状以及减轻鼻腔和呼吸道多种炎症因子的表达具有显著的影响。

Objective To analyze the clinical effect of Fluticasone Propionate Nasal Spray combined with nasal irrigation or endoscopic sinus surgery in treatment of chronic sinusitis caused by allergic rhinitis in children, as well as the impact on expression of various inflammatory factors in children. Methods A total of 120 children with chronic sinusitis caused by allergic rhinitis admitted to Baotou Fourth Hospital from January 2020 to June 2021 were prospectively selected. They were randomly divided into three groups with 40 cases in each group, namely, Fluticasone Propionate Nasal Spray alone (single group), Fluticasone Propionate Nasal Spray combined with nasal irrigation group (combined with nasal irrigation group), and Fluticasone Propionate Nasal Spray combined with endoscopic sinus surgery group (combined with endoscopic sinus surgery group). Children in the single use group were given Fluticasone Propionate Nasal Spray (every spray 50 μg, two sprays per side, total 200 μg, once a day). The children in the combined nasal irrigation group used an adjustable nasal cleaner every morning to add 250 mL of 0.9% Sodium Chloride Injection to fully flush the nasal cavities on both sides, once a day. After washing, they used Fluticasone Propionate Nasal Spray, with the same dosage as the single group. The children in the combined endoscopic sinus surgery group were treated with endoscopic sinus surgery, and Fluticasone Propionate Nasal Spray was used after the surgery, with the same dosage as the single group. All three groups were treated for 12 weeks. The scores of visual analogue scale (VAS), nasal endoscopy and nasal conjunctivitis quality of life questionnaire (RQLQ) were compared before treatment and after 4, 8 and 12 weeks of treatment, and the clinical efficacy of each group was evaluated. The concentration of nitric oxide (NO) in nasal respiratory tract, interleukin 17A (IL-17A) , tumor necrosis factor- α (TNF- α) and immunoglobulin E (IgE) levels in serum were measured in each group. Results With the prolongation of treatment time, the VAS score, nasal endoscopy score and RQLQ score of children in each group decreased gradually (P< 0.05). The VAS scores, nasal endoscopic scores and RQLQ scores of the combined nasal irrigation group and the combined endoscopic sinus surgery group were significantly lower than those of the single group at eight and 12 weeks of treatment (P< 0.05). The clinical effect of the combined nasal irrigation and endoscopic sinus surgery group for 12 weeks were better than that of the single group (P< 0.05). The concentration of NO in nasal respiratory tract and serum IL-17A and TNF-α in the combined nasal irrigation and endoscopic sinus surgery group after 4, 8 and 12 weeks of treatmen were significantly lower than those in the single group (P< 0.05). There was no significant difference in the above indexes between the combined nasal irrigation group and the combined endoscopic sinus surgery group (P> 0.05). Conclusion The efficacy of Fluticasone Propionate Nasal Spray alone in children with chronic sinusitis caused by allergic rhinitis is not ideal. The combination of nasal irrigation or endoscopic sinus surgery has a significant effect on improving the clinical symptoms of children and reducing the expression of multiple inflammatory factors in nasal cavity and respiratory tract.

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包头科技计划支撑项目（2018C2007-4-1）