Efficacy of Nasal Administration of Bikangfu in the Treatment of Chronic Rhinosinusitis in Children
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摘要: 目的 探讨鼻康复鼻腔透药治疗儿童慢性鼻窦炎的临床疗效。方法 168例慢性鼻窦炎患儿随机分为观察组和对照组, 每组84例, 观察组给予鼻康复鼻腔透药疗法, 对照组给予通窍鼻炎颗粒+欧龙马滴剂口服, 疗程均为4周。观察2组患儿治疗前后的VAS评分、中医鼻渊症状与体征积分、鼻窦CT Lund-Mackay评分等的变化, 检测2组患儿治疗前后鼻腔分泌物及血清炎性因子前列腺素D2(PGD2)、白细胞三烯C4(LTC4)、白细胞介素(IL-17、IL-33)、嗜酸性粒细胞阳离子蛋白(ECP)、免疫球蛋白(IgE)的含量。结果 治疗后, 2组患儿VAS评分、中医症状及体征积分、鼻窦CT的Lund-Mackay评分较治疗前均明显下降(P < 0.05, P < 0.01), 观察组优于对照组(P < 0.05, P < 0.01)。观察组总有效率优于对照组(P < 0.01)。2组患儿血清及鼻分泌液中PGD2、LTC4、IL-17、IL-33、ECP、IgE水平较治疗前均降低(P < 0.05, P < 0.01), 观察组优于对照组(P < 0.05, P < 0.01)。2组治疗过程均未见明显不良反应。结论 鼻康复鼻腔透药疗法可有效改善慢性鼻窦炎患儿临床症状, 且无不良反应发生, 其作用机制可能与调节血清及鼻分泌物中的炎性因子水平有关。Abstract: OBJECTIVE To investigate the clinical efficacy of nasal administration of Bikangfu in the treatment of chronic rhinosinusitis in children.METHODS A total of 168 children with chronic rhinosinusitis were randomly divided into observation group and control group, 84 cases in each group. The observation group was given nasal administration of Bikangfu therapy, the control group was given Tongqiao Biyan granules combined with Sinupret drops orally. The course of treatment was four weeks. The changes of visual analog scale (VAS) symptom score, symptoms and signs scores of rhinosinusitis in traditional Chinese medicine, Lund-Mackay score of nasal sinus CT were observed in patients treated before and after treatment. The levels of nasal secretions and serum inflammatory factors including prostaglandin D2 (PGD2), leukotriene C4 (LTC4), interleukins (IL-17, IL-33), eosinophil cationic protein (ECP), and immunoglobulin (IgE) were measured before and after treatment in the two groups.RESULTS After treatment, the VAS score, traditional Chinese medicine symptoms and signs scores, and Lund-Mackay score of nasal sinus CT in the two groups were decreased significantly compared with those before treatment (P < 0.05, P < 0.01), while the results in the observation group were better than those the control group (P < 0.05, P < 0.01). The total effective rate after treatment was better in the observation group than that in the control group (P < 0.01). In addition, the levels of PGD2, LTC4, IL-17, IL-33, ECP, and IgE in the serum and nasal secretions in both groups were lower than those before treatment (P < 0.05, P < 0.01), while the results in the observation group were better than those in the control group (P < 0.05, P < 0.01). Besides, there was no obvious adverse reaction occurred in the two groups after treatment.CONCLUSION With no adverse reaction, nasal administration of Bikangfu therapy can effectively reduce the clinical symptoms of children with chronic rhinosinusitis. Its mechanism of action may be related to the regulation of inflammatory factors in serum and nasal secretions.
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Key words:
- Bikangfu /
- nasal administration /
- rhinosinusitis in children /
- chronic rhinosinusitis /
- clinical study
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图 2 2组患儿治疗前后鼻窦CT比较
注: A.对照组治疗前, 双侧上颌窦及筛窦可见软组织密度影, 气腔变小(红圈处); B.对照组治疗后, 软组织密度影仍在, 气腔较治疗前变大(红圈处); C.观察组治疗前, 双侧上颌窦窦腔密度增高, 可见软组织密度影, 气腔变小(红圈处); D.观察组治疗后, 窦腔内软组织密度影消失, 窦口通畅(红圈处)
表 1 儿童慢性鼻窦炎的西医诊断标准
项目 临床表现 临床症状 主要症状 咳嗽、鼻塞、头痛、流涕 伴随症状 嗅觉减退、听力下降、行为异常 体征 主要体征 下鼻甲充血、肥大, 鼻腔、中鼻道可见黏(脓)性分泌物, 咽后壁淋巴组织增生, 并可见黏(脓)性分泌物 伴随体征 腺样体和(或)扁桃体增生肥大, 分泌性中耳炎的体征 影像学检查 上颌窦、额窦、前组筛窦黏膜见炎性改变 
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表 2 2组患儿治疗前后VAS评分比较(x±s)
组别 例数 治疗前 治疗后 对照组 65 39.61±5.27 16.81±1.84** 观察组 67 38.92±5.96 5.74±0.46**## 注: 组内比较, **P < 0.01;组间比较, ##P < 0.01。
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表 3 2组患儿治疗前后中医鼻渊症状及体征积分比较(x±s)
组别 时间 鼻塞 流涕 咳嗽 头痛 嗅觉减退 总评分 对照组 治疗前 7.49±1.44 8.81±1.52 7.23±1.31 4.18±0.75 3.95±0.79 31.66±5.81 (n=65) 治疗后 3.56±0.32** 4.13±0.53** 3.97±0.37** 1.15±0.13** 1.54±0.16** 14.35±1.51** 观察组 治疗前 7.62±1.52 9.31±1.67 6.54±1.18 4.25±0.76 3.75±0.65 31.47±5.78 (n=67) 治疗后 0.95±0.07**## 0.53±0.04**## 0.47±0.05**## 0.28±0.04**## 0.92±0.11**# 3.15±0.31**## 注: 组内比较, **P < 0.01;组间比较, #P < 0.05, ##P < 0.01。
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表 4 2组患儿临床疗效比较
组别 例数 治愈 显效 有效 无效 总有效率/% 对照组 65 25 14 9 17 73.8 观察组 67 50 8 6 3 95.5## 注: 组间比较, χ2=12.058, ##P < 0.01。
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表 5 2组患儿治疗前后血清炎性因子水平比较(x±s, ng·L-1)
组别 时间 例数 PGD2 LTC4 IL-17 IL-33 对照组 治疗前 65 32.19±5.84 27.56±5.18 478.29±33.52 389.15±22.94 治疗后 65 20.87±3.49* 15.77±3.92* 317.25±28.55* 319.54±19.14* 观察组 治疗前 67 31.54±5.18 29.39±5.14 451.95±40.67 382.13±20.56 治疗后 67 12.38±3.92**# 9.15±3.19**# 210.98±20.85**## 135.63±11.93**## 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, #P < 0.05, ##P < 0.01。
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表 6 2组患儿治疗前后鼻分泌液炎性因子水平比较(x±s, ng·L-1)
组别 时间 例数 PGD2 LTC4 IL-17 IL-33 对照组 治疗前 65 18.96±2.27 14.28±1.08 359.26±23.85 221.35±13.78 治疗后 65 11.68±1.61* 9.54±0.92* 287.95±23.91* 187.77±12.83* 观察组 治疗前 67 17.85±2.56 12.73±1.96 359.28±25.67 219.95±13.54 治疗后 67 3.82±0.56**## 2.94±0.64**## 115.96±17.88**## 95.38±8.12**## 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, ##P < 0.01。
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表 7 2组患儿治疗前后血清及鼻分泌液ECP及IgE表达水平比较(x±s)
组别 时间 例数 血清 鼻分泌液 ECP/(μg·L -1) IgE/(kU·L -1) ECP/(μg·L -1) IgE/(kU·L -1) 对照组 治疗前 65 13.35±2.25 16.81±2.18 25.89±3.88 37.18±5.58 治疗后 65 8.98±1.24* 8.54±1.78* 17.54±3.16* 29.15±3.42* 观察组 治疗前 67 15.89±2.57 17.18±2.16 23.54±3.56 38.16±5.74 治疗后 67 6.04±1.08**# 3.58±2.17**## 10.18±3.95**# 16.75±4.12**## 注: 组内比较, *P < 0.05, **P < 0.01;组间比较, #P < 0.05, ##P < 0.01。
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