目的 分析鼻用糖皮質(zhì)激素丙酸氟替卡松噴霧劑聯(lián)合鼻腔沖洗或內(nèi)鏡下鼻竇手術(shù)治療兒童變應(yīng)性鼻炎導(dǎo)致慢性鼻竇炎的臨床效果，以及對(duì)患兒多種炎癥因子表達(dá)的影響。方法 前瞻性選擇2020年1月-2021年6月包頭市第四醫(yī)院收治的變應(yīng)性鼻炎導(dǎo)致慢性鼻竇炎患兒共120例，采用隨機(jī)數(shù)字法分為3組，每組40例，即單用丙酸氟替卡松噴霧劑（單用組）、丙酸氟替卡松噴霧劑聯(lián)合鼻腔沖洗組（聯(lián)合鼻腔沖洗組）、丙酸氟替卡松噴霧劑聯(lián)合內(nèi)鏡下鼻竇手術(shù)組（聯(lián)合鼻竇手術(shù)組）。單用組患兒采用丙酸氟替卡松鼻噴霧劑，每噴50 μg，每側(cè)2噴，總量200 μg，每天1次；聯(lián)合鼻腔沖洗組患兒每日清晨使用可調(diào)式鼻腔清洗器加入0.9%氯化鈉注射液250 mL對(duì)兩側(cè)鼻腔充分沖洗，每天1次，沖洗完畢后應(yīng)用丙酸氟替卡松鼻噴霧劑，用法用量同單用組；聯(lián)合鼻竇手術(shù)組患兒進(jìn)行內(nèi)鏡下鼻竇手術(shù)，在術(shù)后應(yīng)用丙酸氟替卡松鼻噴霧劑，用法用量同單用組。3組均持續(xù)用藥12周。比較各組患兒治療前及治療4、8、12周的視覺(jué)模擬量表（VAS）評(píng)分、鼻內(nèi)鏡檢查評(píng)分和鼻-結(jié)膜炎生活質(zhì)量問(wèn)卷（RQLQ）評(píng)分，評(píng)估各組治療12周的臨床療效；檢測(cè)各組患兒鼻呼吸道一氧化氮（NO）濃度、血清中白細(xì)胞介素-17A（IL-17A）、腫瘤壞死因子-α（TNF-α）和免疫球蛋白E（IgE）水平。結(jié)果 隨著治療時(shí)間的延長(zhǎng)，各組患兒VAS評(píng)分、鼻內(nèi)鏡檢查評(píng)分和RQLQ評(píng)分均逐漸降低（P＜0.05），聯(lián)合鼻腔沖洗組和聯(lián)合鼻竇手術(shù)組治療8、12周的VAS評(píng)分、鼻內(nèi)鏡檢查評(píng)分和RQLQ評(píng)分均顯著低于單用組（P＜0.05）。聯(lián)合鼻腔沖洗和聯(lián)合鼻竇手術(shù)組治療12周的臨床療效優(yōu)于單用組（P＜0.05）。聯(lián)合鼻腔沖洗和聯(lián)合鼻竇手術(shù)組治療4、8、12周的鼻呼吸道NO濃度及血清IL-17A、TNF-α水平均顯著低于單用組（P＜0.05）。上述各項(xiàng)指標(biāo)聯(lián)合鼻腔沖洗組和聯(lián)合鼻竇手術(shù)組比較，差異不顯著（P＞0.05）。結(jié)論 變應(yīng)性鼻炎導(dǎo)致慢性鼻竇炎患兒?jiǎn)斡帽岱婵ㄋ蓢婌F劑療效不理想，聯(lián)合鼻腔沖洗或內(nèi)鏡下鼻竇手術(shù)，對(duì)改善患兒臨床癥狀以及減輕鼻腔和呼吸道多種炎癥因子的表達(dá)具有顯著的影響。

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.

R987

包頭科技計(jì)劃支撐項(xiàng)目（2018C2007-4-1）