不同内型鼻息肉的扩展局部治疗的临床疗效：一项前瞻性随机对照研究。
Clinical efficacy of an extended local treatment in nasal polyps with different endotypes: A prospective randomized controlled study.
文献信息
| PMID | 42733474 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ziqi Huang |
| 作者单位 | The Department of Otorhinolaryngology, The First affiliated hospital of Sun Yat-sen University, Guangzhou, 510080, China. |
| 期刊 | The World Allergy Organization journal |
| SCI 分区 | Q2 |
| IF | 4.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 比较3种皮质类固醇给药方式的疗效，并评估延长治疗时间是否能改善患者结局。
方法： 这项前瞻性随机对照试验纳入了2019年9月至2025年2月期间在FA医院就诊的138例慢性鼻窦炎伴鼻息肉（CRSwNP）患者。患者被随机分配到3组，接受为期两周的方案：鼻喷剂组（布地奈德鼻喷剂256 μg/天）、鼻滴剂组（布地奈德鼻喷剂256 μg/天及布地奈德鼻滴剂1 mg/天）和口服类固醇组（布地奈德鼻喷剂256 μg/天及口服泼尼松30 mg/天）。在治疗前后评估视觉模拟量表（VAS）、22项鼻窦结局测试（SNOT-22）和鼻息肉内镜评分（NP评分）。将两周的数据与我们既往研究中来自独立队列的一周时间点数据进行比较。
结果： 与基线（第0天）相比，鼻滴剂组在2周后的VAS降低幅度显著大于鼻喷剂组（P = 0.02），尤其是在鼻塞（P = 0.04）和脓性鼻涕（P < 0.01）方面，并与口服组相当（P = 0.96）。在SNOT-22方面，从基线到2周，鼻滴剂组在鼻外症状（P = 0.02）和睡眠障碍症状（P = 0.03）方面的改善优于鼻喷剂组，与口服组相比无显著差异（P = 0.48）。此外，口服皮质类固醇2周与息肉体积显著缩小相关（P = 0.02），尤其是在2型CRSwNP中（P = 0.01）。将治疗时间从1周延长至2周，在鼻滴剂组中带来了显著的主观改善（P = 0.04），而仅在鼻喷剂组中带来了显著的内镜改善（P < 0.01）。
结论： 在鼻喷剂基础上加用鼻滴剂可增强短期症状缓解，而口服类固醇在缩小息肉体积方面更有效，尤其是在2型CRS中。
英文摘要
PURPOSE: To compare the efficacy of 3 corticosteroid delivery methods and assess whether extending treatment duration enhances patient outcomes.
METHODS: This prospective randomized controlled trial enrolled 138 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) from FA Hospital between September 2019 and February 2025. Patients were randomly allocated to 3 groups receiving a two-week regimen: Nasal Spray (budesonide nasal spray 256 μg/day), Nasal Drop (budesonide nasal spray 256 μg/day & budesonide nasal drop 1 mg/day) and Oral Steroids (budesonide nasal spray 256 μg/day & oral prednisone 30 mg/day). Visual-analogue scale (VAS), the 22-item Sinonasal Outcome Test (SNOT-22), and nasal polyps endoscopic scores (NP scores) were assessed pre- and post-treatment. The two-week data were compared to one-week time points from separate cohorts in our prior work.
RESULTS: Compared to baseline (Day 0), the nasal drop group showed significantly greater VAS reduction than the nasal spray group after 2 weeks (P = 0.02), particularly in nasal obstruction (P = 0.04) and purulent rhinorrhea (P < 0.01), and was comparable to the oral group (P = 0.96). Regarding SNOT-22, the nasal drop group demonstrated superior improvement in extranasal (P = 0.02) and sleep disorder symptoms (P = 0.03) compared to the nasal spray group from baseline to 2 weeks, with no significant difference versus the oral group (P = 0.48). Additionally, the 2 weeks use of oral corticosteroids was associated with notable polyp size reduction (P = 0.02), especially in type-2 CRSwNP (P = 0.01). Extending treatment duration from 1 to 2 weeks yielded significant subjective improvements in the nasal drop group (P = 0.04), and significant endoscopic improvement only in the nasal spray group (P < 0.01).
CONCLUSIONS: Adding intranasal drops to nasal spray enhances short-term symptom relief, whereas oral steroids reduce polyp size more effectively, particularly in type 2 CRS.