布地奈德鼻腔冲洗在慢性鼻窦炎术后维持治疗中的治疗价值：一项真实世界研究

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中文摘要

目的： 布地奈德冲洗（BI）已成为慢性鼻窦炎（CRS）术后有效的局部治疗手段，与常规鼻内糖皮质激素喷雾相比可改善药物递送。然而，关于其在术后关键期作为维持治疗策略的证据仍然有限。本研究旨在评估BI与生理盐水冲洗（SI）相比，在功能性内镜鼻窦手术（FESS）后持续存在症状的患者中的临床疗效，并确定治疗效果是否因CRS炎症内型而异。方法：本回顾性队列研究纳入2021年至2024年间接受FESS的121例CRS患者。术后3个月仍有持续症状的患者接受持续SI（n = 54）或BI（n = 67）治疗至少6个月。临床结局包括SNOT-22评分变化、改良Lund-Kennedy内镜评分（mLKS）、经KVSS II评估的嗅觉功能、口服糖皮质激素（CS）使用及疾病控制状态。对嗜酸性CRS（ECRS）和非嗜酸性CRS（NECRS）进行亚组分析。结果：BI组SNOT-22总评分改善显著大于SI组（p < 0.0001），尤其在鼻部症状方面。内镜结局也倾向于BI，mLKS总评分和黏膜水肿评分下降幅度更大。这些获益在ECRS和NECRS中均观察到，尽管客观内镜改善在ECRS中更为明显。接受BI的患者所需口服CS疗程更少（18.42% vs. 52.38%，p = 0.01），并表现出更好的疾病控制（p = 0.03）。然而，嗅觉功能未见显著差异。结论：与SI相比，BI在CRS术后维持治疗中提供更优的症状改善、更好的内镜愈合及更少的口服CS使用，支持其在ECRS和非ECRS亚组中的应用。

英文摘要

Objectives: Budesonide irrigation (BI) has emerged as an effective postoperative topical therapy for chronic rhinosinusitis (CRS), providing improved drug delivery compared with conventional intranasal corticosteroid sprays. However, evidence regarding its role as a maintenance strategy during the critical postoperative period remains limited. This study aimed to evaluate the clinical efficacy of BI compared with saline irrigation (SI) in patients with persistent symptoms following functional endoscopic sinus surgery (FESS) and to determine whether treatment effects differed according to CRS inflammatory endotypes. Methods: This retrospective cohort study included 121 patients with CRS who underwent FESS between 2021 and 2024. Patients with persistent symptoms 3 months post-operation were treated with either continued SI (n = 54) or BI (n = 67) for at least 6 months. Clinical outcomes included changes in SNOT-22 scores, modified Lund-Kennedy endoscopic scores (mLKS), olfactory function assessed by KVSS II, oral corticosteroid (CS) use, and disease control status. Subgroup analyses were conducted for eosinophilic CRS (ECRS) and non-eosinophilic CRS (NECRS). Results: The BI group showed significantly greater improvement in total SNOT-22 scores than the SI group (p < 0.0001), particularly in rhinological symptoms. Endoscopic outcomes also favored BI, with greater reductions in total mLKS and mucosal edema scores. These benefits were observed in both ECRS and NECRS, although objective endoscopic improvements were more pronounced in ECRS. Patients receiving BI required fewer courses of oral CS (18.42% vs. 52.38%, p = 0.01) and demonstrated better disease control (p = 0.03). However, no significant difference was observed in olfactory function. Conclusions: BI provides superior symptom improvement, better endoscopic healing, and reduced oral CS use compared with SI during postoperative CRS maintenance, supporting its use in both ECRS and non-ECRS subgroups.