維生素D對慢性鼻—鼻竇炎鼻內(nèi)鏡手術療效的影響
發(fā)布時間：2018-10-10 07:57
【摘要】：目的:1.研究探討慢性鼻-鼻竇炎伴鼻息肉患者血清維生素D水平,分析其與慢性鼻-鼻竇炎的發(fā)病有無明顯相關性。2.臨床觀察予以維生素D的綜合治療對慢性鼻-鼻竇炎伴鼻息肉患者的療效,分析血清維生素D水平對治療效果的影響。方法:1.隨機對照試驗:隨機抽取2016年01月-2016年12月就診于山西醫(yī)科大學第一醫(yī)院耳鼻咽喉頭頸外科的40例慢性鼻-鼻竇炎伴鼻息肉患者為研究對象,入院測血清25羥基維生素D水平。按照計算機產(chǎn)生的隨機數(shù)字序列進行隨機分組:實驗組和對照組。2.全數(shù)受試對象均詳細記錄年齡、身高、體重、吸煙史及飲酒史、血清25羥基維生素D、血清嗜酸性粒細胞計數(shù)及比例、血清肌酐濃度。3.全數(shù)受試對象入院后進行鼻內(nèi)鏡Lund-Kennedy評分、由統(tǒng)一專業(yè)人士進行引導填寫SNOT-20條(sino-nasal outcome test)、視覺模擬量表(visual analogue scale,VAS)。4.由同一術者按照Messerklinger術式行鼻內(nèi)鏡手術,術后抽取鼻腔填塞物后開始進行分組治療。實驗組給予口服維生素D(國藥控股星鯊制藥)800UI/次1次/日+布地奈德噴鼻劑噴鼻(64μg/噴,2噴/次1次/天)。對照組只給以布地奈德噴鼻劑噴鼻,隨訪8周。8周后復查血清25羥基維生素D,再次記錄鼻內(nèi)鏡LundKennedy評分、SNOT-20、視覺模擬量表VAS評分。5.實驗數(shù)據(jù)完成后,將VAS評分和SNOT-20量表資料進行統(tǒng)一整理,分別輸入到Excel中,并進行仔細核對與糾正。SNOT-20量表直接計算條目記分,統(tǒng)計學方法經(jīng)SPSS21.0 Windows統(tǒng)計學軟件進行處理和分析。檢驗水準α=0.05。結果:1.篩查60例試驗對象血清維生素D水平,其中80%患者伴有VD不足(50nmol/L,2%為重度不足、46%為中度不足、52%為輕度不足)。提示在慢性鼻-鼻竇炎患者中血清維生素D水平普遍較低。2.實驗組與對照組患者性別、年齡、體質(zhì)指數(shù)均無統(tǒng)計學差異,具有可比性。3.術前VD水平與血清嗜酸性粒細胞百分比存在線性關系,且呈負相關。4.試驗前兩組間VD水平的差異無統(tǒng)計學意義,尚不能認為試驗前試驗組與對照組的VD水平有統(tǒng)計學差異;試驗后兩組間VD水平的差異有統(tǒng)計學意義,可認為試驗后試驗組VD水平高于對照組。5.治療后,試驗組與對照組間鼻塞、膿涕、頭面部疼痛、VAS總分等評分的差異均具有統(tǒng)計學意義;兩組間嗅覺障礙癥狀評分的差異無統(tǒng)計學意義。治療后試驗組與對照組間SNOT-20量表評分、Lund-Kennedy評分的差異均具有統(tǒng)計學意義。結論:在慢性鼻-鼻竇炎患者中血清維生素D水平普遍較低,臨床上對患者予以補充維生素D后可顯著提高患者血清中25羥基維生素D的水平,與改善慢性鼻-鼻竇炎伴鼻息肉患者的臨床癥狀及提高臨床綜合治療效果呈正相關。
[Abstract]:Purpose 1. To investigate the serum vitamin D level in patients with chronic rhinosinusitis and nasal polyps, and to analyze the correlation between vitamin D and chronic rhinosinusitis. Objective: to observe the effect of comprehensive treatment of vitamin D on chronic rhinosinusitis with nasal polyps and to analyze the effect of serum vitamin D level on the therapeutic effect in patients with chronic rhinosinusitis and nasal polyps. Method 1: 1. Randomized controlled trial: 40 patients with chronic rhinosinusitis associated with nasal polyps were randomly selected from January 2016 to December 2016 in otolaryngology and head and neck surgery, the first Hospital of Shanxi Medical University. The serum 25 hydroxyvitamin D levels were measured in patients with chronic rhinosinusitis and nasal polyps. According to the computer generated random number sequence were randomly divided: experimental group and control group. 2. Age, height, weight, smoking history and drinking history, serum 25 hydroxyvitamin D, eosinophil count and proportion, serum creatinine concentration were recorded in all subjects. All subjects were given nasal endoscopic Lund-Kennedy score after admission, and were guided by unified professionals to fill out sino-nasal outcome test), visual analogue scale (visual analogue scale,VAS). 4. Nasal endoscopy was performed by the same operator according to Messerklinger procedure. The experimental group was given oral vitamin D (Chinese drug holding star shark pharmaceutical) 800UI/ once a day (64 渭 g / d) budesonide nasal spray (64 渭 g / time once a day). The control group was only given budesonide nasal spray. After 8 weeks follow-up, the serum 25 hydroxyvitamin D was re-examined, and the nasal endoscopy LundKennedy score was recorded again, and the visual analogue scale (VAS) score was 5. 5. After the experiment data were finished, the data of VAS score and SNOT-20 scale were arranged and input into Excel respectively, and SNOT-20 scale was carefully checked and corrected. The statistical method was processed and analyzed by SPSS21.0 Windows software. The test level is 偽 0. 05. The result is 1: 1. Serum vitamin D levels were screened in 60 subjects, of which 80% were accompanied by VD deficiency (50 nmol / L / L 2% was severe deficiency 46% was moderate deficiency 52% was mild deficiency). It suggests that the serum vitamin D level is generally low in patients with chronic rhinosinusitis. There was no significant difference in sex, age and BMI between the experimental group and the control group. There was a linear relationship between preoperative VD level and the percentage of eosinophils in serum, and there was a negative correlation. 4. 4. There was no significant difference in VD levels between the two groups before the trial, and there was no statistical difference between the VD levels between the experimental group and the control group before the trial, and there was a significant difference in the VD level between the two groups after the trial. The level of VD in the experimental group was higher than that in the control group. After treatment, the scores of nasal obstruction, purulent snot and total score of VAS were significantly different between the two groups, but there was no significant difference in the score of olfactory disorders between the two groups. There were significant differences in SNOT-20 scale and Lund Kennedy score between the trial group and the control group after treatment. Conclusion: the serum vitamin D level is generally low in patients with chronic rhinosinusitis. It was positively correlated with the improvement of clinical symptoms and the effect of comprehensive treatment in patients with chronic rhinosinusitis and nasal polyps.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R765.9
本文編號：2261243
[Abstract]:Purpose 1. To investigate the serum vitamin D level in patients with chronic rhinosinusitis and nasal polyps, and to analyze the correlation between vitamin D and chronic rhinosinusitis. Objective: to observe the effect of comprehensive treatment of vitamin D on chronic rhinosinusitis with nasal polyps and to analyze the effect of serum vitamin D level on the therapeutic effect in patients with chronic rhinosinusitis and nasal polyps. Method 1: 1. Randomized controlled trial: 40 patients with chronic rhinosinusitis associated with nasal polyps were randomly selected from January 2016 to December 2016 in otolaryngology and head and neck surgery, the first Hospital of Shanxi Medical University. The serum 25 hydroxyvitamin D levels were measured in patients with chronic rhinosinusitis and nasal polyps. According to the computer generated random number sequence were randomly divided: experimental group and control group. 2. Age, height, weight, smoking history and drinking history, serum 25 hydroxyvitamin D, eosinophil count and proportion, serum creatinine concentration were recorded in all subjects. All subjects were given nasal endoscopic Lund-Kennedy score after admission, and were guided by unified professionals to fill out sino-nasal outcome test), visual analogue scale (visual analogue scale,VAS). 4. Nasal endoscopy was performed by the same operator according to Messerklinger procedure. The experimental group was given oral vitamin D (Chinese drug holding star shark pharmaceutical) 800UI/ once a day (64 渭 g / d) budesonide nasal spray (64 渭 g / time once a day). The control group was only given budesonide nasal spray. After 8 weeks follow-up, the serum 25 hydroxyvitamin D was re-examined, and the nasal endoscopy LundKennedy score was recorded again, and the visual analogue scale (VAS) score was 5. 5. After the experiment data were finished, the data of VAS score and SNOT-20 scale were arranged and input into Excel respectively, and SNOT-20 scale was carefully checked and corrected. The statistical method was processed and analyzed by SPSS21.0 Windows software. The test level is 偽 0. 05. The result is 1: 1. Serum vitamin D levels were screened in 60 subjects, of which 80% were accompanied by VD deficiency (50 nmol / L / L 2% was severe deficiency 46% was moderate deficiency 52% was mild deficiency). It suggests that the serum vitamin D level is generally low in patients with chronic rhinosinusitis. There was no significant difference in sex, age and BMI between the experimental group and the control group. There was a linear relationship between preoperative VD level and the percentage of eosinophils in serum, and there was a negative correlation. 4. 4. There was no significant difference in VD levels between the two groups before the trial, and there was no statistical difference between the VD levels between the experimental group and the control group before the trial, and there was a significant difference in the VD level between the two groups after the trial. The level of VD in the experimental group was higher than that in the control group. After treatment, the scores of nasal obstruction, purulent snot and total score of VAS were significantly different between the two groups, but there was no significant difference in the score of olfactory disorders between the two groups. There were significant differences in SNOT-20 scale and Lund Kennedy score between the trial group and the control group after treatment. Conclusion: the serum vitamin D level is generally low in patients with chronic rhinosinusitis. It was positively correlated with the improvement of clinical symptoms and the effect of comprehensive treatment in patients with chronic rhinosinusitis and nasal polyps.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R765.9
【參考文獻】
相關期刊論文 前3條
1 裴育;劉敏燕;盧艷慧;成曉玲;方福生;馬麗超;金萌萌;李楠;鐘文雯;李劍;李春霖;;北京市某社區(qū)漢族男性維生素D營養(yǎng)狀態(tài)及與骨轉(zhuǎn)換指標的關系[J];中華骨質(zhì)疏松和骨礦鹽疾病雜志;2013年04期
2 ;慢性鼻-鼻竇炎診斷和治療指南(2012年,昆明)[J];中國醫(yī)刊;2013年11期
3 朱漢民;程群;甘潔民;杜艷萍;洪維;朱曉穎;李慧林;;上海地區(qū)人群維生素D狀態(tài)研究[J];中華骨質(zhì)疏松和骨礦鹽疾病雜志;2010年03期
，本文編號：2261243
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