【摘要】：目的:觀察鼻用激素聯(lián)合二代抗組胺藥或白三烯受體拮抗劑對(duì)中-重度變應(yīng)性鼻炎患者的臨床療效,探討變應(yīng)性鼻炎患者個(gè)性化治療的優(yōu)選方案。方法:將57例持續(xù)性中-重度變應(yīng)性鼻炎患者隨機(jī)分為3組,分別用糠酸莫米松鼻噴劑(MOM組)、糠酸莫米松鼻噴劑聯(lián)合氯雷他定(MOM+L組)、糠酸莫米松鼻噴劑聯(lián)合孟魯司特鈉(MOM+M組)連續(xù)治療4周,采用"癥狀分級(jí)評(píng)分法"對(duì)治療前和治療后1、2、4周時(shí)鼻塞、鼻癢、噴嚏和流涕4項(xiàng)臨床癥狀進(jìn)行評(píng)分,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:治療后各組患者鼻部癥狀總分均呈持續(xù)性下降趨勢(shì),且不同時(shí)間點(diǎn)之間均差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)于鼻塞癥狀,MOM+M組在治療后2、4周時(shí)的癥狀評(píng)分顯著低于MOM組和MOM+L組。對(duì)于噴嚏、鼻癢癥狀,在治療后1、2和4周時(shí)MOM+L組評(píng)分均最低,且與MOM組相比均差異有統(tǒng)計(jì)學(xué)意義(P0.05),而MOM組和MOM+M組間均差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)于流涕癥狀,治療后各組流涕癥狀評(píng)分均呈下降趨勢(shì),而MOM+L組和MOM+M組評(píng)分下降的更為明顯;其中,治療后1、2周時(shí)MOM+L組的評(píng)分顯著低于MOM組(P0.05),治療后2、4周時(shí)MOM+M組的評(píng)分顯著低于MOM組(P0.05),而MOM+L組和MOM+M組之間均差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:鼻噴激素單用或聯(lián)合二代抗組胺藥、白三烯受體拮抗劑均能有效控制中-重度變應(yīng)性鼻炎患者的鼻部癥狀,聯(lián)合用藥效果更佳。對(duì)于緩解鼻塞癥狀,鼻用激素聯(lián)合白三烯受體拮抗劑更具優(yōu)勢(shì);對(duì)于緩解鼻癢、噴嚏癥狀,鼻用激素聯(lián)合二代抗組胺藥效果更佳;對(duì)于流涕癥狀,鼻用激素聯(lián)合二代抗組胺藥或白三烯受體拮抗劑效果相當(dāng),相對(duì)而言聯(lián)合二代抗組胺藥起效較快,聯(lián)合白三烯受體拮抗劑起效較慢。
[Abstract]:Objective: to observe the clinical effect of nasal hormone combined with second generation antihistamine or leukotriene receptor antagonist in patients with moderate to severe allergic rhinitis, and to explore the optimal scheme for individualized treatment of allergic rhinitis. Methods: Fifty-seven patients with persistent moderate to severe allergic rhinitis were randomly divided into three groups: MOM group, MOM group and (MOM L group. The patients were treated with momethasone furoate nasal spray combined with montelukast sodium (MOM M group for 4 weeks. The clinical symptoms of nasal obstruction, itching, sneezing and runny were evaluated by "symptom grading method" before and after treatment. Statistical analysis was carried out. Results: after treatment, the total scores of nasal symptoms of each group showed a continuous downward trend, and the differences between different time points were statistically significant (P0.05). The score of nasal congestion in, MOM M group was significantly lower than that in MOM group and MOM L group 2 weeks after treatment. For sneezing and nasal itch symptoms, the scores of MOM L group were the lowest at 2 and 4 weeks after treatment, and there was significant difference compared with MOM group (P0.05), but there was no significant difference between MOM group and MOM M group (P0.05). For the symptoms of snot, the scores of snot in each group showed a downward trend after treatment, but the scores of MOM L and MOM M decreased more obviously. One week after treatment, the score of MOM L group was significantly lower than that of MOM group (P0.05), the score of MOM M group was significantly lower than that of MOM group at 2 weeks after treatment (P0.05), but there was no significant difference between MOM L group and MOM M group (P0.05). Conclusion: the nasal symptoms of patients with moderate to severe allergic rhinitis can be effectively controlled by nasal spray alone or combined with second generation antihistamines and leukotriene receptor antagonists. For relieving nasal congestion symptoms nasal hormone combined with leukotriene receptor antagonist is more advantageous for relieving nasal itching sneezing symptoms nasal hormone combined with second-generation antihistamine. The effects of nasal hormone combined with second generation antihistamines or leukotrienes receptor antagonists were similar to those of second generation antihistamine drugs, but the effects of combination of second generation antihistamine drugs and leukotriene receptor antagonists were relatively fast.
【作者單位】： 溫州醫(yī)科大學(xué)附屬第一醫(yī)院耳鼻咽喉科;
【基金】：浙江省自然科學(xué)基金一般項(xiàng)目(No:LY17H130002) 溫州市科技局公益性科技計(jì)劃項(xiàng)目(No:Y20150270)
【分類號(hào)】：R765.21

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