维生素D对慢性鼻—鼻窦炎鼻内镜手术疗效的影响

发布时间：2018-10-10 07:57

【摘要】：目的:1.研究探讨慢性鼻-鼻窦炎伴鼻息肉患者血清维生素D水平,分析其与慢性鼻-鼻窦炎的发病有无明显相关性。2.临床观察予以维生素D的综合治疗对慢性鼻-鼻窦炎伴鼻息肉患者的疗效,分析血清维生素D水平对治疗效果的影响。方法:1.随机对照试验:随机抽取2016年01月-2016年12月就诊于山西医科大学第一医院耳鼻咽喉头颈外科的40例慢性鼻-鼻窦炎伴鼻息肉患者为研究对象,入院测血清25羟基维生素D水平。按照计算机产生的随机数字序列进行随机分组:实验组和对照组。2.全数受试对象均详细记录年龄、身高、体重、吸烟史及饮酒史、血清25羟基维生素D、血清嗜酸性粒细胞计数及比例、血清肌酐浓度。3.全数受试对象入院后进行鼻内镜Lund-Kennedy评分、由统一专业人士进行引导填写SNOT-20条(sino-nasal outcome test)、视觉模拟量表(visual analogue scale,VAS)。4.由同一术者按照Messerklinger术式行鼻内镜手术,术后抽取鼻腔填塞物后开始进行分组治疗。实验组给予口服维生素D(国药控股星鲨制药)800UI/次1次/日+布地奈德喷鼻剂喷鼻(64μg/喷,2喷/次1次/天)。对照组只给以布地奈德喷鼻剂喷鼻,随访8周。8周后复查血清25羟基维生素D,再次记录鼻内镜LundKennedy评分、SNOT-20、视觉模拟量表VAS评分。5.实验数据完成后,将VAS评分和SNOT-20量表资料进行统一整理,分别输入到Excel中,并进行仔细核对与纠正。SNOT-20量表直接计算条目记分,统计学方法经SPSS21.0 Windows统计学软件进行处理和分析。检验水准α=0.05。结果:1.筛查60例试验对象血清维生素D水平,其中80%患者伴有VD不足(50nmol/L,2%为重度不足、46%为中度不足、52%为轻度不足)。提示在慢性鼻-鼻窦炎患者中血清维生素D水平普遍较低。2.实验组与对照组患者性别、年龄、体质指数均无统计学差异,具有可比性。3.术前VD水平与血清嗜酸性粒细胞百分比存在线性关系,且呈负相关。4.试验前两组间VD水平的差异无统计学意义,尚不能认为试验前试验组与对照组的VD水平有统计学差异;试验后两组间VD水平的差异有统计学意义,可认为试验后试验组VD水平高于对照组。5.治疗后,试验组与对照组间鼻塞、脓涕、头面部疼痛、VAS总分等评分的差异均具有统计学意义;两组间嗅觉障碍症状评分的差异无统计学意义。治疗后试验组与对照组间SNOT-20量表评分、Lund-Kennedy评分的差异均具有统计学意义。结论:在慢性鼻-鼻窦炎患者中血清维生素D水平普遍较低,临床上对患者予以补充维生素D后可显著提高患者血清中25羟基维生素D的水平,与改善慢性鼻-鼻窦炎伴鼻息肉患者的临床症状及提高临床综合治疗效果呈正相关。
[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 伪 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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.9

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