鼻窦灌注液冲洗对鼻息肉术后鼻黏膜细胞因子的影响

发布时间：2018-04-08 16:40

本文选题：鼻窦灌注液　切入点：鼻腔冲洗　出处：《广州中医药大学》2014年硕士论文

【摘要】：目的：鼻息肉的高复发率是鼻息肉治疗的难点,研究表明鼻息肉的复发是因为鼻腔炎症持续状态存在,而细胞因子与鼻腔炎症关系密切。以往研究认为鼻窦灌注液有良好的抗炎作用,故本文通过鼻内镜术后使用鼻窦灌注液冲洗鼻腔的研究,验证鼻窦灌注液的疗效并观察它对细胞因子(IL-5、IL-8、IL-10、IFN-γ、GM-CSF、TNF-α)的影响。方法：选取2012年3月至2013年6月在广州中医药大学第一附属医院进行手术的鼻息肉患者作为研究对象,将符合研究标准的研究对象分为2组,所有患者均在鼻内镜术后接受3个月的鼻腔冲洗治疗,鼻窦灌注液组使用鼻窦灌注液冲洗鼻腔,而生理盐水组使用0.9%生理盐水。采用SNOT-20及Lund-Kennedy评分评估疗效,并在术中以及术后3个月时分别取鼻腔中鼻道黏膜组织作为检验标本,采用酶联免疫法(ELISA)检测两组黏膜组织中的6项细胞因子水平(IL-5、IL-8、IL-10、IFN-γ、TNF-α、GM-CSF)。将所得数据应用SPSS17.0进行统计学分析,分别对比两组疗效、治疗前后细胞因子改变以及两组的组间差异。结果：符合入选标准的研究对象共39例,其中男性25例,女性14例,男性明显多于女性；年龄在21岁至63岁之间,平均年龄为37.9±12.35岁；湿热蕴积鼻窍型27例,寒湿凝聚鼻窍型14例。 SNOT-20及Lund-Kennedy评分方面,两组自身前后对比均有显著性差异,术后3月两组评分均较术前降低(P0.05)；两组组间比较,治疗前及治疗后两组间均无显著差异(P0.05)。细胞因子水平方面,两组自身前后对比均有显著性差异,术后3月两组各项细胞因子水平(IL-5、IL-8、IL-10、IFN-γ、TNF-α、GM-CSF)较术前显著降低(P0.05)；两组间比较,术前鼻窦灌组和生理盐水组之间各项细胞因子水平无明显差异(P0.05),术后鼻窦灌注液组IL-5、IL-8、IL-10、IFN-γ水平明显低于生理盐水组(P0.05),而术后两组TNF-α、GM-CSF水平相当(P0.05)。结论：术后3月鼻窦灌注液组与生理盐水组在对改善研究对象生活质量及鼻腔形态方面的疗效相当,而鼻窦灌注液对IL-5、IL-8、IL-10、IFN-γ的调节作用强于生理盐水,提示经长期观察也许能降低鼻息肉的复发率。
[Abstract]:Objective:The high recurrence rate of nasal polyps is a difficult point in the treatment of nasal polyps. Studies show that the recurrence of nasal polyps is due to the persistent state of nasal inflammation, and cytokines are closely related to nasal inflammation.Previous studies have shown that the nasal sinus perfusion fluid has a good anti-inflammatory effect. Therefore, the study of nasal cavity irrigation with nasal sinus perfusion fluid after nasal endoscopy was carried out to verify the efficacy of nasal sinus perfusion fluid and to observe its effect on cytokine IL-8 IL-10 IL-10 IFN- 纬 GM-CSFU TNF- 伪.Methods:From March 2012 to June 2013, the patients with nasal polyps who underwent surgery in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine were selected as the study objects. The subjects who met the research criteria were divided into two groups.All the patients were treated with nasal cavity irrigation for 3 months after nasal endoscopy. The nasal cavity was washed with nasal sinus perfusion solution in the nasal sinus perfusion group and 0.9% normal saline was used in the normal saline group.The data were analyzed by SPSS17.0, and the results were compared between the two groups, the changes of cytokines before and after treatment and the differences between the two groups.Results:There were 39 subjects who met the inclusion criteria, including 25 males and 14 females, with more males than females, aged from 21 to 63 years, with an average age of 37.9 卤12.35 years, 27 cases with dampness and heat accumulation of nasal orifices, and 14 cases with cold and wet condensed nose orifices.In terms of SNOT-20 and Lund-Kennedy scores, there were significant differences between the two groups before and after treatment. The scores of the two groups were significantly lower than those of the preoperation at 3 months after operation, and there was no significant difference between the two groups before and after treatment (P 0.05).In terms of cytokine levels, there were significant differences between the two groups before and after operation. The levels of IL-5, IL-8, IL-10, IFN- 伪, TNF- 伪 and GM-CSF in the two groups were significantly lower than those before operation (P 0.05).There was no significant difference in the levels of cytokines between the nasal sinus perfusion group and the normal saline group before operation (P 0.05). The levels of IL-5, IL-8, IL-10, IFN- 纬 in the nasal sinus perfusion fluid group were significantly lower than those in the normal saline group, while the levels of TNF- 伪 GM-CSF in the two groups were similar to that in the normal saline group (P 0.05).Conclusion:Three months after operation, the nasal sinus perfusion solution group and the normal saline group had the same effect on improving the quality of life and the nasal cavity morphology, while the nasal sinus perfusion fluid had stronger regulation effect on IL-5 IL-8 + IL-10 and IFN- 纬 than normal saline, and the effect of the nasal sinus perfusion solution on the improvement of the quality of life and nasal cavity morphology was similar to that of the normal saline group.It suggests that long-term observation may reduce the recurrence rate of nasal polyps.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R276.1

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