翼管神经切断术治疗血管运动性鼻炎的疗效及机制的探讨

发布时间：2018-04-19 07:43

本文选题：鼻炎 + 血管运动性鼻炎　；参考：《中南大学》2010年硕士论文

【摘要】： 目的：应用“鼻结膜炎生存质量表’'(RQLQ)评价鼻内镜下翼管神经切断术治疗血管运动性鼻炎的临床疗效。方法： 2005年1月-2007年1月收治的顽固性血管运动性鼻炎经鼻内镜下翼管神经切断术的患者45例,对术前及术后3-5年的疗效用“鼻炎生存质量表(RQLQ)"进行评估。结果: 1.按症状积分评价疗效,术后3-5年的显效病例为37例(82.2%),有效病例4例(8.9%),无效4例(8.9%)。生活质量表评价显示,术后鼻眼和非鼻眼症状、日常生活及睡眠质量、情感状态都显著改善(表1,P0.001),解决实际问题能力也显著增强。鼻眼症状中改善最显著的是喷嚏和清涕(p0.0001)。术后量表总评分下降超过50%的39例(86.7%),总评分下降不超过20%的3例(6.7%)。 2.追踪随访45例病人术前术后鼻结膜炎生活质量表存在显著性差异,P0.05。结论: 使用鼻炎症状积分或鼻结膜炎生存质量量表评价鼻内镜下翼管神经切断术治疗血管运动性鼻炎得出其手术疗效显著,安全性好。目的：鼻内镜下翼管神经切断术是一种被推荐在术后能保留患者鼻部基础功能,并在较长时间内能有效缓解血管运动性鼻炎的手术治疗方式。这项研究是通过研究VIP、CGRP、SP,神经功能相关肽以及IL-4、IL-5等炎症因子在血管运动性鼻炎鼻腔黏膜中术前术后的表达和分布的改变,来探讨鼻内镜下翼管神经切断术治疗血管运动性鼻炎的临床可行性,通过研究鼻内镜下翼管神经切断术治疗血管运动性鼻炎后局部鼻腔黏膜炎症相关因子改变,对解释该病的发病机制以及探讨其诊断、治疗等方面能够提供一条新的思路。方法：对2009年6月-2009年12月我院收入院的20例血管运动性鼻炎患者实施了鼻内镜下翼管神经切断术,并于术后6个月行追踪复查随访,其中10例未失访患者,取术前及术后3个月鼻腔鼻甲黏膜,同时取5例正常鼻腔鼻甲黏膜,通过HE染色和细胞免疫学试验观察鼻腔鼻甲黏膜中的P物质(SP),降钙素相关蛋白(CGRP),血管活性肽(VIP), IL-4, IL-5,嗜酸性粒细胞计数变化情况,并进行比较分析。结果： 1.血管活性肽(VIP),降钙素相关蛋白(CGRP), P物质(SP)术前术后比较存在显著性差异,p0.05。 2. IL-4, IL-5等生物活性物质在术前术后比较存在显著性差异,p0.05。 3.血管活性肽(VIP),降钙素相关蛋白(CGRP), P物质(SP)、IL-4, IL-5等生物活性物质在实验组术后标本与对照组标本比较无显著性差异,p0.05。结论: 1.血管运动性鼻炎的发病可能与神经相关肽相关,同时可能通过激活Th2分泌的细胞因子IL-4、IL-5等发挥作用,而引起变应性鼻炎类似症状。 2.翼管神经切断通过降低神经肽VIP、CGRP和SP等,以及Th2分泌的细胞因子在鼻黏膜中的水平,从而抑制血管运动性鼻炎的症状。
[Abstract]:Objective:To evaluate the clinical effect of endoscopic pterygotomy in the treatment of vasomotor rhinitis by RQLQ.Methods:From January 2005 to January 2007, 45 patients with refractory vasomotor rhinitis underwent transnasal endoscopic pterygotomy. The efficacy of RQLQ before and after operation was evaluated with rhinitis quality of life (RQLQ).Results:1.According to the symptom score, 37 cases of marked effect were found in 3 to 5 years after operation, 4 cases with effective cases with 8. 9% and 4 cases with no effect with 8. 9%.The evaluation of quality of life table showed that the symptoms of nasal eye and non-nasal eye, the quality of daily life and sleep, and the emotional state were improved significantly (Table 1, P 0.001), and the ability to solve practical problems was also significantly improved.The most significant improvement in nasal and eye symptoms was sneezing and snot (P 0.0001).The total score of the scale decreased by more than 50% in 39 cases (86.7%) and the total score in 3 cases (less than 20%).2.The quality of life (QOL) of 45 patients with rhinoconjunctivitis was significantly different before and after operation (P 0.05).Conclusion:To evaluate the efficacy and safety of endoscopic pterygotomy in the treatment of vasomotor rhinitis with rhinitis symptom score or quality of life scale for conjunctivitis.Objective:Endoscopic pterygotomy is a recommended surgical treatment that can preserve the basic function of the nasal region and relieve vasomotor rhinitis for a long time.The purpose of this study was to investigate the expression and distribution of inflammatory factors such as VIPG CGRPU SPP, neuro-function-related peptide and IL-4 / IL-5 in nasal mucosa of patients with vasomotor rhinitis before and after operation.To explore the clinical feasibility of endoscopic pterygotomy in the treatment of vasomotor rhinitis, and to study the changes of local nasal mucosal inflammation related factors after endoscopic pterygotomy in the treatment of vasomotor rhinitis.It can provide a new way to explain the pathogenesis of the disease and to discuss its diagnosis and treatment.Methods:Twenty patients with vasomotor rhinitis admitted to our hospital from June 2009 to December 2009 were treated with endoscopic pterygotomy and followed up 6 months after operation.The mucous membrane of nasal cavity and turbinate was taken before and 3 months after operation, and 5 cases of normal nasal turbinate mucosa were taken out at the same time.The changes of substance P (SP), calcitonin associated protein (CGR), vasoactive peptide (VIPP), IL-4, IL-5 and eosinophil in nasal turbinate mucosa were observed by HE staining and cell immunological test.Results:1.There was significant difference in vasoactive peptide (VIPP), calcitonin associated protein (CGRP), substance P (P) between the two groups before and after operation (P 0.05).2.IL-4, IL-5 and other bioactive substances were significantly different before and after operation (P 0.05).3.There was no significant difference in bioactive substances such as vasoactive peptide VIPP, calcitonin related protein (CGRP), substance P (SP), IL-4 and IL-5 between the experimental group and the control group (p 0.05).Conclusion:1.The pathogenesis of vasomotor rhinitis may be related to neuro-related peptides, and it may play a role by activating the cytokine IL-4 and IL-5 secreted by Th2, which may cause allergic rhinitis similar symptoms.2.Pterygotomy inhibits the symptoms of vasomotor rhinitis by reducing the levels of neuropeptide VIPP CGRP and SP and cytokines secreted by Th2 in nasal mucosa.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21

【相似文献】