Di Rienzo L, Artuso A, Cerqua N
A.C.O. San Filippo Neri, Unità Operativa di Otorinolaringoiatria, Roma.
Acta Otorhinolaryngol Ital. 2000 Oct;20(5):336-42.
There is a high incidence of post-surgical recurrences of nasal polyps (NP) in patients suffering from the ASA Syndrome. The numerous theories as to the pathogenesis of the ASA Syndrome include an increase in lipoxygenase-mediated arachidonic acid metabolism, with the subsequent hyperproduction of leukotrienes (LT), and an inhibition of the cycloxygenase. Therefore, based on the information acquired on the immunobiological action mechanism of montelukast, a cysteinyl-LT receptor antagonist, it appeared worth testing the effectiveness of this substance in preventing post-surgical NP recurrences in a group of ASA Syndrome patients. After taking a case history, filling out a questionnaire scoring nasal symptoms, undergoing rhinoendoscopy and rhinomanometry, 40 patients suffering from ASA-Syndrome and NP (age range 30-72 years) were recruited for the study. They were uniformly classified according to Lund and Mackay using high resolution CT of the nose and paranasal sinuses performed after at least 1 month of nasal medical treatment. All the patients underwent microendoscopic anterior-posterior ethmoidectomy and bilateral maxillary antrostomy. After removing the nasal packing, the only treatment administered was 10 mg of montelukast/die for 6 months, with the drug suspended for 1 months after the first 3 months of treatment. The monthly follow-up included rhinoendoscopy, rhinomanometry and the questionnaire to score symptoms. After the seventh month a new CT was performed and compared with the pre-operative CT. In a control group of subjects, homogeneous with the test group, momethasone furoate nasal spray was administered at a dose of 100 mcg per nostril/die and loratadin tablets 10 mg/die. The results obtained in the patients treated with montelukast were analogous with those obtained in the second group, and during follow-up all patients showed total absence of any local recurrence, good nasal patency and no significant nasal symptom score on the questionnaire. In no case did the comparative CT, performed after the seventh month, show any signs of recurrence. The patients taking the montelukast reported a significant reduction in the use of steroids and bronchodilator inhalants during the course of the study than did the second group; indeed the number of asthmatic episodes dropped and they reported an improvement in the quality of life. Based on these results, the authors suggest that the use of montelukast in the treatment of post-surgical NP recurrences in ASA Syndrome is possible and advisable, even in synergetic association with the treatment administered to the second group. The positive results also support the hypothesis of altered arachidonic acid metabolism and call attention to the role of cysteinyl-LT in the pathogenesis of the ASA Syndrome.
阿司匹林三联征（ASA综合征）患者术后鼻息肉（NP）复发率很高。关于ASA综合征发病机制的众多理论包括脂氧合酶介导的花生四烯酸代谢增加，随后白三烯（LT）过度产生，以及环氧化酶受到抑制。因此，基于所获得的关于孟鲁司特（一种半胱氨酰白三烯受体拮抗剂）免疫生物学作用机制的信息，在一组ASA综合征患者中测试该物质预防术后NP复发的有效性似乎是值得的。在采集病史、填写鼻症状评分问卷、接受鼻内镜检查和鼻阻力测量后，招募了40名患有ASA综合征和NP的患者（年龄范围30 - 72岁）进行研究。在至少1个月的鼻腔药物治疗后，使用鼻和鼻窦的高分辨率CT，根据Lund和Mackay标准对他们进行统一分类。所有患者均接受了鼻内镜前后筛窦切除术和双侧上颌窦造瘘术。取出鼻腔填塞物后，唯一给予的治疗是每天10毫克孟鲁司特，持续6个月，在治疗的前3个月后停药1个月。每月随访包括鼻内镜检查、鼻阻力测量和症状评分问卷。在第7个月后进行了一次新的CT检查，并与术前CT进行比较。在与试验组同质的对照组受试者中，给予每侧鼻孔每天100微克糠酸莫米松鼻喷雾剂和每天10毫克氯雷他定片。用孟鲁司特治疗的患者所获得的结果与第二组相似，并且在随访期间所有患者均未出现任何局部复发，鼻腔通畅良好，问卷上的鼻症状评分无显著变化。在第7个月后进行的对比CT检查中，未发现任何复发迹象。服用孟鲁司特的患者在研究过程中报告使用类固醇和支气管扩张剂吸入剂的次数比第二组显著减少；事实上，哮喘发作次数减少，他们报告生活质量有所改善。基于这些结果，作者认为在ASA综合征患者术后NP复发的治疗中使用孟鲁司特是可行且可取的，即使与第二组所给予的治疗联合使用也有协同作用。这些阳性结果也支持了花生四烯酸代谢改变的假说，并引起人们对半胱氨酰白三烯在ASA综合征发病机制中作用的关注。
