Raza T, Elsherif H S, Zulianello L, Plouin-Gaudon I, Landis B N, Lacroix J S
Rhinology-Olfactology Unit, Clinic of Otorhinolaryngology/ Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.
Rhinology. 2008 Mar;46(1):15-22.
To determine a selected concentration of sodium hypochlorite (NaOCl) in saline solution for nasal lavage and evaluate its clinical efficiency in the treatment of symptomatic patients with persistent, Staphylococcus aureus (SA) associated rhinosinusitis (RS).
In vitro tests for cilia and epithelial cell viability were done on reconstituted primary epithelial cells in vitro. Cells were exposed for 5 and 15 minutes twice daily for 5 consecutive days to one of the following conditions, (1) saline, (2) 0.5% NaOCl in saline, and (3) 0.05% NaOCl in saline. In order to evaluate tolerance, immunostaining was done for ezrin and F-actin network and observed with confocal microscopy. The patients (n=20) were all persistent SA symptomatic carriers, with unique patient-specific SA clonotypes, and multiple infection recurrence despite effective systemic antibiotic therapy. Each patient applied first saline alone for 3 months followed by saline + 0.05% NaOCl solution, as nasal lavage twice daily on both nostrils for 3 months. Symptom intensity and endoscopic findings were recorded with visual analogue scale (VAS). Nasal airway resistance (NAR) and nasal Nitric Oxide (NO) levels were measured before and after the saline lavage regimen, and after the saline + NaOCl treatment.
F-actin network loss and decreased expression of ezrin were significant in cells exposed to 0.5%, but not in those exposed to 0.05% NaOCl. These changes were more obvious when exposed for 15 min. than 5 min. daily. The nasal lavage with 0.05% NaOCl in saline was well tolerated and a significant improvement in nasal obstruction (p = 0.001), posterior nasal discharge (p = 0.018), olfaction (p = 0.007) and headache (p = 0.009) was demonstrated. Significant improvement was also recorded in nasal endoscopic grading of oedema (p = 0.001), erythema (p = 0.001), purulent discharge (p = 0.002), nasal crusts (p = 0.001), and NAR (p = 0.05) as measured by rhinomanometry. There was no significant improvement in nasal NO production or subjective anterior nasal discharge. Bacteriological cultures of middle meatus secretions collected one month after the end of the treatment revealed the persistence of SA.
Nasal lavage with 0.05% NaOCl solution in saline is suitable for long-term use and seems to be a good alternative to lavage with saline alone in the management of symptomatic RS associated with recurrent SA infections due to patient-specific SA clonotypes.
确定用于鼻腔灌洗的盐溶液中次氯酸钠（NaOCl）的选定浓度，并评估其对患有持续性金黄色葡萄球菌（SA）相关性鼻窦炎（RS）的有症状患者的临床治疗效果。
对体外重建的原代上皮细胞进行纤毛和上皮细胞活力的体外测试。细胞连续5天每天暴露于以下条件之一两次，每次5分钟和15分钟：（1）生理盐水，（2）盐溶液中的0.5% NaOCl，（3）盐溶液中的0.05% NaOCl。为了评估耐受性，对埃兹蛋白和F-肌动蛋白网络进行免疫染色并通过共聚焦显微镜观察。患者（n = 20）均为持续性SA有症状携带者，具有独特的患者特异性SA克隆型，尽管进行了有效的全身抗生素治疗，但仍多次感染复发。每位患者先单独使用生理盐水3个月，然后使用生理盐水+ 0.05% NaOCl溶液，每天对双侧鼻孔进行两次鼻腔灌洗共3个月。用视觉模拟量表（VAS）记录症状强度和内镜检查结果。在生理盐水灌洗方案前后以及生理盐水+ NaOCl治疗后测量鼻气道阻力（NAR）和鼻一氧化氮（NO）水平。
暴露于0.5% NaOCl的细胞中F-肌动蛋白网络丢失和埃兹蛋白表达降低显著，但暴露于0.05% NaOCl的细胞中则不显著。当每天暴露15分钟时，这些变化比暴露5分钟时更明显。盐溶液中0.05% NaOCl的鼻腔灌洗耐受性良好，鼻塞（p = 0.001）、鼻后滴漏（p = 0.018）、嗅觉（p = 0.007）和头痛（p = 0.009）有显著改善。鼻内镜下水肿分级（p = 0.001）、红斑（p = 0.001）、脓性分泌物（p = 0.002）、鼻痂（p = 0.001）以及通过鼻阻力计测量的NAR（p = 0.05）也有显著改善。鼻NO产生或主观鼻前分泌物无显著改善。治疗结束后1个月收集的中鼻道分泌物细菌培养显示SA持续存在。
盐溶液中0.05% NaOCl溶液的鼻腔灌洗适合长期使用，对于因患者特异性SA克隆型导致的复发性SA感染相关的有症状RS的管理，似乎是单独用生理盐水灌洗的良好替代方法。
