Department of Otorhinolaryngology, University Hospital Ghent, 9000 Ghent, Belgium.
J Allergy Clin Immunol. 2010 May;125(5):1069-1076.e4. doi: 10.1016/j.jaci.2010.02.020.
There is little scientific evidence to support the current practice of using oral glucocorticosteroids and antibiotics to treat patients with chronic rhinosinusitis and nasal polyps.
We evaluated the effects of oral glucocorticoids and doxycycline on symptoms and objective clinical and biological parameters in patients with chronic rhinosinusitis and nasal polyps.
In a double-blind, placebo-controlled, multicenter trial, we randomly assigned 47 participants with bilateral nasal polyps to receive either methylprednisolone in decreasing doses (32-8 mg once daily), doxycycline (200 mg on the first day, followed by 100 mg once daily), or placebo for 20 days. Participants were followed for 12 weeks. Patients were assessed for nasal peak inspiratory flow and symptoms and by nasal endoscopy. Markers of inflammation such as eosinophilic cationic protein (ECP), IL-5, myeloperoxidase, matrix metalloproteinase 9, and IgE were measured in nasal secretions. Concentrations of eosinophils, ECP, and soluble IL-5 receptor alpha were measured in peripheral blood samples.
Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo. The effect of methylprednisolone was maximal at week 3 and lasted until week 8, whereas the effect of doxycycline was moderate but present for 12 weeks. Methylprednisolone significantly reduced levels of ECP, IL-5, and IgE in nasal secretions, whereas doxycycline significantly reduced levels of myeloperoxidase, ECP, and matrix metalloproteinase 9 in nasal secretions.
This is the first double-blind, placebo-controlled study to show a significant effect of oral methylprednisolone and doxycycline on size of nasal polyps, nasal symptoms, and mucosal and systemic markers of inflammation.
目前，在治疗慢性鼻-鼻窦炎伴鼻息肉患者时，使用口服糖皮质激素和抗生素的做法缺乏科学依据。
我们评估了口服糖皮质激素和多西环素对慢性鼻-鼻窦炎伴鼻息肉患者症状和客观临床及生物学参数的影响。
在一项双盲、安慰剂对照、多中心试验中，我们将 47 例双侧鼻息肉患者随机分为 3 组，分别接受递减剂量的甲泼尼龙（32-8 mg，每日 1 次）、多西环素（第 1 天 200 mg，随后每日 100 mg）或安慰剂治疗 20 天。患者随访 12 周。通过鼻峰流速和症状评估以及鼻内镜对患者进行评估。测量鼻分泌物中的炎症标志物，如嗜酸性阳离子蛋白（eosinophilic cationic protein，ECP）、IL-5、髓过氧化物酶、基质金属蛋白酶 9 和 IgE。还测量外周血样本中的嗜酸性粒细胞、ECP 和可溶性 IL-5 受体 α 的浓度。
与安慰剂相比，甲泼尼龙和多西环素均显著减小鼻息肉体积。甲泼尼龙的作用在第 3 周达到最大，并持续到第 8 周，而多西环素的作用则适中，但持续 12 周。甲泼尼龙显著降低了鼻分泌物中的 ECP、IL-5 和 IgE 水平，而多西环素显著降低了鼻分泌物中的髓过氧化物酶、ECP 和基质金属蛋白酶 9 水平。
这是第一项显示口服甲泼尼龙和多西环素对鼻息肉大小、鼻部症状以及鼻黏膜和全身炎症标志物具有显著影响的双盲、安慰剂对照研究。
