Peric Aleksandar, Vojvodic Danilo, Baletic Nenad, Peric Aneta, Miljanovic Olivera
Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Dec;154(4):327-33. doi: 10.5507/bp.2010.049.
Cytokine levels in nasal secretions reflect the inflammatory status of the nasal and paranasal sinus mucosa and the development of mucosal disease. The results of previous investigations suggest that macrolide antibiotics can be effective in treatment of chronic rhinosinusitis and nasal polyposis. The aim of this prospective study was to compare the immunomodulatory and clinical effects of long-term low-dose macrolide treatment of nonatopic and atopic patients with nasal polyposis.
Forty (n = 40) patients with nasal polyposis, 22 allergic and 18 nonallergic were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory Th1 cytokines TNF-α and IL-1β, Th2 cytokines IL-4, IL-5 and IL-6, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using flow cytometric method. We also scored each of the 40 patients before and after therapy according to nasal symptom score and endoscopic score.
Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-α (p<0.01) in nasal secretions in nonallergic patients. In subjects with nasal polyposis and allergy, we found decreased levels of IL-8 (p<0.01), IL-6 (p<0.05) and IL-1β (p<0.01). Macrolide therapy decreased the size of polyps in 45.45% of nonatopic and in 50% of atopic patients. After macrolide treatment, we found 67.83% patients in nonallergic group and 55.55% patients in allergic group with improved nasal symptoms.
Long-term low-dose treatment with CAM was effective in the management of nasal polyposis. Our results showed that macrolide treatment of nasal polyposis have different immunomodulatory and similar clinical effects in allergic and nonallergic patients.
鼻分泌物中的细胞因子水平反映了鼻腔和鼻窦黏膜的炎症状态以及黏膜疾病的发展。先前的研究结果表明，大环内酯类抗生素可有效治疗慢性鼻窦炎和鼻息肉。本前瞻性研究的目的是比较长期低剂量大环内酯治疗非特应性和特应性鼻息肉患者的免疫调节作用和临床效果。
40例鼻息肉患者，其中22例为变应性，18例为非变应性，给予克拉霉素（CAM）500mg/天单次口服，持续8周。采用流式细胞术方法，在治疗前后测量鼻液样本中促炎Th1细胞因子TNF-α和IL-1β、Th2细胞因子IL-4、IL-5和IL-6以及趋化因子IL-8的水平。我们还根据鼻症状评分和内镜评分对40例患者治疗前后进行评分。
治疗后，我们发现非变应性患者鼻分泌物中IL-8（p<0.01）和TNF-α（p<0.01）水平显著降低。在鼻息肉合并变应性疾病的患者中，我们发现IL-8（p<0.01）、IL-6（p<0.05）和IL-1β（p<0.01）水平降低。大环内酯治疗使45.45%的非特应性患者和50%的特应性患者息肉体积减小。大环内酯治疗后，我们发现非变应性组67.83%的患者和变应性组55.55%的患者鼻症状改善。
长期低剂量CAM治疗对鼻息肉的管理有效。我们的结果表明，大环内酯治疗鼻息肉在变应性和非变应性患者中具有不同的免疫调节作用和相似的临床效果。
