Wang Tianqi, Su Jinfei, Feng Yanjun
Department of Otorhinolaryngology, Head and Neck Surgery Capital Medical University Xuanwu Hospital, No. 45 Changchunjie Street, Xicheng District, Beijing, 100053, China,
Eur Arch Otorhinolaryngol. 2015 Aug;272(8):1923-9. doi: 10.1007/s00405-014-3269-y. Epub 2014 Sep 13.
Chronic rhinosinusitis (CRS) is believed to be the result of an exaggerated reaction to fungi in the nasal mucosa, and topical amphotericin B (AMB) is a commonly used treatment. The purpose of this study was to perform a meta-analysis of high-quality comparative studies to examine the efficacy of topical AMB for the treatment of CRS. A search was conducted of Medline, Cochrane, EMBASE, and ISI Web of Knowledge until December 31, 2013 using combinations of the search terms chronic rhinosinusitis, human, treatment, antibiotics, nasal irrigation, nebulized, nasal lavage, sinonasal rinses, and antimicrobials. Inclusion criteria were (1) comparative studies, (2) a diagnosis of CRS or chronic sinusitis, and (3) the intervention was a topical antifungal. The primary outcome measure was quality of life (QOL), and the secondary was nasal endoscopy score. Of 235 article initially identified, five randomized controlled trials were included in the meta-analysis. Analysis of four studies with complete QOL data found no difference between treatment and placebo groups [standard difference in means 0.78, 95 % confidence interval (CI) -0.25 to 1.81, P = 0.138]. Analysis of four studies with complete nasal endoscopy score data found no difference between the treatment and placebo groups (standard difference in means 0.34, 95 % CI -0.08 to 0.76, P = 0.117). AMB is not more effective than placebo in improving QOL or nasal endoscopy scores in patients with CRS.
慢性鼻-鼻窦炎（CRS）被认为是鼻腔黏膜对真菌的过度反应所致，局部应用两性霉素B（AMB）是常用的治疗方法。本研究的目的是对高质量的比较研究进行荟萃分析，以检验局部应用AMB治疗CRS的疗效。截至2013年12月31日，通过使用慢性鼻-鼻窦炎、人类、治疗、抗生素、鼻腔冲洗、雾化、鼻腔灌洗、鼻窦冲洗和抗菌药物等检索词组合，对Medline、Cochrane、EMBASE和ISI Web of Knowledge进行了检索。纳入标准为：（1）比较研究；（2）CRS或慢性鼻窦炎诊断；（3）干预措施为局部抗真菌治疗。主要结局指标为生活质量（QOL），次要指标为鼻内镜评分。在最初确定的235篇文章中，有5项随机对照试验纳入了荟萃分析。对4项有完整QOL数据的研究分析发现，治疗组和安慰剂组之间无差异[平均标准差0.78，95%置信区间（CI）-0.25至1.81，P = 0.138]。对4项有完整鼻内镜评分数据的研究分析发现，治疗组和安慰剂组之间无差异（平均标准差0.34，95%CI -0.08至0.76，P = 0.117）。在改善CRS患者的QOL或鼻内镜评分方面，AMB并不比安慰剂更有效。
