de Oliveira Isamara Simas, Borges Crosara Paulo Fernando Tormin, Cassali Geovanni Dantas, Dos Reis Diego Carlos, Rodrigues Danilo Santana, Nunes Flavio Barbosa, Guimarães Roberto Eustáquio Santos
Post Graduate Program in Surgery and Ophthalmology, Universidade Federal de Minas Gerais [UFMG], Belo Horizonte, Brazil.
Allergy Rhinol (Providence). 2016 Jan;7(2):55-61. doi: 10.2500/ar.2016.7.0160. Epub 2016 Jul 26.
Macrolides used as immunomodulators are a promising tool for chronic inflammatory airway diseases. Eosinophilic nasal polyposis (ENP) is still considered a disease that is difficult to control with the currently standardized treatments.
To evaluate prolonged treatment with low-dose azithromycin for ENP based on clinical and histopathologic variables.
The present investigation was a self-paired case study of 33 patients with ENP. A comparison was performed between patients before and after treatment with azithromycin for 8 weeks. The patients were subjected to clinical examinations, staging (three-dimensional imaging by endoscopy), application of the questionnaire, and biopsy of nasal polyps at the beginning and at the end of the treatment.
The treatment yielded a clinical improvement regarding the two variables studied: polyposis staging (69.7%) and questionnaire (57.6%). We did not find significant differences in the inflammatory pattern and in the percentage or absolute number of eosinophils per field between samples obtained before and after the treatment (p > 0.05). There was no difference between the answers obtained from groups with and without asthma and/or aspirin intolerance (p > 0.3). The patients with advanced initial staging exhibited lower subjective improvement index and staging reduction (p = 0.031 and p = 0.012, respectively).
Based on this study, azithromycin may be considered as another therapeutic option for ENP. However, further studies are necessary to define the real mechanism of action involved.
作为免疫调节剂使用的大环内酯类药物是治疗慢性炎症性气道疾病的一种有前景的工具。嗜酸性粒细胞性鼻息肉（ENP）仍然被认为是一种难以通过目前标准化治疗进行控制的疾病。
基于临床和组织病理学变量评估低剂量阿奇霉素对ENP的长期治疗效果。
本研究是一项对33例ENP患者进行的自身配对病例研究。对阿奇霉素治疗8周前后的患者进行了比较。在治疗开始和结束时，对患者进行了临床检查、分期（通过内镜进行三维成像）、问卷调查以及鼻息肉活检。
治疗在两个研究变量方面取得了临床改善：息肉分期（69.7%）和问卷调查（57.6%）。我们在治疗前后获得的样本之间，未发现炎症模式以及每视野嗜酸性粒细胞百分比或绝对数量存在显著差异（p>0.05）。有哮喘和/或阿司匹林不耐受组与无哮喘和/或阿司匹林不耐受组的回答之间没有差异（p>0.3）。初始分期较高的患者主观改善指数和分期降低程度较低（分别为p = 0.031和p = 0.012）。
基于本研究，阿奇霉素可被视为ENP的另一种治疗选择。然而，需要进一步研究来确定其中真正的作用机制。
