Pinto Bezerra Soter A C, Bezerra T F, Pezato R, Teles Abdo T R, Pilan R M, Pinna F R, Gevaert P, van Zele T, Bachert C, Voegels R L
Department of Otolaryngology and Ophthalmology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Upper Airway Research Laboratory (URL), Department of Otorhinolaryngology, Ghent University Hospital, Ghent University, Ghent, Belgium.
Rhinology. 2017 Jun 1;55(2):175-180. doi: 10.4193/Rhino15.291.
This study aimed to assess clinical outcomes of long-term low-dose oral doxycycline therapy in difficult-to-treat chronic rhinosinusitis with polyps (CRSwNP).
This was a prospective, open-label study of 60 patients with difficult-to-treat CRSwNP who had undergone endoscopic sinus surgery. Patients were divided into two groups: 28 received nasal steroids, saline irrigation, and doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks, while 30 received only nasal steroids and saline irrigation. The main outcome measure was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Other outcome measures were the SNOT-20, NOSE, and Lund-Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, non-steroidal-exacerbated respiratory disease (NERD), and baseline serum IgG, IgA, IgE, IgM, ANCA, and eosinophil count.
There was an adequate effect size of doxycycline treatment on clinically meaningful significant improvement of SNOT-20. Patients who received doxycycline also had significantly better outcomes regarding SNOT-20, NOSE, and Lund-Kennedy scores. There was a negative association among a clinically significant improvement of SNOT-20 and presence of asthma, NERD, and elevated serum IgE levels before treatment.
These findings suggest that doxycycline may have a beneficial role for CRSwNP patients, especially for patients without asthma, NERD or high levels of serum IgE before treatment.
本研究旨在评估长期低剂量口服多西环素治疗伴有鼻息肉的难治性慢性鼻-鼻窦炎（CRSwNP）的临床疗效。
这是一项针对60例接受过鼻内镜鼻窦手术的难治性CRSwNP患者的前瞻性、开放标签研究。患者分为两组：28例接受鼻用类固醇、盐水冲洗和多西环素（首日200mg，随后每日100mg）治疗12周，而30例仅接受鼻用类固醇和盐水冲洗。主要结局指标是多西环素治疗对SNOT-20临床意义上的显著改善的充分效应量。其他结局指标为SNOT-20、NOSE和Lund-Kennedy评分。还分析了以下参数：哮喘、鼻炎、非甾体类药物加重的呼吸道疾病（NERD）以及基线血清IgG、IgA、IgE、IgM、抗中性粒细胞胞浆抗体（ANCA）和嗜酸性粒细胞计数。
多西环素治疗对SNOT-20临床意义上的显著改善具有充分效应量。接受多西环素治疗的患者在SNOT-20、NOSE和Lund-Kennedy评分方面也有显著更好的结果。SNOT-20的临床显著改善与哮喘、NERD的存在以及治疗前血清IgE水平升高之间存在负相关。
这些发现表明，多西环素可能对CRSwNP患者有益，尤其是对治疗前无哮喘、NERD或血清IgE水平不高的患者。
