Lin L, Lu Q, Tang X Y, Dai F, Wei J J
Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Jun 7;52(6):446-452. doi: 10.3760/cma.j.issn.1673-0860.2017.06.010.
To observe the therapeutic effect of simple 3.0% saline nasal irrigation and combined treatment of 3.0% saline nasal irrigation and budesonide nasal spray for vasomotor rhinitis (VMR), and explore the long-term effect for VMR. Through examination of levels of substance P (SP) and mucin (MUC)5B in nasal lavage fluid, the mechanisms of nasal irrigation treatment for VMR was discussed. One hundred and one patients from Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University with VMR were randomly divided into 4 groups. The number of patients was 24 in control group, 25 in budesonide nasal spray treatment group (budesonide group), 25 in nasal irrigation treatment group (nasal irrigation group) and 27 in budesonide nasal spray + nasal irrigation group (combined treatment group). Control patients were left untreated. Budesonide group was under budesonide nasal spray treatment, nasal irrigation group was treated using 3.0% saline with a temperature of 40℃ and combined treatment group was given both treatments. The duration of the intervention period was 3 months (90 days). Visual Analog Scale (VAS) was used to evaluate nasal symptoms, and the health-related quality of life was assessed using the 12-item Short Form Health Survey version 2.0 (SF-12v2). Enzyme-linked immunosorbent assay (ELISA) was used to assess the contents of SP and MUC5B in nasal lavage fluid before and after 3-month treatments in budesonide and nasal irrigation group in the study. MUC5B in nasal lavage fluid after the SP challenge and anticholinergic drug intervention in control group were also evaluated with ELISA. Nighty out of 101 patients completed the study. In the budesonide and combined treatment group after relevant interventions, the total VAS score of nasal symptoms decreased (5.91±0.21 3.82±0.15, 6.18±0.17 3.92±0.15, value was 8.193, 10.060, respectively, all <0.05) and SF-12v2 score increased (146.00±1.23 152.30±0.97, 146.00±1.08 155.40±0.90, value was 3.982, 6.697, respectively, all <0.05), with both scores showed no significant differences in the nasal irrigation group (5.96±0.17 5.72±0.15, 146.10±1.17 147.00±0.94, value was 1.038, 0.607, respectively, all >0.05) after the first month. In the budesonide and combined treatment group after relevant interventions, the total VAS score of nasal symptoms decreased (5.91±0.21 5.05±0.15, 6.18±0.17 5.10±0.12, value was 3.374, 5.351, respectively, all <0.05) and SF-12v2 score increased (146.00±1.23 150.90±0.76, 146.00±1.08 153.60±0.94, value was 3.373, 5.343, respectively, all <0.05), with both scores showed no significant differences in the nasal irrigation group (5.96±0.17 5.78±0.17, 146.10±1.17 148.10±0.80, value was 0.716, 1.438, respectively, all >0.05) after the second month. By the end of the third month, in nasal irrigation and combined treatment group, the VAS score was diminished (5.96±0.17 4.80±0.12, 6.18±0.17 4.44±0.13, value was 5.485, 8.264, respectively, all <0.05) and SF-12v2 score was elevated (146.10±1.17 150.80±0.96, 146.00±1.08 152.90±0.85, value was 3.163, 5.008, respectively, all <0.05), but there were no significant differences in budesonide group (5.91±0.21 5.68±0.18, 146.00±1.23 148.40±0.85, value was 0.819, 1.587, respectively, all >0.05). Additionally, SP in nasal lavage fluid decreased and MUC5B showed no statistical changes in budesonide group after three months, however, SP showed no any changes and MUC5B reduced significantly in nasal lavage fluid in nasal irrigation group. Furthermore, the anticholinergic drug could not decrease the concentration of MUC5B after the SP challenge in nasal cavity in control group. The therapeutic effect of simple nasal irrigation with 3.0% saline or combined treatment of 3.0% saline nasal irrigation and nasal corticosteroids is superior to simple nasal corticosteroids. Nasal corticosteroids plays a role in the inhibition of sensory nerve endings in nasal mucosa, but neurotransmitter plays a limited role in the pathogenesis of VMR.
观察单纯3.0%盐水鼻腔冲洗及3.0%盐水鼻腔冲洗联合布地奈德鼻喷雾剂治疗血管运动性鼻炎（VMR）的疗效，并探讨其对VMR的长期影响。通过检测鼻灌洗液中P物质（SP）和黏蛋白（MUC）5B的水平，探讨鼻腔冲洗治疗VMR的机制。复旦大学附属华山医院耳鼻咽喉头颈外科的101例VMR患者被随机分为4组。对照组24例，布地奈德鼻喷雾剂治疗组（布地奈德组）25例，鼻腔冲洗治疗组（鼻腔冲洗组）25例，布地奈德鼻喷雾剂+鼻腔冲洗组（联合治疗组）27例。对照组患者未接受治疗。布地奈德组接受布地奈德鼻喷雾剂治疗，鼻腔冲洗组使用温度为40℃的3.0%盐水进行治疗，联合治疗组同时给予两种治疗。干预期为3个月（90天）。采用视觉模拟量表（VAS）评估鼻部症状，使用12项简明健康调查量表第2版（SF-12v2）评估健康相关生活质量。采用酶联免疫吸附测定（ELISA）法评估研究中布地奈德组和鼻腔冲洗组治疗3个月前后鼻灌洗液中SP和MUC5B的含量。对照组在鼻腔给予SP激发试验和抗胆碱能药物干预后，也用ELISA法评估鼻灌洗液中MUC5B的含量。101例患者中有90例完成了研究。在布地奈德组和联合治疗组进行相关干预后，鼻部症状的VAS总分降低（5.91±0.21降至3.82±0.15，6.18±0.17降至3.92±0.15，P值分别为8.193、10.060，均<0.05），SF-12v2评分升高（146.00±1.23升至152.30±0.97，146.00±1.08升至155.40±0.90，P值分别为3.982、6.697，均<0.05），而鼻腔冲洗组在第1个月后这两项评分均无显著差异（5.96±0.17降至5.72±0.15，146.10±1.17升至147.00±0.94，P值分别为1.038、0.607，均>0.05）。在布地奈德组和联合治疗组进行相关干预后，鼻部症状的VAS总分降低（5.91±0.21降至5.05±0.15，6.18±0.17降至5.10±0.12，P值分别为3.374、5.351，均<0.05），SF-12v2评分升高（146.00±1.23升至150.90±0.76，146.00±1.08升至153.60±0.94，P值分别为3.373、5.343，均<0.05），而鼻腔冲洗组在第2个月后这两项评分均无显著差异（5.96±0.17降至5.78±0.17，146.10±1.17升至148.10±0.80，P值分别为0.716、1.438，均>0.05）。到第3个月末，鼻腔冲洗组和联合治疗组的VAS评分降低（5.96±0.17降至4.80±0.12，6.18±0.17降至4.44±0.13，P值分别为5.485、8.264，均<0.05），SF-12v2评分升高（146.10±1.17升至150.80±0.96，146.00±1.08升至152.90±0.85，P值分别为3.163、5.008，均<0.05），但布地奈德组无显著差异（5.91±0.21降至5.68±0.18，146.00±1.23升至148.40±0.85，P值分别为0.819、1.587，均>0.05）。此外，3个月后布地奈德组鼻灌洗液中SP降低，MUC5B无统计学变化，而鼻腔冲洗组鼻灌洗液中SP无变化，MUC5B显著降低。此外，对照组在鼻腔给予SP激发试验后，抗胆碱能药物不能降低MUC5B的浓度。单纯用含3.0%盐水的鼻腔冲洗或3.0%盐水鼻腔冲洗联合鼻用糖皮质激素的治疗效果优于单纯鼻用糖皮质激素。鼻用糖皮质激素在抑制鼻黏膜感觉神经末梢方面起作用，但神经递质在VMR发病机制中的作用有限。
