联合皮质类固醇治疗可改善慢性鼻-鼻窦炎伴鼻息肉患者的鼻内镜手术疗效：一项前瞻性队列研究

Combined corticosteroid therapy enhances outcomes of endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps: a prospective cohort study.

作者信息

Liao Zhiping, Xue Zhangwei, Huang Jinqiao, Mao Linwei, Lin Chaofan, Lin Enrun

机构信息

Department of Otolaryngology, Affiliated Hospital of Putian University Putian 351100, Fujian, China.

出版信息

Am J Transl Res. 2025 Jul 15;17(7):5173-5185. doi: 10.62347/XYEC4626. eCollection 2025.

DOI:10.62347/XYEC4626

PMID:40821092

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12351598/

Abstract

OBJECTIVES

To compare the efficacy and safety of nasal endoscopic surgery combined with pharmacological therapy versus surgery alone for chronic rhinosinusitis with nasal polyps (CRSwNP).

METHODS

In this prospective cohort study, 94 CRSwNP patients were randomized into two groups: a drug combination group (surgery + budesonide suspension, n=47) and a surgery-alone group (n=47). Outcomes were assessed at 1, 3, 6, 9, 12, and 18 months postoperatively, including Lund-Kennedy scores, SNOT-22 (with subdomain analysis), inflammatory biomarkers (blood/tissue eosinophils, IL-4, IL-5, IgE), nasal ventilation parameters (NMCA, DCAN), mucociliary clearance rate, and olfactory function scores.

RESULTS

Compared with surgery alone, the combination group showed significantly lower Lund-Kennedy scores at 6 months (P=0.036), 12 months (P<0.010), and 18 months (P<0.010). SNOT-22 subdomain analysis revealed greater improvements in nasal symptoms at postoperative 3 months (P<0.010) and sleep dysfunction at postoperative 1 month (3.12±0.58 vs. 3.73±0.63, P=0.007). The recurrence rate was significantly lower in the combination group (2.13% vs. 8.51%, P<0.010). Inflammatory biomarkers showed greater suppression in the combination group, including a 41.3% reduction in IL-5 at postoperative 12 months (P<0.010) and a sustained decrease in peripheral blood eosinophil percentage at postoperative 18 months (P<0.010). Nasal ventilation improved at postoperative 12 months (NMCA, P<0.010). Mucociliary clearance was significantly enhanced in the combination group at postoperative 12 months (5.210±0.360 vs. 4.812±0.334 mm/min, P<0.011). Olfactory function scores were significantly better at 6 months (P<0.012) and 12 months (P<0.010).

CONCLUSION

Compared to surgery alone, combining corticosteroids with surgery more effectively suppresses type-2 inflammation, improves multidimensional symptom control (particularly nasal and sleep domains), enhances nasal function, and reduces recurrence. This combination strategy offers a more comprehensive strategy for CRSwNP management.

摘要

目的

比较鼻内镜手术联合药物治疗与单纯手术治疗慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的疗效和安全性。

方法

在这项前瞻性队列研究中，94例CRSwNP患者被随机分为两组：药物联合组（手术+布地奈德混悬液，n = 47）和单纯手术组（n = 47）。在术后1、3、6、9、12和18个月评估结果，包括Lund-Kennedy评分、SNOT-22（进行子域分析）、炎症生物标志物（血液/组织嗜酸性粒细胞、IL-4、IL-5、IgE）、鼻通气参数（NMCA、DCAN）、黏液纤毛清除率和嗅觉功能评分。

结果

与单纯手术相比，联合组在术后6个月（P = 0.036）、12个月（P < 0.010）和18个月（P < 0.010）时Lund-Kennedy评分显著更低。SNOT-22子域分析显示，术后3个月鼻症状改善更明显（P < 0.010），术后1个月睡眠功能障碍改善更明显（3.12±0.58 vs. 3.73±0.63，P = 0.007）。联合组的复发率显著更低（2.13% vs. 8.51%，P < 0.010）。炎症生物标志物在联合组受到更大抑制，包括术后12个月IL-5降低41.3%（P < 0.010），术后18个月外周血嗜酸性粒细胞百分比持续下降（P < 0.010）。术后12个月鼻通气改善（NMCA，P < 0.010）。联合组术后12个月黏液纤毛清除率显著提高（5.210±0.360 vs. 4.812±0.334 mm/min，P < 0.011）。嗅觉功能评分在术后6个月（P < 0.012）和12个月（P < 0.010）时显著更好。