Meltzer E O, Jalowayski A A, Orgel H A, Harris A G
Allergy & Asthma Medical Group and Research Center, San Diego, Calif, USA.
J Allergy Clin Immunol. 1998 Jul;102(1):39-49. doi: 10.1016/s0091-6749(98)70053-3.
Efficacy of topical nasal steroid therapy for allergic rhinitis is usually evaluated by patient and clinician assessments of subjective symptom changes in diaries and at clinical interviews.
We sought to complement the subjective measures with objective measures of nasal cytology, biochemistry, and function.
In this double-blind, randomized study patients with seasonal allergic rhinitis (SAR) 12 years of age or older received 200 microg mometasone furoate nasal spray (n = 80) or placebo spray (n = 41) once daily for 2 weeks. Subjective assessments by clinician and patient comprised symptom/sign scores and overall therapeutic response evaluations. Objective measures included nasal cytology, nasal biochemistry, nasal airway resistance (NAR), mucociliary clearance, and olfactory functions.
Mometasone furoate produced a significantly greater decrease than placebo in subjective measures of SAR for total symptom score (-46% vs -30%, p < 0.05), total nasal score (-47% vs -30%, p < 0.024), individual nasal symptom scores, and overall therapeutic response. The objective measures of eosinophil, basophil, and neutrophil counts and mucociliary clearance were significantly better in mometasone furoate- than in placebo-treated patients. Similarly, within-treatment statistically significant improvements were produced by mometasone furoate but not by placebo sprays for levels of eosinophilic cationic protein, tryptase and albumin, NAR, and odor identification. Significant positive correlations were found between NAR and nasal stuffiness and between eosinophils, basophils, and neutrophils and both eosinophilic cationic protein and albumin.
Subjective measures of SAR were significantly improved in the mometasone furoate group by comparison with placebo-treated patients. Objective assessments supported the subjective findings because within-treatment measures were frequently significantly improved after mometasone furoate treatment but not after placebo treatment.
变应性鼻炎局部用鼻用类固醇疗法的疗效通常通过患者和临床医生对日记中主观症状变化的评估以及临床访谈来评价。
我们试图用鼻细胞学、生物化学和功能的客观指标来补充主观指标。
在这项双盲、随机研究中，12岁及以上的季节性变应性鼻炎（SAR）患者每天接受一次200微克糠酸莫米松鼻喷雾剂（n = 80）或安慰剂喷雾剂（n = 41），持续2周。临床医生和患者的主观评估包括症状/体征评分和总体治疗反应评估。客观指标包括鼻细胞学、鼻生物化学、鼻气道阻力（NAR）、黏液纤毛清除和嗅觉功能。
糠酸莫米松在SAR主观指标方面的改善明显大于安慰剂，总症状评分（-46% 对 -30%，p < 0.05）、总鼻评分（-47% 对 -30%，p < 0.024）、各个鼻症状评分以及总体治疗反应。糠酸莫米松治疗患者的嗜酸性粒细胞、嗜碱性粒细胞和中性粒细胞计数以及黏液纤毛清除的客观指标明显优于安慰剂治疗患者。同样，对于嗜酸性阳离子蛋白、类胰蛋白酶和白蛋白水平、NAR以及气味识别，糠酸莫米松喷雾剂在治疗期间产生了统计学上显著的改善，而安慰剂喷雾剂则未产生。在NAR与鼻阻塞之间以及嗜酸性粒细胞、嗜碱性粒细胞和中性粒细胞与嗜酸性阳离子蛋白和白蛋白之间均发现显著的正相关。
与安慰剂治疗患者相比，糠酸莫米松组的SAR主观指标有显著改善。客观评估支持主观结果，因为治疗期间的指标在糠酸莫米松治疗后经常有显著改善，而安慰剂治疗后则没有。
