慢性鼻窦炎可能是一种免疫失调


  March 24, 2004(旧金山) - 研究人员于美国过敏气喘免疫学协会举办的年会发表的一项随机化小型试验指出,慢性鼻窦炎是一种经由空气传播真菌类引发的潜在性免疫失调疾病,能以抗真菌剂的药物有效治疗。
  
  来自美国纽约水牛城大学耳鼻喉科临时教授的第一作者David A. Sherris医师向Medscape表示,他们证明以抗真菌剂能改善慢性鼻窦炎患者的客观结果。Sherris医师是在Mayo诊所进行这项研究。研究人员假设由空气传播的真菌启始了部分对慢性鼻窦炎敏感的患者静脉窦的免疫反应。
  
  在一项随机分配、安慰剂控制、双盲的研究中,30位慢性鼻窦炎的成人患者,接受每日两次鼻腔喷入20mL的amphotericin B、杀真菌剂或安慰剂。其中有24位病患的资料被分析。研究人员在实验一开始及六个月后对病患进行计算机断层摄影(CT),他们并在实验一开始,三个月及六个月后进行内视镜检查。
  
  依据CT的结果,研究人员发现,接受抗真菌剂的病患平均减少8.8%的发炎黏膜增厚,比较之下接受安慰剂的患者增加2.5%。同样地,接受抗微生物的病患剂有70%在内视镜检查计分得到改善,而安慰剂组则无显著改变。与安慰剂组相比,治疗组的鼻腔内黏液interleukin-5浓度也有显著减少。有二位病患对药物治疗产生鼻腔肿胀的过敏性反应。
  
  Sherris医师表示,这项研究显示出使用抗真菌剂治疗慢性鼻窦炎的多中心试验之需要,他们主张更大群的病患和满怀希望地试验,以领导食品药物管理局(FDA)对药品的核准。Sherris医师进一步表示,他早以仿单核准适应症外的使用治疗病患,他认为已有足够的证据,在接下来几年内我们将看到食品及药物管理局的试验。
  
  会议主持人与奥罗拉科罗拉多大学临床教授Allen Adinoff博士表示,假如你相信这些真菌对于引起慢性鼻窦炎的免疫反应是很重要的,这有可能成为令人兴奋的治疗方法。不过,试验是否合理仍有争论,他们需要观察灰尘座落之处。

Chronic Rhinosinusitis May Be<

By
Medscape Medical News

Melissa Schorr

March 24, 2004 (San Francisco) — Chronic rhinosinusitis, potentially an immune disorder triggered by airborne fungus, was effectively treated with antifungal medications in a small randomized clinical trial, researchers said here Tuesday at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

"We demonstrated an improvement using antifungals in an objective finding for people with chronic rhinosinusitis," lead author David A. Sherris, MD, interim chair of the department of otolaryngology at the University of Buffalo in New York, told Medscape. Dr. Sherris conducted the research while at the Mayo Clinic.

The researchers hypothesized that airborne fungi initiate an immune reaction in the sinuses in certain people sensitive to chronic sinusitis.

In a randomized, placebo-controlled, double-blind study, 30 adult patients with chronic rhinosinusitis were either given 20 mL of amphotericin B, a fungicide, or a placebo squirted into the nasal cavity twice daily. Data were analyzed for 24 patients.

Researchers performed computed tomography (CT) of patients at baseline and at six months, and they conducted endoscopic examinations for inflammation at baseline, three, and six months.

Based on CT findings, the researchers found that patients receiving the antifungal had an average reduction of 8.8% in the inflammatory mucosal thickening compared with an increase of 2.5% in those receiving placebo. Similarly, 70% of the patients receiving amphotericin had an improvement in endoscopy scores, while the placebo group showed no change.

The treatment group also had significant reductions of intranasal mucus levels of interleukin-5 compared with the placebo group.

Two patients suffered an allergic reaction to the medication, with intranasal swelling.

This study indicates a need for a multicenter trial using antifungals for chronic sinusitis, Dr. Sherris said. "We advocate a larger group of patients and hopefully trials leading to [Food and Drug Administration] FDA approval of a product."

"I treat patients already with off-label use," Dr. Sherris said. "I think there's enough evidence. You'll see FDA trials within the next couple of years."

"If you believe these fungi are important in causing an immune response that promotes chronic sinusitis, this could potentially be exciting therapy," said Allen Adinoff, MD, session moderator and a clinical professor at the University of Colorado in Aurora. "A trial would be reasonable to consider. This is still controversial. We need to see where the dust settles."

The research was supported by grants from the National Institutes of Health and the Mayo Foundation for Education and Research.

AAAAI 60th Annual Meeting: Abstract 1228. Presented March 23, 2004.

Reviewed by Gary D. Vogin, MD

Melissa Schorr is a freelance writer for Medscape.

    
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