皮质类固醇可以有效治疗鼻息肉


  July 8, 2005 - 世界过敏医学组织在德国慕尼黑举行的第14届大会中,一项先期性的研究结果指出,短期的使用口服皮质类固醇,加上局部血管收缩剂,再接续以外用皮质类固醇作长期治疗,对于皮息肉的治疗会是一项有效的方法,尤其针对患有阿斯匹灵敏感性气喘的患者。
  
  Deska Dimitrievska医师向Medscape表示,在我们的诊所中,发现很多患者罹患阿斯匹灵敏感性气喘及鼻息肉症;几年以前,这些患者皆以外科手术作治疗,但是这个方法并无法解决问题,息肉会复发,呼吸道受到更严重的阻碍。
  
  Dimitrievska为一胸腔科医师,在马其顿斯科普里的临床中心任职。
  
  在该项研究中,研究人员对药物治疗的效果进行评估,对象有50位患者(31位女性,19位男性;年龄介于20-56岁),皆患有不同程度的鼻息肉(28%突出;34%阻塞;38%部分阻塞)。
  
  以变动剂量的方式投予高剂量的口服皮质类固醇(methylprednisolone,三日剂量,每日分别为120、80及40mg),再加上10天的血管收缩治疗;之后,以日剂量200μg的外用belcomethasone dipropionate作长期治疗。
  
  在10天之后进行鼻镜检查,结果发现,66%的患者,息肉的现象完全的纾解;相较于基线期,鼻息肉症状严重度皆有著显著的降低(突出0% vs 28%;阻塞14% vs 34%;部分阻塞20% vs 38%);患者们皆持续的进步当中,所有的息肉患者皆在两年之内获得纾解。
  
  鼻塞、流鼻水及嗅觉障碍等现象的提报,皆有显著的降低;患者的提报和X光诊断的发现是一致的;在第3年时,96%的患者仍然无鼻息肉;2位患者出现部份阻塞性鼻息肉的复发,1位则提报嗅觉障碍。
  
  Dimitrievska医师总结表示,在3年的追踪期里,我们观察到,鼻息肉的复发率很低,因为每日使用外用皮质类固醇的关系,患者的生活质量持续的转好;我们建议,将此列为第一线疗法,治疗阿斯匹灵敏感性气喘患者的鼻息肉。
  
  研究人员未公布其资金流向。

Corticosteroid Therapy Is Effe

By
Medscape Medical News

July 8, 2005 — A short course of systemic corticosteroid plus local vasoconstrictor therapy followed by long-term use of a topical corticosteroid is an effective approach for the management of nasal polyps in patients with aspirin-sensitive asthma, according to the results of a prospective study presented last week at the XIX World Allergy Organization Congress in Munich, Germany.

"In our clinic, we see a lot of patients with aspirin-sensitive asthma and nasal polyposis. Years ago, these patients were treated surgically but that kind of treatment does not solve the problem — the [polyps recur] and aggravate airway obstruction," Deska Dimitrievska, MD, told Medscape.

Dr. Dimitrievska is a pulmologist at the Clinic of Pulmology and Allerology at the Clinical Center in Skopje, Macedonia.

In the study, investigators evaluated the efficacy of pharmacologic therapy in 50 patients (31 women, 19 men; age, 20 - 56 years) with nasal polyps of varying severity (prominent, 28%; obstructive, 34%; partially obstructive, 38%).

Patients were administered a tapered course of high-dose systemic corticosteroid (methylprednisolone, three days each of 120, 80, and 40 mg/day) plus local vasoconstrictor therapy for 10 days, followed by long-term topical treatment with 200 µg per day beclomethasone dipropionate.

Results obtained at 10 days via anterior rhinoscopy showed complete resolution of polyps in 66% of patients. A significant decrease in the severity of remaining polyps was observed compared with baseline (prominent, 0% vs 28%; obstructive, 14% vs 34%; partially obstructive, 20% vs 38%). Patients continued to improve, and all patients achieved resolution of polyps within two years.

Decreases in patient-reported incidence of nasal blockage, rhinorrhea, and smelling disturbances correlated well with these and x-ray findings. At three years, 96% of patients continued to be clear of nasal polyps. Two patients had a recurrence of partially obstructive polyps, and smelling disturbance was reported by one patient only.

For a three-year follow-up, we observed a low recurrence rate of nasal polyps that led to an improved quality of life for our patients as they continued to apply the topical corticosteroid each day, Dr. Dimitrievska concluded. "We recommend [pharmacologic] treatment as first-line therapy of nasal polyposis in patients with aspirin-sensitive asthma."

Investigators report no pertinent financial disclosures.

XIX WAO Congress: Abstract 746. Presented June 29, 2005.

Reviewed by Gary D. Vogin, MD

    
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