术前规范化药物治疗对鼻内镜下慢性鼻窦炎伴鼻息肉患者术后鼻黏膜重塑的影响

Impact of preoperative standardized drug therapy on nasal mucosal remodeling in patients with chronic rhinosinusitis with nasal polyps under nasal endoscopy

摘要:

目的 探讨术前规范化药物治疗对鼻内镜下慢性鼻窦炎（CRS）伴鼻息肉（CRSwNP）患者术后鼻黏膜重塑的影响。方法 选取2022年1月－2023年6月该院收治的CRSwNP患者80例，根据随机数表法将患者分为观察组（n = 40）和对照组（n = 40），对照组给予功能性鼻内镜手术治疗，观察组在对照组的基础上给予术前规范化药物综合治疗。比较两组患者鼻腔黏液纤毛清除功能、鼻功能和鼻黏膜重塑变化；采用广义估计方程（GEE）模型，分析其改善情况；采用多元线性回归模型，分析其与各评分之间的关系；采用双重差分模型，分析治疗效果。结果 两组患者组内不同时点（治疗前、治疗后3个月和治疗后6个月）的糖精清除时间、鼻黏液纤毛清除率、黏液纤毛清除速率、鼻腔容积（NCV）、鼻腔最小横截面积（NMCA）、最小横截面积距前鼻孔距离（DCAN）、嗜酸性粒细胞（EOS）、转化生长因子β1（TGF-β1）和血管内皮细胞生长因子（VEGF）水平比较，差异均有统计学意义（F = 124.36，P = 0.000；F = 113.58，P = 0.000；F = 98.67，P = 0.000；F = 87.37，P = 0.000；F = 107.26，P = 0.000；F = 77.45，P = 0.000；F = 3.80，P = 0.008；F = 2.56，P = 0.012；F = 2.13，P = 0.015）；观察组治疗后3和6个月糖精清除时间较对照组短，鼻黏液纤毛清除率较对照组高，黏液纤毛清除速率较对照组快，NCV和NMCA较对照组大，DCAN较对照组短，EOS、TGF-β1和VEGF水平较对照组低，差异均有统计学意义（F = 44.36，P = 0.000；F = 38.23，P = 0.000；F = 30.44，P = 0.000；F = 27.33，P = 0.000；F = 36.11，P = 0.000；F = 22.00，P = 0.000；F = 2.44，P = 0.014；F = 1.89，P = 0.017；F = 1.75，P = 0.021）；两组患者糖精清除时间、鼻黏液纤毛清除率、黏液纤毛清除速率、NCV、NMCA、DCAN、EOS、TGF-β1和VEGF水平变化趋势比较，差异均有统计学意义（F = 18.33，P = 0.000；F = 15.78，P = 0.000；F = 13.00，P = 0.000；F = 8.17，P = 0.002；F = 10.23，P = 0.000；F = 4.34，P = 0.004；F = 2.89，P = 0.013；F = 1.67，P = 0.022；F = 1.43，P = 0.031）。GEE分析结果显示，观察组鼻黏液纤毛清除率、黏液纤毛清除速率、NMCA、NCV、DCAN和糖精清除时间的改善情况明显优于对照组，差异均有统计学意义（P < 0.05）；治疗后6个月，两组患者Lund-Kennedy评分、Lund-Mackay评分和鼻腔鼻窦结局测试-20（SNOT-20）评分明显低于术前，且观察组明显低于对照组，差异均有统计学意义（P < 0.05）；多元线性回归模型分析结果显示，糖精清除时间、DCAN、EOS、TGF-β1、VEGF水平、鼻黏液纤毛清除率、黏液纤毛清除速率、NCV和NMCA与Lund-Kennedy评分、Lund-Mackay评分和SNOT-20量表评分密切相关（P < 0.05）。双重差分模型结果显示，观察组Lund-Kennedy评分、Lund-Mackay评分和SNOT-20量表评分的改善情况明显优于对照组。观察组总有效率为92.50%，明显高于对照组的75.00%，差异均有统计学意义（P < 0.05）。结论 在鼻内镜术前采用规范化药物治疗，可以有效地促进CRSwNP患者鼻黏膜修复，抑制术后鼻腔重塑，且疗效较好，值得临床推广应用。

Abstract:

Objective To explore the impact of preoperative standardized drug therapy on postoperative nasal mucosal remodeling in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) patients under nasal endoscopy.Methods 80 patients with CRSwNP from January 2022 to June 2023 were selected as the research subjects. They were randomly divided into an observation group (n = 40) and a control group (n = 40) according to the random number table method. The control group received functional endoscopic surgery, while the observation group received preoperative standardized drug comprehensive treatment on the basis of the control group. The changes in mucociliary clearance function, nasal function, and nasal mucosal remodeling between the two groups of patients were compared. The Generalized Estimation Equation (GEE) model was used to analyze its improvement situation; The multivariate linear regression analysis was used to analyze its correlation with various scores; The Difference-in-difference model was used to analyze the treatment effect of patients.Results The saccharin clearance time, nasal mucociliary clearance rate, mucociliary clearance rate, nasal cavity volume (NCV), nasal minimum cross-sectional area (NMCA), distance from the minimum cross-sectional area to the anterior nostril (DCAN), eosinophil (EOS), transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) level at different time points within the two groups of patients (before treatment, 3 months after treatment, and 6 months after treatment), the analysis of variance using repeated measurements showed that there were statistically significant differences (F = 124.36, P = 0.000; F = 113.58, P = 0.000; F = 98.67, P = 0.000; F = 87.37, P = 0.000; F = 107.26, P = 0.000; F = 77.45, P = 0.000; F = 3.80, P = 0.008; F = 2.56, P = 0.012; F = 2.13, P = 0.015); After 3 and 6 months of treatment, the observation group had a shorter saccharin clearance time, a higher nasal mucociliary clearance rate, a faster mucociliary clearance rate, larger NCV and NMCA, shorter DCAN, and lower levels of EOS, TGF -β1, and VEGF compared to the control group. The differences were statistically significant (F = 44.36, P = 0.000; F = 38.23, P = 0.000; F = 30.44, P = 0.000; F = 27.33, P = 0.000; F = 36.11, P = 0.000; F = 22.00, P = 0.000; F = 2.44, P = 0.014; F = 1.89, P = 0.017; F = 1.75, P = 0.021). There were statistically significant differences in the trends of saccharin clearance time, nasal mucociliary clearance rate, mucociliary clearance rate, NCV, NMCA, DCAN, EOS, TGF-β1, and VEGF level between the two groups (F = 18.33, P = 0.000; F = 15.78, P = 0.000; F = 13.00, P = 0.000; F = 8.17, P = 0.002; F = 10.23, P = 0.000; F = 4.34, P = 0.004; F = 2.89, P = 0.013; F = 1.67, P = 0.022; F = 1.43, P = 0.031). The GEE analysis results showed that the nasal mucociliary clearance rate, NMCA, mucociliary clearance rate, NCV, DCAN, saccharin clearance time were better than those of the control group (P < 0.05); After 6 months treatment, the Lund-Kennedy score, Lund-Mackay score, and sino-nasal outcome test-20 (SNOT-20) score of both groups decreased compared with before treatment, and the observation group was lower than that of the control group (P < 0.05); The results of multivariate linear regression analysis showed that the saccharin clearance time, DCAN, EOS, TGF-β1, VEGF level, and the nasal mucociliary clearance rate, mucociliary clearance rate, NCV, and NMCA were closely related to Lund-Kennedy score, Lund-Mackay score, and SNOT-20 score, respectively (P < 0.05); The results of the Difference-in-difference model showed that the improvement of Lund-Kennedy score, Lund-Mackay score, and SNOT-20 score in the observation group were better than those in the control group. After treatment, the total effective rate of the observation group (92.50%) was higher than that of the control group (75.00%), the difference was statistically significant (P < 0.05).Conclusion Standardized drug therapy before nasal endoscopy can effectively promote nasal mucosal repair in CRSwNP patients, inhibit postoperative nasal remodeling, and has good therapeutic effects, which is worthy of clinical application.