慢性鼻窦炎（chronic rhinosinusitis,CRS）是耳鼻咽喉头颈外科最常见的疾病之一,一般分为单纯慢性鼻窦炎（CRS without nasal polyps,CRSsNP）和慢性鼻窦炎鼻息肉（CRS with nasal polyps,CRSwNP）,二者的比例约为4：1。当前CRS的治疗...慢性鼻窦炎（chronic rhinosinusitis,CRS）是耳鼻咽喉头颈外科最常见的疾病之一,一般分为单纯慢性鼻窦炎（CRS without nasal polyps,CRSsNP）和慢性鼻窦炎鼻息肉（CRS with nasal polyps,CRSwNP）,二者的比例约为4：1。当前CRS的治疗主要是围绕药物治疗和手术治疗制定治疗策略。展开更多
Chronic rhinosinusitis(CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be div...Chronic rhinosinusitis(CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be divided into eosinophilic CRS(ECRS) and non-ECRS subtypes based on the presence of tissue eosinophilic infiltration or not. There are significant geographic and ethnic differences in the tissue eosinophilic infiltration, which is predominant in Western white patients and less common in East Asians, despite an increasing tendency for its prevalence in East Asia countries. ECRS differs significantly from non-ECRS in clinical characteristics, treatment outcomes and strategies, and underlying pathogenic mechanisms. ECRS commonly demonstrates more severe symptoms, polyp diseases with a higher incidence of bilateral polyps and sinonasal diseases on computed tomography, and the increase in blood eosinophils. ECRS is considered a special and recalcitrant subtype of CRS, commonly with poor treatment outcomes compared to non-ECRS. The differentiation of specific subtypes and clinical features of CRS will be important for developing novel treatment strategies and improving treatment outcomes for individual phenotypes of CRS. This review discusses clinical features, diagnosis, treatment and prognosis of ECRS in East Asians.展开更多
目的系统评价中药液冲洗治疗对慢性鼻窦炎鼻内镜术后术腔恢复的临床疗效和安全性。方法计算机检索PubMed(1980.1～2009.1)、MEDLINE(1980～2009)、EBSCOhost(1975.1～2009.1)、CALIS外文期刊网(1984～2009)、CNKI(1979～2007)、VIP(1989...目的系统评价中药液冲洗治疗对慢性鼻窦炎鼻内镜术后术腔恢复的临床疗效和安全性。方法计算机检索PubMed(1980.1～2009.1)、MEDLINE(1980～2009)、EBSCOhost(1975.1～2009.1)、CALIS外文期刊网(1984～2009)、CNKI(1979～2007)、VIP(1989～2009)、CBM(1978～2009),并手工检索《中华耳鼻咽喉头颈科杂志》(1990～2008)、《临床耳鼻咽喉头颈外科杂志》(1988～2008)、《耳鼻咽喉头颈外科》(1990～2008)、《中国中西医结合耳鼻咽喉科杂志》(1996～2008)等,收集慢性鼻窦炎鼻内镜术后使用中药冲洗治疗的随机对照试验(RCT)。按纳入与排除标准筛选试验、提取资料和评价质量,而后采用RevMan 4.2.10软件进行统计分析。结果 3个亚组共纳入32篇中文文献,合计6272例患者进行Meta分析。结果显示,各试验组治愈率[OR=1.99,95%CI(1.78,2.23)],总有效率[OR=2.66,95%CI(2.20,3.22)],术后症状Ⅰ级改善率[OR=2.22,95%CI(1.60,3.06)],术后症状总改善率[OR=8.77,95%CI(1.09,70.64)],术腔清洁时间[OR=2.54,95%CI(1.70,3.79)],术腔上皮化时间[OR=–29.46,95%CI(–37.73,–21.18)],鼻腔纤毛运动速率(mucociliary transport rate,MTR)[OR=1.14,95%CI(0.22,2.06)]均优于对照组。安全性评价共纳入4篇文献进行Meta分析,结果显示试验组胃肠道反应与对照组相比差异无统计学意义[OR=0.25,95%CI(0.00,33.78)],而局部反应与对照组相比差异有统计学意义[OR=0.03,95%CI(0.01,0.12)]。结论在慢性鼻窦炎鼻内镜术后的治疗中,采用中药液冲洗治疗可提高临床疗效、加快愈合时间,不良反应发生率较小,但由于纳入试验方法学质量普遍较低,评价指标较完善的文献较少,尚需进一步开展设计科学、指标合理的随机对照试验。经过筛选,本课题组建议使用如下中药组成冲洗液:黄芩、薄荷、鱼腥草、金银花、辛夷、白芷、黄芪、当归、荆芥。展开更多
文摘慢性鼻窦炎（chronic rhinosinusitis,CRS）是耳鼻咽喉头颈外科最常见的疾病之一,一般分为单纯慢性鼻窦炎（CRS without nasal polyps,CRSsNP）和慢性鼻窦炎鼻息肉（CRS with nasal polyps,CRSwNP）,二者的比例约为4：1。当前CRS的治疗主要是围绕药物治疗和手术治疗制定治疗策略。
文摘Chronic rhinosinusitis(CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be divided into eosinophilic CRS(ECRS) and non-ECRS subtypes based on the presence of tissue eosinophilic infiltration or not. There are significant geographic and ethnic differences in the tissue eosinophilic infiltration, which is predominant in Western white patients and less common in East Asians, despite an increasing tendency for its prevalence in East Asia countries. ECRS differs significantly from non-ECRS in clinical characteristics, treatment outcomes and strategies, and underlying pathogenic mechanisms. ECRS commonly demonstrates more severe symptoms, polyp diseases with a higher incidence of bilateral polyps and sinonasal diseases on computed tomography, and the increase in blood eosinophils. ECRS is considered a special and recalcitrant subtype of CRS, commonly with poor treatment outcomes compared to non-ECRS. The differentiation of specific subtypes and clinical features of CRS will be important for developing novel treatment strategies and improving treatment outcomes for individual phenotypes of CRS. This review discusses clinical features, diagnosis, treatment and prognosis of ECRS in East Asians.
文摘目的系统评价中药液冲洗治疗对慢性鼻窦炎鼻内镜术后术腔恢复的临床疗效和安全性。方法计算机检索PubMed(1980.1～2009.1)、MEDLINE(1980～2009)、EBSCOhost(1975.1～2009.1)、CALIS外文期刊网(1984～2009)、CNKI(1979～2007)、VIP(1989～2009)、CBM(1978～2009),并手工检索《中华耳鼻咽喉头颈科杂志》(1990～2008)、《临床耳鼻咽喉头颈外科杂志》(1988～2008)、《耳鼻咽喉头颈外科》(1990～2008)、《中国中西医结合耳鼻咽喉科杂志》(1996～2008)等,收集慢性鼻窦炎鼻内镜术后使用中药冲洗治疗的随机对照试验(RCT)。按纳入与排除标准筛选试验、提取资料和评价质量,而后采用RevMan 4.2.10软件进行统计分析。结果 3个亚组共纳入32篇中文文献,合计6272例患者进行Meta分析。结果显示,各试验组治愈率[OR=1.99,95%CI(1.78,2.23)],总有效率[OR=2.66,95%CI(2.20,3.22)],术后症状Ⅰ级改善率[OR=2.22,95%CI(1.60,3.06)],术后症状总改善率[OR=8.77,95%CI(1.09,70.64)],术腔清洁时间[OR=2.54,95%CI(1.70,3.79)],术腔上皮化时间[OR=–29.46,95%CI(–37.73,–21.18)],鼻腔纤毛运动速率(mucociliary transport rate,MTR)[OR=1.14,95%CI(0.22,2.06)]均优于对照组。安全性评价共纳入4篇文献进行Meta分析,结果显示试验组胃肠道反应与对照组相比差异无统计学意义[OR=0.25,95%CI(0.00,33.78)],而局部反应与对照组相比差异有统计学意义[OR=0.03,95%CI(0.01,0.12)]。结论在慢性鼻窦炎鼻内镜术后的治疗中,采用中药液冲洗治疗可提高临床疗效、加快愈合时间,不良反应发生率较小,但由于纳入试验方法学质量普遍较低,评价指标较完善的文献较少,尚需进一步开展设计科学、指标合理的随机对照试验。经过筛选,本课题组建议使用如下中药组成冲洗液:黄芩、薄荷、鱼腥草、金银花、辛夷、白芷、黄芪、当归、荆芥。
