A study of poor responders for long-term, low-dose macrolide administration for chronic sinusitis.
A study of poor responders for long-term, low-dose macrolide administration for chronic sinusitis.
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发表时间：
2009-03
期刊：
影响因子：
7.2
通讯作者：
S. Haruna;C. Shimada;M. Ozawa;S. Fukami;H. Moriyama
中科院分区：
文献类型：
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作者：
S. Haruna;C. Shimada;M. Ozawa;S. Fukami;H. Moriyama
目的回顾性分析慢性鼻窦炎对大环内酯类抗生素耐药的临床因素（CT、鼻内镜及过敏因素）。方法对68例成人慢性鼻窦炎患者应用ME治疗8-20周。根据影像学检查结果（R 0-R3，根据影像严重程度）、鼻部检查结果（N 0：无息肉，N1：单发息肉，N2：多发息肉）、过敏因素（A0：无过敏，A1：鼻过敏，A2：支气管哮喘）和客观鼻部症状，对每个因素的影响进行评价。此外，对N1和N2组的息肉切除术和组织学检查后的效果进行了评估。结果68例患者中48例（70.6%）有效率。息肉组ME疗效明显低于无息肉组（p < 0.05）。R1组和R3组之间的治疗效果显著不同（p < 0.05），从R1到R3的结局有变差的趋势。哮喘组疗效明显低于过敏性鼻炎组和非过敏性鼻炎组（P < 0.05）。N2组息肉切除术后疗效明显改善，而N1组无明显改善。耐药组鼻息肉中嗜酸性粒细胞/总炎性细胞数（%）明显高于明显好转组。结论对于息肉病、CT表现严重、支气管哮喘和息肉伴嗜酸性粒细胞浸润的患者，ME的疗效较差。息肉切除术导致ME的疗效显著改善。
PURPOSE We investigated the clinical factors (CT images, endoscopic nasal findings and allergic factors) involved in resistance of chronic sinusitis to macrolide therapy (ME) retrospectively. METHODS ME was administered for 8-20 weeks in 68 adults with chronic sinusitis cases. The effect was evaluated in each factor from radiographic findings (R0-R3 according to the severity of the images), nasal findings (N0: no polyp, N1: a single polyp and N2: multiple polyps), allergic factors (A0: no allergy, A1: nasal allergy, A2: bronchial asthma) and objective nasal symptoms. In addition, an effect after polypectomy and histological examination were assessed for N1 and N2 groups. RESULTS ME was effective in 70.6% (48/68 patients). The efficacy of ME was significantly less in the polyp group compared with the polyp-free group (p < 0.05). Therapeutic efficacy was significantly different between R1 and R3 groups (p < 0.05) with a tendency for worse outcome from R1 to R3. The efficacy in asthma patients was significantly less compared with patients with allergic rhinitis or no allergy (p < 0.05). The efficacy after polypectomy was significantly improved in N2 group but not in N1 group. The number of eosinophil/total inflammatory cells (%) in nasal polyps of resistant cases was significantly higher than in marked improved cases. CONCLUSION The efficacy of ME was less in patients with polyposis; CT scans indicating severe findings, bronchial asthma and polyps with increased eosinophil infiltrations. Polypectomy resulted in significant improvement in the efficacy of ME.