氯雷他定联合A型肉毒毒素治疗变应性鼻炎的疗效观察(1)
【摘要】 目的 观察氯雷他定联合A型肉毒毒素(BTX-A)治疗变应性鼻炎(AR)的疗效。方法 80例常年性持续性中-重度AR患者， 随机分为治疗组和对照组， 各40例。治疗组给予口服氯雷他定+鼻腔黏膜下注射BTX-A治疗， 对照组给予口服氯雷他定+鼻腔黏膜下注射等容量生理盐水治疗。比较两组患者的临床疗效、症状评分及不良反应发生情况。结果 治疗组总有效率为82.5%(33/40)， 高于对照组的60.0%(24/40)， 差异具有统计学意义(P<0.05)。治疗后， 两组患者的鼻塞、鼻痒、打喷嚏、流涕单个症状评分及症状总评分均低于本组治疗前， 且治疗组鼻痒、打喷嚏单个症状评分及症状总评分分别为(1.23±0.66)、(1.30±0.72)、(4.63±1.41)分， 均低于对照组的(1.57±0.71)、(1.70±0.79)、(5.70±1.54)分， 差异均具有统计学意义(P<0.05);两组患者治疗后的鼻塞、流涕单个症状评分比较， 差异均无统计学意义(P>0.05)。两组不良反应发生率比较， 差异无统计学意义(P>0.05)。结论 氯雷他定联合BTX-A治疗AR安全有效， 鼻内注射BTX-A有望成为治疗AR的新手段之一， 值得进一步研究。
【关键词】 变应性鼻炎;A型肉毒毒素;氯雷他定;疗效
DOI：10.14163/j.cnki.11-5547/r.2020.20.005
【Abstract】 Objective To observe the efficacy of loratadine combined with botulinum toxin A (BTX-A) in the treatment of allergic rhinitis (AR). Methods A total of 80 patients with moderate-to-severe persistent AR were randomly divided into treatment group and control group， with 40 cases in each group. The treatment group was treated by oral loratadine + subnasal injection of BTX-A， and the control group was treated by oral loratadine + subnasal injection of equal volume of normal saline. The clinical efficacy， symptom score and occurrence of adverse reactions were compared between the two groups. Results The total effective rate of the treatment group was 82.5%(33/40)， which was higher than that of the control group 60.0%(24/40)， and the difference was statistically significant (P<0.05). After treatment， the nasal obstruction， itching， sneezing and runny nose score and total score of the two groups was lower than those before treatment， and the itching， sneezing and total score of the treatment group was (1.23±0.66)， (1.30±0.72) and (4.63±1.41) points respectively， which was lower than that of the control group (1.57±0.71)， (1.70±0.79) and (5.70±1.54) points， and the difference was statistically significant (P<0.05). After treatment， there was no statistically significant difference in the nasal obstruction and runny nose score between the two groups (P>0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups (P>0.05). Conclusion Loratadine combined with botulinum toxin A is safe and effective in the treatment of AR， and intranasal injection of BTX-A is expected to become a new treatment strategy for AR.
【Key words】 Allergic rhiniti; Botulinum toxin A; Loratadine; Efficacy
變应性鼻炎(allergic rhinitis， AR)是主要由免疫球蛋白E(immunoglobulin E， IgE)介导的以鼻塞、鼻痒、发作性喷嚏、流清涕为主要症状的鼻黏膜变态反应性炎症。AR是常见病、多发病， 治疗困难， 世界范围内AR的防治负担都日益加重[1]。近年有文献报道鼻腔内使用肉毒毒素(botulinum neurotoxin， BoNT)对AR具有较好的治疗有效性和安全性[2]。BoNT能抑制乙酰胆碱释放从而降低副交感神经兴奋性， 也作用于感觉神经抑制P物质(SP)等释放， 因而能缓解AR症状。BoNT有多个血清型， 其中A型肉毒毒素(botulinum toxin type A， BTX-A)应用最广。目前国内BTX-A治疗AR的研究不多。氯雷他定为抗组胺药， 可抑制、缓解AR患者鼻痒、打喷嚏、流清涕等症状， 单独用药对部分AR患者疗效欠佳， 联合用药有可能提高疗效。本研究对确诊AR患者， 予口服氯雷他定联合鼻内注射BTX-A治疗， 通过分析治疗前后患者症状评分来评估口服氯雷他定联合鼻内注射BTX-A对AR的临床疗效。报告如下。, 百拇医药(蒙逖航 黄浩 马聪)
【关键词】 变应性鼻炎;A型肉毒毒素;氯雷他定;疗效
DOI：10.14163/j.cnki.11-5547/r.2020.20.005
【Abstract】 Objective To observe the efficacy of loratadine combined with botulinum toxin A (BTX-A) in the treatment of allergic rhinitis (AR). Methods A total of 80 patients with moderate-to-severe persistent AR were randomly divided into treatment group and control group， with 40 cases in each group. The treatment group was treated by oral loratadine + subnasal injection of BTX-A， and the control group was treated by oral loratadine + subnasal injection of equal volume of normal saline. The clinical efficacy， symptom score and occurrence of adverse reactions were compared between the two groups. Results The total effective rate of the treatment group was 82.5%(33/40)， which was higher than that of the control group 60.0%(24/40)， and the difference was statistically significant (P<0.05). After treatment， the nasal obstruction， itching， sneezing and runny nose score and total score of the two groups was lower than those before treatment， and the itching， sneezing and total score of the treatment group was (1.23±0.66)， (1.30±0.72) and (4.63±1.41) points respectively， which was lower than that of the control group (1.57±0.71)， (1.70±0.79) and (5.70±1.54) points， and the difference was statistically significant (P<0.05). After treatment， there was no statistically significant difference in the nasal obstruction and runny nose score between the two groups (P>0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups (P>0.05). Conclusion Loratadine combined with botulinum toxin A is safe and effective in the treatment of AR， and intranasal injection of BTX-A is expected to become a new treatment strategy for AR.
【Key words】 Allergic rhiniti; Botulinum toxin A; Loratadine; Efficacy
變应性鼻炎(allergic rhinitis， AR)是主要由免疫球蛋白E(immunoglobulin E， IgE)介导的以鼻塞、鼻痒、发作性喷嚏、流清涕为主要症状的鼻黏膜变态反应性炎症。AR是常见病、多发病， 治疗困难， 世界范围内AR的防治负担都日益加重[1]。近年有文献报道鼻腔内使用肉毒毒素(botulinum neurotoxin， BoNT)对AR具有较好的治疗有效性和安全性[2]。BoNT能抑制乙酰胆碱释放从而降低副交感神经兴奋性， 也作用于感觉神经抑制P物质(SP)等释放， 因而能缓解AR症状。BoNT有多个血清型， 其中A型肉毒毒素(botulinum toxin type A， BTX-A)应用最广。目前国内BTX-A治疗AR的研究不多。氯雷他定为抗组胺药， 可抑制、缓解AR患者鼻痒、打喷嚏、流清涕等症状， 单独用药对部分AR患者疗效欠佳， 联合用药有可能提高疗效。本研究对确诊AR患者， 予口服氯雷他定联合鼻内注射BTX-A治疗， 通过分析治疗前后患者症状评分来评估口服氯雷他定联合鼻内注射BTX-A对AR的临床疗效。报告如下。, 百拇医药(蒙逖航 黄浩 马聪)