糖皮质激素治疗伴鼻息肉的慢性鼻-鼻窦炎患者嗅觉有效性的Meta分析

李泽文; 郭俊宇; 周洁; 严福波; 杨志敏; 丁珠华

doi:10.13201/j.issn.1001-1781.2015.21.007

糖皮质激素治疗伴鼻息肉的慢性鼻-鼻窦炎患者嗅觉有效性的Meta分析

- 1. 孝感市中心医院耳鼻咽喉科(湖北孝感, 432100);
- 2. 孝感市第一人民医院五官科

详细信息

通讯作者: 李泽文,E-mail:ent_lizewen@126.com

中图分类号: R765.21

收稿日期: 2015-08-03

Meta-analysis of The olfaction effectiveness of glucocorticoid in the management of chronic rhinosinusitis with nasal polyposis

- 1 Department of Otolarynglogy, the Central Hospital of Xiaogan, Xiaogan, 432100, China;
- 2 Department of Otolarynglogy, the First People's Hospital of Xiaogan

More Information

Corresponding author: LI Zewen, E-mail: ent_lizewen@126.com

Received Date: 03 August 2015

摘要

摘要: 目的: 系统评价糖皮质激素治疗伴鼻息肉的慢性鼻-鼻窦炎患者嗅觉的有效性。方法: 计算机检索Medline、Cochrane、EMBASE、Springer和CNKI等数据库,文献检索起至时间从建库到2014年12月止,收集公开发表的所有关于糖皮质激素治疗伴鼻息肉的慢性鼻-鼻窦炎患者嗅觉的随机对照研究,按纳入标准筛选文献并评价纳入研究质量后,应用RevMan 5.3软件进行Meta分析。结果: 共纳入5个随机对照研究,共计325例患者。Meta分析结果显示,与对照组相比,口服糖皮质激素不仅能显著提高患者的主观嗅觉评分[SMD=-2.22,95%CI(-3.94~-0.49),P<0.05],而且也能显著提高患者的客观嗅觉评分[SMD=0.65,95%CI(0.28~1.01),P<0.005]。但后期鼻内应用糖皮质激素却不能改善患者的主、客观嗅觉评分[SMD=-2.15,95%CI(-5.67,1.38),P>0.05],[SMD=0.28,95%CI(-0.08~0.64),P>0.05]。结论: 目前证据证明,口服糖皮质激素能显著提高患者的主、客观嗅觉功能,而鼻内应用糖皮质激素则不能改善患者的主、客观嗅觉障碍。
- 糖皮质激素 /
- 慢性鼻-鼻窦炎 /
- 嗅觉 /
- Meta分析 /
- 随机对照试验
Abstract: Objective: To evaluate the effectiveness of glucocorticoid in the management of olfaction in patients with chronic rhinosinusitis accompanied with nasal polyposis. Method: The published studies of the effectiveness of glucocorticoid in the management of chronic rhinosinusitis with nasal polyposis were searched in the Medline,Cochrane,EMBASE,Springer and CNKI databases(from the date of establishment of the databases to December 2014).The trails selection based on inclusion criteria and the quality of the included studies was assessed and meta-analysis was performed with RevMan 5.3 software. Result: A total of 5 trials involving 325 patients were included. The Meta-analysis showed that oral glucocorticoid showed more significant improvement in subjective olfaction scores compared to placebo[SMD=-2.22,95%CI(-3.94——0.49),P<0.05], oral glucocorticoid also showed significant improvement in objective olfaction scores compared to placebo[SMD=0.65,95%CI(0.28-1.01),P<0.05].But subsequent use of nasal glucocorticoid had no impact on subjective and objective olfaction scores[SMD=-2.15,95%CI(-5.67-1.38),P>0.05],[SMD=0.28,95%CI(-0.08-0.64),P>0.05]。Conclusion: According to current evidence, oral glucocorticoid can significantly improve subjective and objective olfaction among patients with CRSwNP, but nasal glucocorticoid cannot improve subjective or objective olfaction dysfunction.
- glucocorticoid /
- chronic rhinosinusitis /
- olfaction /
- Meta-analysis /
- randomized controlled trials

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参考文献(21)

[1]	FOKKENS W J, LUND V J, MULLOL J, et al. European position paper on rhinosinusitis and nasal polyps 2012[J]. Rhinol Suppl, 2012, 23:1-298.
[2]	LITVACK J R, MACE J C, SMITH T L. Olfactory function and disease severity in chronic rhinosinusitis[J]. Am J Rhinol Allergy, 2009, 23:139-144.
[3]	NEULAND C, BITTER T, MARSCHNER H, et al. Health-related and specific olfaction-related quality of life in patients with chronic functional anosmia or severe hyposmia[J]. Laryngoscope, 2011, 121:867-872.
[4]	LITVACK J R, FONG K, MACE J, et al. Predictors of olfactory dysfunction in patients with chronic rhinosinusitis[J]. Laryngoscope, 2008,118:2225-2230.
[5]	VAN ZELE T, GEVAERT P, HOLTAPPELS G, et al. Oral steroids and doxycycline:two different approaches to treat nasal polyps[J]. J Allergy Clin Immunol,2010,125:1069-1076.
[6]	VIDELER W J, BADIA L, HARVEY R J, et al. Lack of efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis:a randomized controlled trial[J]. Allergy, 2011,66:1457-1468.
[7]	EBBENS F A, SCADDING G K, BADIA L, et al. Amphotericin B nasal lavages:not a solution for patients with chronic rhinosinusitis[J]. J Allergy Clin Immunol,2006, 118:1149-1156.
[8]	PINTO J M, MEHTA N, DITINEO M,et al. A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis[J]. Rhinology, 2010,48:318-324.
[9]	ALOBID I, BENITEZ P, PUJOLS L, et al. Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment[J]. Rhinology, 2006,44:8-13.
[10]	KROFLIC B, COER A, BAUDOIN T, et al. Topical furosemide versus oral steroid in preoperative management of nasal polyposis[J]. Eur Arch Otorhinolaryngol, 2006,263:767-771.
[11]	ALOBID I, BENITEZ P, VALERO A, et al. Oral and intranasal steroid treatments improve nasal patency and paradoxically increase nasal nitric oxide in patients with severe nasal polyposis[J]. Rhinology,2012,50:171-177.
[12]	VAIDYANATHAN S, BARNES M, WILLIAMSON P, et al. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids:a randomized trial[J]. Ann Intern Med,2011,154:293-302.
[13]	ALOBID I, BENÍTEZ P, CARDELÚS S, et al. Oral plus nasal corticosteroids improve smell, nasal congestion, and inflammation in sino-nasal polyposis[J]. Laryngoscope,2014,124:50-56.
[14]	SMALL C B, HERNANDEZ J, REYES A, et al. Efficacy and safety of mometasone furoate nasal spray in nasal polyposis[J]. J Allergy Clin Immunol,2005,116:1275-1281.
[15]	JANKOWSKI R, KLOSSEK J M, ATTALI V, et al. Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis[J]. Allergy,2009,64:944-950.
[16]	EHNHAGE A, OLSSON P, KÖLBECK K G, et al. Functional endoscopic sinus surgery improved asthma symptoms as well as PEFR and olfaction in patients with nasal polyposis[J]. Allergy,2009,64:762-769.
[17]	FRIEDMAN M, HAMILTON C, SAMUELSON C G, et al. Dead sea salt irrigations vs saline irrigations with nasal steroids for symptomatic treatment of chronic rhinosinusitis:a randomized, prospective double-blind study[J]. Int Forum Allergy Rhinol,2012,2:252-257.
[18]	MACKAY I S, DURHAM S R. ABC of allergies. Perennial rhinitis[J]. BMJ,1998,316:917-920.
[19]	CARDESÍN A, ALOBID I, BENÍTEZ P, et al. Barcelona Smell Test-24(BAST-24):validation and smell characteristics in the healthy Spanish population[J]. Rhinology, 2006,44:83-89.
[20]	POETKER D M, JAKUBOWSKI L A, LAL D, et al. Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps:an evidence-based review with recommendations[J]. Int Forum Allergy Rhinol,2013,3:104-120.
[21]	HOWARD B E, LAL D. Oral steroid therapy in chronic rhinosinusitis with and without nasal polyposis[J]. Curr Allergy Asthma Rep, 2013,13:236-243.