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摘要: 目的：比较口服单倍剂量抗组胺药与鼻喷糖皮质激素联用和口服双倍剂量抗组胺药，对于季节性变应性鼻炎的疗效及不良反应。方法：随机、平行对照研究，为期2周。将82例圆柏花粉过敏所致变应性鼻炎患者分为2个组：联合组每日口服依巴斯汀10 mg加鼻喷糠酸莫米松200 μg；双倍组每日口服依巴斯汀20 mg。花粉季中，2组患者均记录每日鼻结膜炎症状评分及方案外按需用药情况。分组治疗2周后，反馈调查患者用药不良反应及剂型偏好。在治疗前后测量外周血中细胞因子IL-6、IL-8和TNF-α的水平。结果：在圆柏花粉播散期间，联合组的鼻结膜炎日均症状评分[（3.7±0.4）分]显著低于双倍组[（4.5±0.5）分]，差异有统计学意义（P<0.001）。联合组的日均按需用药评分[（1.3±0.6）分]也显著低于双倍组[（1.7±0.7）分]，差异有统计学意义（P<0.001）。联合组日均总药费为（7.08±0.33）元，低于双倍组[（7.28±0.51）元]，差异有统计学意义（P=0.002）。2组药物不良反应发生率差异无统计学意义。分组治疗2周后，外周血炎症因子IL-6、IL-8和TNF-α的水平组间差异无统计学意义。结论：该研究提示在季节性变应性鼻炎的治疗中，鼻喷糖皮质激素和口服单倍剂量抗组胺药的联合疗法优于口服双倍抗组胺药的剂量增倍法。Abstract: Objective: To compare the efficacy and side effects of combined therapy with single-dose oral antihistamine and intranasal corticosteroid to monotherapy with double-dose oral antihistamine in the treatment of seasonal allergic rhinitis.Method: Eighty-two patients with seasonal allergic rhinitis caused by cypress pollen were enrolled in a randomized, parallel-group studycomparing 2 weeks therapy of either 10mg oral ebastine plus 200 μg intranasal mometasone furoate once daily (combined group) or 20 mg oral ebastine once daily (double-dose group) during the pollen season. Daily rhinoconjunctivitis symptom score and rescue medication use were recorded in both groups. After the treatment period, questionnaires were used to survey the side effects of medicines and dosage form preference of the patients. The levels of IL-6, IL-8 and TNF-α in the peripheral blood were measured before and after the therapy.Result: During the cypress pollen season, the daily rhinoconjunctivitis symptom score of the combined group (n=42, 3.7±0.4) was significantly lower than that of double-dose group (n=40, 4.5±0.5), P<0.001. The daily rescue medication score of the combined group (1.3±0.6) was also significantly lower than double-dose group(1.7±0.7), P<0.001. The daily medication cost of combined group was 7.08±0.33 Yuan, which was less than that of double-dose group (7.28±0.51 Yuan, P=0.002). There was no statistical difference in the rate of adverse reactions between the two groups. The peripheral levels of IL-6, IL-8 and TNF-α in two groups did not show significant difference at the end of therapy.Conclusion: The combined therapy with single-dose oral antihistamine and intranasal corticosteroid was superior to the monotherapy with double-dose oral antihistamine in the treatment of seasonal allergic rhinitis in our study.
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Key words:
- rhinitis, allergic /
- antihistamine /
- intranasal corticosteroid /
- treatment effect /
- cypress pollen
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[1] 天津指南中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南(2015年, 天津)[J].中华耳鼻咽喉头颈外科杂志, 2016, 51(1):6-24.
[2] 李丽莎, 关凯.不同致敏变应原所致变应性鼻炎患者164例生活质量调查[J].临床耳鼻咽喉头颈外科杂志, 2015, 29(3):226-229.
[3] D'AMBROSIO F P, GANGEMI S, MERENDINO R A, et al.Comparative study between fluticasone propionate and cetirizine in the treatment of allergic rhinitis[J].Allergol Immunopathol (Madr), 1998, 26:277-282.
[4] LEYNADIER F, MEES K, ARENDT C, et al.Efficacy and safety of levocetirizine in seasonal allergic rhinitis[J].Acta Otorhinolaryngol Belg, 2001, 55:305-312.
[5] HURST M, SPENCER C M.Ebastine:an update of its use in allergic disorders[J].Drugs, 2000, 59:981-1006.
[6] CANONICA G W, BOUSQUET J, MULLOL J, et al.A survey of the burden of allergic rhinitis in Europe[J].Allergy, 2007, 62Suppl 85:17-25.
[7] ÖZGR A, ARSLANOGLU S, ETIT D, et al.Comparison of nasal cytology and symptom scores in patients with seasonal allergic rhinitis, before and after treatment[J].J Laryngol Otol, 2011, 125:1028-1032.
[8] GUILLÉN-AGUINAGA S, JÁUREGUI PRESA I, AGUINAGA-ONTOSO E, et al.Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria:a systematic review and meta-analysis[J].Br J Dermatol, 2016, 175:1153-1165.
[9] STORMS W W.Clinical studies of the efficacy and tolerability of ebastine 10or 20 mg once daily in the treatment of seasonal allergic rhinitis in the US[J].Drugs, 1996, 52Suppl 1:20-25.
[10] BERGER W E, NAYAK A S, STAUDINGER H W.Mometasone furoate improves congestion in patients with moderate-to-severe seasonal allergic rhinitis[J].Ann Pharmacother, 2005, 39:1984-1989.
[11] MINSHALL E, GHAFFAR O, CAMERON L, et al.Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis[J].Otolaryngol Head Neck Surg, 1998, 118:648-654.
[12] RAPOPORT A M, BIGAL M E, TEPPER S J, et al.Intranasal medications for the treatment of migraine and cluster headache[J].CNS Drugs, 2004, 18:671-685.
[13] BRADDING P, ROBERTS J A, BRITTEN K M, et al.Interleukin-4, -5, and-6and tumor necrosis factoralpha in normal and asthmatic airways:evidence for the human mast cell as a source of these cytokines[J].Am J Respir Cell Mol Biol, 1994, 10:471-480.
[14] BRADDING P.The role of the mast cell in asthma:a reassessment[J].Curr Opin Allergy Clin Immunol, 2003, 3:45-50.
[15] SHI J, LUO Q, CHEN F, et al.Induction of IL-6and IL-8by house dust mite allergen Der p1in cultured human nasal epithelial cells is associated with PAR/PI3K/NFkappaB signaling[J].ORL J Otorhinolaryngol Relat Spec, 2010, 72:256-265.
[16] BOCAN C I, BUJOR A I, MIRON N, et al.In vivo anti-inflammatory effect of H1antihistamines in allergic rhinitis:a randomized clinical trial[J].Balkan Med J, 2015, 32:352-358.
[17] MULLOL J, PUJOLS L, ALOBID I, et al.Fluticasone furoate inhibits cytokine secretion from nasal epithelial cells and reduces eosinophil survival in an in vitro model of eosinophilic inflammation[J].Int Arch Allergy Immunol, 2014, 163:225-33.
[18] 瞿申红, 李敏, 黄永坚, 等.变应原和糖皮质激素对变应性鼻炎患者外周血Th17细胞及其转录因子RORγt的作用[J].中华耳鼻咽喉头颈外科杂志, 2009, 44(12):996-1000.
[19] KITA H, JORGENSEN R K, REED C E, et al.Mechanism of topical glucocorticoid treatment of hay fever:IL-5and eosinophil activation during natural allergen exposure are suppressed, but IL-4, IL-6, and IgE antibody production are unaffected[J].J Allergy Clin Immunol, 2000, 106:521-529.
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