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摘要: 肉毒毒素是由肉毒梭菌产生的神经毒素超家族，通过抑制突触前神经末梢神经递质的释放，干扰神经肌肉和神经腺体接头处的信号传递，已广泛用于神经肌肉、腺体分泌过多和自主神经系统疾病。近年来，A型肉毒毒素被用于治疗慢性鼻炎。研究表明A型肉毒毒素鼻腔给药安全有效，可以减轻患者的鼻部症状，并且效果持久。本文对A型肉毒毒素治疗慢性鼻炎的研究进展进行综述。Abstract: Botulinum toxin(BoNT), a superfamily of neurotoxins produced by the bacterium Clostridium botulinum, disturbs the signal transmission at the neuromuscular and neuroglandular junctions by inhibiting the neurotransmitter release from the presynaptic nerve terminal. BoNT has been widely used in neuromuscular, hypersecretory, and autonomic nerve system disorders. In recent years, botulinum toxin type A(BoNT-A) has been used to treat chronic rhinitis. Studies have shown that intranasal administration of BoNT-A is safe and effective, and can reduce nasal symptoms in rhinitis patients with long-lasting effects. This article reviews the research progress of BoNT-A in the treatment of chronic rhinitis.
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Key words:
- rhinitis /
- botulinum toxin /
- intranasal administration
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表 1 BoNT-A治疗AR的随机对照临床研究
纳入研究 例数 给药方法 BoNT-A品牌和剂量(每侧) 对照 随访 结果 不良反应 Unal等[22] 34 中、下鼻甲注射 Botox®，20 U或30 U 生理盐水 8周 两种剂量BoNT-A在8周内均能有效减轻除鼻痒外的其他鼻部症状，显著优于生理盐水 无 Yang等[23] 39 下鼻甲注射 Botox®，25 U 曲安奈德、生理盐水 20周 BoNT-A组及曲安奈德组疗效显著优于生理盐水组; 8周后BoNT-A组鼻塞和流涕评分显著优于曲安奈德组; BoNT-A组疗效长达20周 无 Hashemi等[24] 50 下鼻甲注射 Dysport®，75 U 口服西替利嗪 8周 两组患者症状严重程度评分、生活质量评分均显著改善 鼻出血(4%)、鼻腔干燥(4%) Shemshadi等[26] 44 浸润的海绵填塞30 min Dysport®，100 U 生理盐水 12周 治疗组症状严重程度评分改善显著高于对照组 无 Sarhan等[25] 90 中、下鼻甲注射 Botox®，5 U 皮质类固醇鼻甲注射联合口服抗组胺药 12周 BoNT-A可显著缓解AR症状，尤其是流涕症状 无 蒙逖航等[27] 80 中鼻甲注射联合氯雷他定口服(10 mg/d) 衡力®，12 U 生理盐水鼻甲注射联合氯雷他定口服 2周 治疗组总有效率显著高于对照组; 治疗组鼻痒、打喷嚏症状评分及总评分改善显著低于对照组; 鼻塞、流涕症状评分无差异 鼻出血、疼痛、嗜睡 Piromchai等[29] 17 下鼻甲注射 Dysport®，40 U、30 U或20 U 不同剂量BoNT-A 12周 40 U组鼻塞、流涕、打喷嚏和嗅觉丧失显著改善，30 U组鼻塞、打喷嚏和嗅觉丧失显著改善，20 U组仅鼻塞和嗅觉丧失显著改善; 40U和30 U组鼻腔通畅率显著改善 鼻出血(11.8%)、鼻腔干燥(23.5%) 
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表 2 BoNT-A治疗特发性鼻炎的随机对照临床研究
纳入研究 例数 给药方法 BoNT-A品牌和剂量(每侧) 对照 随访 结果 不良反应 Kim等[36] 60 中、下鼻甲注射 Botox®，4 U 生理盐水 24周 BoNT-A在4周内流涕显著减少，但对鼻塞、打喷嚏无改善 无 Ozcan等[39] 35 中、下鼻甲注射 Botox®，5 U或10 U 生理盐水 12周 两个剂量BoNT-A组都能显著改善流涕、鼻塞、打喷嚏症状 无 Sapci等[37] 38 中、下鼻甲注射 Botox®，5 U 异丙托溴铵、生理盐水 12周 BoNT-A与异丙托溴铵均能显著改善流涕症状 无 Rohrbach等[38] 20 海绵鼻腔填塞30 min Botox®，40 U 生理盐水 12周 BoNT-A在12周内能显著改善流涕、打喷嚏症状 无
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| 引用本文: |
张元文, 王桂芳. A型肉毒毒素治疗慢性鼻炎的研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(11): 878-883. doi: 10.13201/j.issn.2096-7993.2022.11.015
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| Citation: |
ZHANG Yuanwen, WANG Guifang. Research progress of botulinum toxin type A in the treatment of chronic rhinitis[J]. J Clin Otorhinolaryngol Head Neck Surg, 2022, 36(11): 878-883. doi: 10.13201/j.issn.2096-7993.2022.11.015
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