维生素D对慢性鼻-鼻窦炎鼻内镜手术疗效的影响

胡彬 陈雪春

[摘要] 目的 探讨维生素D对慢性鼻-鼻窦炎（CRS）患者鼻内镜手术疗效的影响。 方法 选择2018年6月～2019年6月在我院耳鼻喉科就诊的慢性鼻-鼻窦炎患者60例，随机分为观察组（n=30）与对照组（n=30）。对照组采用鼻内镜手术联合布地奈德喷雾剂方案治疗，观察组采用维生素D口服治疗。两组患者均持续用药2个月，用药前后检测患者体内维生素D含量，通过视觉模拟评分量表（VAS）、鼻腔鼻窦结局测试-20（SNOT-20）评价疗效。结果 对照组治疗前后维生素D水平比较，差异无统计学意义（P<0.05）;观察组患者治疗后体内维生素D水平高于治疗前及对照组患者治疗前后，观察组患者VAS评分分值除嗅觉障碍外均低于对照组，观察组SONT-20评分明显低于对照组，差异均有统计学意义（P<0.05）。 结论 慢性鼻-鼻窦炎患者体内维生素D水平明显低于正常水平，提高其体内维生素D水平可提高内镜术后效果，具有重要的诊疗意义。

[关键词] 维生素D水平;慢性鼻-鼻窦炎;鼻内镜手术;手术疗效

[中图分类号] R765.4          [文献标识码] B          [文章编号] 1673-9701（2020）27-0075-03

[Abstract] Objective To investigate the effect of vitamin D levels on postoperative outcomes in patients with chronic rhinosinusitis（CRS） undergoing endoscopic sinus surgery. Methods A total of 60 patients with CRS admitted to department of otolaryngology in our hospital from June 2018 to June 2019 were selected and randomly divided into the observation group（n=30） and the control group（n=30）. The control group was treated with endoscopic sinus surgery combined with budesonide spray; while the observation group was treated orally with vitamin D. Patients of both groups were treated with the drug for 2 months. The vitamin D content in the patients was measured before and after the drug administration， and the efficacy was evaluated by the visual analog scale（VAS） and sino-nasal outcome test-20（SNOT-20）. Results There was no statistically significant difference in vitamin D level in the control group before and after treatment（P<0.05）. The vitamin D level in the observation group after treatment was higher than that before treatment and those before and after treatment in the control group， the VAS scores in the observation group were lower than those in the control group except for dysosmia， and SNOT-20 score in the observation group was significantly lower than that of the control group， the differences were statistically significant（P<0.05）. Conclusion The level of vitamin D in patients with CRS is significantly lower than normal. Increasing the level of vitamin D in patients with CRS can improve the effect of endoscopic sinus surgery， which is of great significance for diagnosis and treatment.

[Key words] Vitamin D levels; Chronic rhinosinusitis; Endoscopic sinus surgery; Surgical effect

慢性鼻-鼻竇炎（Chronic Rhinosinusitis，CRS）是指鼻腔及一个或多个鼻窦发生的慢性炎症反应。临床往往伴有严重的呼吸道感染，主要表现为鼻塞、流鼻涕、嗅觉障碍、眼胀及头痛。感染、过敏及鼻息肉肥大等均可诱发慢性鼻-鼻窦炎，而鼻息肉肥大则是慢性鼻-鼻窦炎最常见的诱因，鼻息肉肥大时鼻腔内空气积存，可导致细菌聚集，如伴有上呼吸道感染，则会加重细菌积存和感染情况，进而引起慢性鼻-鼻窦炎[1]。鼻内镜则是改善慢性鼻-鼻窦炎的主要治疗方法，研究发现，通过鼻内镜切除鼻息肉，可以改善鼻塞症状、清除各鼻窦中的细菌及分泌物，从而缓解炎症反应[2]。研究指出，部分鼻内镜术后患者病情复发、症状改善不明显，进一步研究显示，维生素D在呼吸道感染中发挥重要的作用[3]。本研究探讨维生素D对慢性鼻-鼻窦炎鼻内镜手术疗效的影响，现报道如下。