維生素D對慢性鼻-鼻竇炎鼻內鏡手術療效的影響

胡彬 陳雪春

[摘要] 目的 探討維生素D對慢性鼻-鼻竇炎（CRS）患者鼻內鏡手術療效的影響。 方法 選擇2018年6月～2019年6月在我院耳鼻喉科就診的慢性鼻-鼻竇炎患者60例，隨機分為觀察組（n=30）與對照組（n=30）。對照組采用鼻內鏡手術聯合布地奈德噴霧劑方案治療，觀察組采用維生素D口服治療。兩組患者均持續用藥2個月，用藥前后檢測患者體內維生素D含量，通過視覺模擬評分量表（VAS）、鼻腔鼻竇結局測試-20（SNOT-20）評價療效。結果 對照組治療前后維生素D水平比較，差異無統計學意義（P<0.05）;觀察組患者治療后體內維生素D水平高于治療前及對照組患者治療前后，觀察組患者VAS評分分值除嗅覺障礙外均低于對照組，觀察組SONT-20評分明顯低于對照組，差異均有統計學意義（P<0.05）。 結論 慢性鼻-鼻竇炎患者體內維生素D水平明顯低于正常水平，提高其體內維生素D水平可提高內鏡術后效果，具有重要的診療意義。

[關鍵詞] 維生素D水平;慢性鼻-鼻竇炎;鼻內鏡手術;手術療效

[中圖分類號] R765.4? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 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）是指鼻腔及一個或多個鼻竇發生的慢性炎癥反應。臨床往往伴有嚴重的呼吸道感染，主要表現為鼻塞、流鼻涕、嗅覺障礙、眼脹及頭痛。感染、過敏及鼻息肉肥大等均可誘發慢性鼻-鼻竇炎，而鼻息肉肥大則是慢性鼻-鼻竇炎最常見的誘因，鼻息肉肥大時鼻腔內空氣積存，可導致細菌聚集，如伴有上呼吸道感染，則會加重細菌積存和感染情況，進而引起慢性鼻-鼻竇炎[1]。鼻內鏡則是改善慢性鼻-鼻竇炎的主要治療方法，研究發現，通過鼻內鏡切除鼻息肉，可以改善鼻塞癥狀、清除各鼻竇中的細菌及分泌物，從而緩解炎癥反應[2]。研究指出，部分鼻內鏡術后患者病情復發、癥狀改善不明顯，進一步研究顯示，維生素D在呼吸道感染中發揮重要的作用[3]。本研究探討維生素D對慢性鼻-鼻竇炎鼻內鏡手術療效的影響，現報道如下。