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摘要
Background. The pathogenesis of nasal polyposis remains unknown, although polyps seem to be a manifestation of chronic inflammation of the nasal/paranasal sinus mucosa in both allergic and nonallergic subjects. Eosinophil infiltration and accumulation is a hallmark of nasal polyposis. Recent epidemiologic and experimental studies have reported that long-term low-dose macrolide administration is effective in the treatment of chronic rhinosinusitis and nasal polyposis.
Objectives. The aim of this study was to examine the clinical effects of macrolide treatment in comparison with the effects of intranasal corticosteroid treatment of nonallergic and allergic patients with nasal polyposis. The relationship between the level of eosinophil infiltration of the nasal polyp tissue and the quality of the clinical outcome after macrolide therapy were also assessed.
Material and Methods. Forty (n = 40) patients with nasal polyposis, 22 nonallergic and 18 allergic, were administered clarithromycin (CAM) 500 mg/day in a single oral dose for eight weeks. Thirty (n = 30) nasal polyp patients, 17 nonallergic and 13 with comorbid allergic rhinitis, were treated by steroid momethasone-furoate intranasal spray (200 mu g daily), also for eight weeks. The control group consisted of twenty (n = 20) patients with nasal polyps, 10 nonallergic and 10 allergic, who didn't use any medication during the same period. Each of the 90 patients was scored before and after eight weeks according to endoscopic findings. The subjects were categorized in two groups - the improvement group and the no improvement group - after macrolide/corticosteroid treatment. Following macrolide treatment, functional endoscopic sinus surgery (FESS) was performed on all patients in whom we found nasal polyps of different sizes. The eosinophils were counted in hematoxylin-and-eosin-stained sections of nasal polyp samples, in the epithelium and in the lamina propria separately.
Results. In the control group, the average nasal polyp size increased from 4.70 +/- 0.81 to 5.40 +/- 1.24 in the nonallergic group, and from 4.70 +/- 0.79 to 5.30 +/- 1.10 in the allergic group. Macrolide therapy decreased the size of polyps in 45.45% of the nonatopic patients and in 50% of the atopic patients. In the improvement group, comparing the endoscopic findings before and after CAM therapy, there was a large and statistically significant difference in the nasal polyp size. In the nonallergic patients, the size of the polyps decreased from 4.80 +/- 1.01 to 2.60 +/- 0.67 (p < 0.01). In the allergic subjects, the average endoscopic score improved from 4.10 +/- 0.82 to 2.20 +/- 0.54 (p < 0.01). In the nonatopic and atopic patients' polyps, comparing epithelial eosinophil infiltration, a higher mean number of eosinophils was found in the no improvement group than in the improvement group (p < 0.05). Corticosteroid therapy decerased nasal polyp size in all patients. In the nonallergic patients, the size decreased from 4.88 +/- 1.22 to 2.70 +/- 0.58 (p < 0.01), whereas in the allergic patients, the nasal polyps shrank from 5.23 +/- 0.77 to 3.23 +/- 0.62 (p < 0.05).
Conclusions. CAM is more effective in reducing the size of smaller polyps than bigger ones. Allergies have no influence on the clinical efficacy of either corticosteroid or macrolide treatment. In both allergic and nonallergic patients, more intense eosinophil infiltration of the epithelium is related to a worse clinical response to macrolides. Intranasal steroid treatment is more effective in shrinking nasal polyps than macrolide treatment (Adv Clin Exp Med 2011, 20, 3, 325-334).
- 出版日期2011
- 单位河北医科大学; 中国人民解放军军事医学科学院
