Abstract
Objective To explore the impact of preoperative standardized drug therapy on postoperative nasal mucosal remodeling in chronic rhinosinusitis(CRS)with nasal polyps(CRSwNP)patients under nasal endoscopy.Methods 80 patients with CRSwNP from January 2022 to June 2023 were selected as the research subjects.They were randomly divided into an observation group(n=40)and a control group(n=40)according to the random number table method.The control group received functional endoscopic surgery,while the observation group received preoperative standardized drug comprehensive treatment on the basis of the control group.The changes in mucociliary clearance function,nasal function,and nasal mucosal remodeling between the two groups of patients were compared.The Generalized Estimation Equation(GEE)model was used to analyze its improvement situation;The multivariate linear regression analysis was used to analyze its correlation with various scores;The Difference-in-difference model was used to analyze the treatment effect of patients.Results The saccharin clearance time,nasal mucociliary clearance rate,mucociliary clearance rate,nasal cavity volume(NCV),nasal minimum cross-sectional area(NMCA),distance from the minimum cross-sectional area to the anterior nostril(DCAN),eosinophil(EOS),transforming growth factor-β1(TGF-β1)and vascular endothelial growth factor(VEGF)level at different time points within the two groups of patients(before treatment,3 months after treatment,and 6 months after treatment),the analysis of variance using repeated measurements showed that there were statistically significant differences(F=124.36,P=0.000;F=113.58,P=0.000;F=98.67,P=0.000;F=87.37,P=0.000;F=107.26,P=0.000;F=77.45,P=0.000;F=3.80,P=0.008;F=2.56,P=0.012;F=2.13,P=0.015);After 3 and 6 months of treatment,the observation group had a shorter saccharin clearance time,a higher nasal mucociliary clearance rate,a faster mucociliary clearance rate,larger NCV and NMCA,shorter DCAN,and lower levels of EOS,TGF-β1,and VEGF compared to the control group.The differences were statistically significant(F=44.36,P=0.000;F=38.23,P=0.000;F=30.44,P=0.000;F=27.33,P=0.000;F=36.11,P=0.000;F=22.00,P=0.000;F=2.44,P=0.014;F=1.89,P=0.017;F=1.75,P=0.021).There were statistically significant differences in the trends of saccharin clearance time,nasal mucociliary clearance rate,mucociliary clearance rate,NCV,NMCA,DCAN,EOS,TGF-β1,and VEGF level between the two groups(F=18.33,P=0.000;F=15.78,P=0.000;F=13.00,P=0.000;F=8.17,P=0.002;F=10.23,P=0.000;F=4.34,P=0.004;F=2.89,P=0.013;F=1.67,P=0.022;F=1.43,P=0.031).The GEE analysis results showed that the nasal mucociliary clearance rate,NMCA,mucociliary clearance rate,NCV,DCAN,saccharin clearance time were better than those of the control group(P<0.05);After 6 months treatment,the Lund-Kennedy score,Lund-Mackay score,and sino-nasal outcome test-20(SNOT-20)score of both groups decreased compared with before treatment,and the observation group was lower than that of the control group(P<0.05);The results of multivariate linear regression analysis showed that the saccharin clearance time,DCAN,EOS,TGF-β1,VEGF level,and the nasal mucociliary clearance rate,mucociliary clearance rate,NCV,and NMCA were closely related to Lund-Kennedy score,Lund-Mackay score,and SNOT-20 score,respectively(P<0.05);The results of the Difference-in-difference model showed that the improvement of Lund-Kennedy score,Lund-Mackay score,and SNOT-20 score in the observation group were better than those in the control group.After treatment,the total effective rate of the observation group(92.50%)was higher than that of the control group(75.00%),the difference was statistically significant(P<0.05).Conclusion Standardized drug therapy before nasal endoscopy can effectively promote nasal mucosal repair in CRSwNP patients,inhibit postoperative nasal remodeling,and has good therapeutic effects,which is worthy of clinical application.关键词
慢性鼻窦炎(CRS)/鼻息肉/术前规范化药物治疗/鼻黏膜重塑/鼻内镜Key words
chronic rhinosinusitis(CRS)/nasal polyp/preoperative standardized drug therapy/nasal mucosal remodeling/nasal endoscopy分类
医药卫生
