Objective To evaluate the safety of intranasal use of beclomethasone dipropionate, budesonide, fluticasone propionate and mometasone for adults and children with chronic sinusitis/nasal polyps and allergic rhinitis. Methods Randomized controlled trials were located. Study quality was evaluated by two researchers independently. RevMan 4.2 was used for meta-analysis. Results Seven RCTs involving 826 patients were included. Compared with placebo, local use of fluticasone proprionate in adults showed no statistically significant trend to increase incidence of acute sinusitis (OR 16.87, 95% CI 0.87 to 301.62), but no significant difference was seen for epistaxis (OR 7.76, 95% CI 0.38 to 157.14): 1 trial, 60 patients. In another trial, no cases of nasal atrophy were reported in either fluticasone or placebo groups. No significant differences were seen between local use ofbudesonide and placebo in adults for dryness of nasal mucosa (OR 3.38, 95%CI 0.66 to 17.18) and epistaxis (OR 2.20, 95%CI 0.39 to 12.32): 1 trial, 193 participantions. No significant difference was seen between budesonide and pollinex for headache (OR 1.71, 95%CI 0.52 to 5.62). No differences were seen between placebo and fluticasone propionate in children for epistaxis (OR 0.85, 95%CI 0.20 to 3.66), headache (OR 0.25, 95%CI 0.02 to 2.83), plasma cortisol concentration (OR 1.56, 95%CI 0.06 to 38.69) and dryness of nasal mucosa (OR 4.76, 95%CI 0.25 to 89.54). Beclomethasone dipropionate in children showed no statistical differences for dryness of nasal mucosa (OR 0.51, 95%CI 0.14 to 1.87), epistaxis (OR 0.68, 95%CI 0.26 to 1.73) and rhinitis (OR 0.47, 95%CI 0.04 to 5.36). No decrease of plasma cortisol concentration was detected in either group. Mometasone and placebo showed no significant differences in children for epistaxis (OR 1.57, 95%CI 0.41 to 5.95), rhinitis (OR 0.33, 95%CI 0.01 to 8.22) or headache (OR 0.33, 95%CI 0.01 to 8.22). Decrease of plasma cortisol concentration was not detected. Conclusions According to this systematic review, long term intranasal use of steroid for adults and children may be safe based on the two high quality, four moderate quality trials and one with b bias. High quality studies with larger sample sizes and in other languages are needed to provide ber evidence.
Objective To evaluate the clinical effectiveness and safety of compound loratadine capsule in the treatment of allergic rhinitis. Methods A multi-center randomized single blind controlled trial (by using a random number table generated random sequence and the sequence was concealed by sealed envelopes) was designed. Two hundred and forty outpatients with allergic rhinitis who met the inclusion and exclusion criteria were randomized to the treatment group (n=120 with compound loratadine capsule, 1 capsule q 24 h) or the control group (n=120 with loratadine tablet, 1 tablet q 12 h). All patients were given standard therapy. Results ① At the end of the treatment, in the compound loratadine group, 101 patients completed the study, and 19 patients withdrew. In the loratadine group, 103 patients completed the study, 17 patients withdrew. According to intention-to-treat analysis (ITT), the improvement rates of the treatment and control groups were 89.17% (107/120) and 88.33% (106/120) respectively. No significant difference was seen between the two groups (rank sum test, u=-1.8348, P＞0.05). According to per-protocol analysis (PP), the improvement rates of the treatment and control groups were 96.04% (97/101) and 91.26% (94/103) respectively. No significant difference was seen between the two groups (rank sum test, u=-1.625 7, P＞0.05). ② Adverse events were slight to moderate.The adverse event rates were 22.5% (27/120) and 21.67% (26/120) in the treatment and control groups respectively. No significant difference was seen between the two groups ( χ2 test, P＞0.05). Conclusion Compound loratadine capsule is effective and safe for allergic rhinitis.
Objective To analyse the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA). Methods The clinical data of 26 patients diagnosed as ABPA from September 2016 to February 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results Among 26 patients with ABPA, 15 were female, 11 were male, with a mean age of (47.6±11.7) years. Before the diagnosis of ABPA, 13 cases had been misdiagnosed as bronchial asthma, 8 as bronchiectasis, 8 as pulmonary infection, 3 as tuberculosis. All patients had cough, sputum production, wheeze in 2, fever in 5, hemoptysis in 4, chest pain in 4, dyspnea in 2. The wheezing sound were heard in 20 patients and wet rales were heard in 4 cases. All patients had increased total IgE level ［median 5 000 (654 – 5 337)IU/ml］. The eosinophil counts were increased in 23 patients ［median 0.99 (0.50 – 3.69)×109/L］ and percentages of peripheral blood eosinophil were elevated to (0.36±0.10). Skin prink test was positive in 10 cases. All patients had increased Aspergillus fumigatus specific IgE ［median 15.1 (0.4 – 29.6)kU/L). Chest X-ray showed fleeting consolidation. Chest CT showed multiple pachy, central cylindrical bronchiectasis, mucous plugging, band linear or glover-finger opacities. Sixteen cases underwent bronchoscopy, out of them 5 cases underwent transbronchial lung biopsy, 2 cases underwent CT guided percutaneous lung biopsy. Fourteen cases were treated with oral corticosteroids combined with antifungal therapy. Conclusions ABPA is a relatively rare and without specific clinical manifestations. In the early period, it is mostly misdiagnosed as bronchial asthma, so it is necessary to improve the early diagosis of ABPA and give appropriate treatment. Regular follow-up should be made to prevent the recurrence.
ObjectiveTo investigate the chest radiographic and computed tomographic manifestations of allergic bronchopulmonary aspergillosis (ABPA). MethodWe retrospectively analyzed the chest radiographic and computed tomographic manifestations of 20 ABPA patients treated between December 2005 and December 2013. ResultsChest radiograph showed that there were 4 negative cases, 14 cases of solid mass, 10 cases of increased and disorder of bronchovascular shadows, and 5 cases of bronchiectasis. Chest computed tomography showed that there were one negative case, 18 cases of bronchiectasis, 17 cases of central bronchiectasis among which central and peripheral bronchi were involved in 6 cases and 1 case presented as pure peripheral bronchiectasis, 11 cases of tree-in-bud signs, 6 cases of mucous embolism, 8 cases of solid mass, 5 cases of ground-glass opacity, 4 cases of pleural thickening, 3 cases of pleural effusion, and 2 cases of atelectasis. ConclusionsFor asthma and cystic fibrosis patients, central bronchiectasis on chest CT indicates the diagnosis of ABPA, but it cannot be considered as a characteristic feature. Bronchiectasis combined with high attenuation mucus may be a characteristic feature of ABPA although it is rare.
【摘要】 目的 调查凉山地区青少年四种常见变应性疾病——湿疹、荨麻疹、变应性鼻炎（allergic rhinitis，AR）、支气管哮喘（bronchial asthma，BA）的发病情况，及农村与城区患病差异。 方法 采用分层整群抽样方式确定调查点。受调查者填写调查问卷，接受皮肤科、耳鼻喉科、内科专科医师检查。 结果 湿疹调查8 113人，发现患者810例，患病率10.0%，标准化患病率9.3%；男性患病率8.1%，女性患病率11.2%（Plt;0.01）；城区与农村患病率均为10.0%。荨麻疹调查8 113人，发现患者513例，患病率6.3%，标准化患病率6.5%；男性患病率4.6%，女性患病率7.5%（Plt;0.01）；农村患病率6.9%，城区患病率4.9% （Plt;0.01）。AR调查7 977人，发现患者741人，患病率9.3%，标准化患病率9.1%；男性患病率9.4%，女性患病率9.2%（Pgt;0.05）；农村患病率9.0%，城区10.1%（Pgt;0.05）。BA调查7 741人，发现患者296例，患病率3.8%，标准化患病率4.0%；男性患病率3.2%， 女性患病率4.2%（Plt;0.05）；农村患病率4.1%，城区患病率2.9%（Plt;0.05）。 结论 通过调查获得了凉山地区青少年四种变应疾病患病数据。发现女性湿疹、荨麻疹、BA患病率均高于男性，AR患病率相近。农村湿疹、荨麻疹、支气管哮喘患病率均高于城区，AR患病率相近。【Abstract】 Objective To obtain the prevalence rate of four common allergic diseases, including eczema, urticaria, allergic rhinitis, and bronchial asthma, in adolescent of Lianshan district; and to explore the differences of these allergic diseases prevalence rate between rural area and urban area. Methods A survey was conducted in adolescent. The cluster sampling was used. The subjects were required to fulfill the self-report questionnaires and also received physical examinations by doctors. Results A total of 8 113 individuals were included in eczema studis, in whom eczema were present in 810 with a morbidity of eczema of 10.0% (9.3% after standardized). The prevalence rate of eczema in males and females were 8.1% and 11.2%, respectively (Plt;0.01). The prevalence rate of eczema in urban area was the same as that in rural area (10.0%). A total of 8 113 people were included in the urticaria study, in whom urticaria were found in 513. The prevalence rate was 6.3% (6.5% after standardized). The prevalence rate of urticaria in males and females were 4.5% and 7.6%, respectively (Plt;0.01), and were 6.9% and 4.9% respectively in rural area and urban area (Plt;0.01). A total of 7 977 people were included in AR studis. AR was present in 741 people, and the prevalence rate of AR was 9.3% (9.1% after standardized). The prevalence rate of AR in males and females were 9.4% and 9.2% respectively (Pgt;0.05), and were 10.1% and 9.0% respectively in urban area and rural area (Pgt;0.05). A total of 7 741 people were included in BA study, and BA were present in 296 people. The prevalence rate of BA were 3.8% (4.0% after standardized). The prevalence rate in males and females were 3.2% and 4.2% respectively (Plt;0.05), and were 2.9% and 4.1% respectively in urban area and rural area (Plt;0.05). Conclusion The prevalence rate of these commom allergic diseases in adolescent of Liangshan district was obtained. The females have a higher prevalence rate of eczema, urticaria and BA than that in the males; the prevalence rate of AR in males is similar to which in the females. A higher prevalence rate of eczema, urticaria and BA is found in rural area than that in urban area; the prevalence rate of AR in urban area is similar to which in rural area.
【摘要】 目的 观察鼻内镜下激光治疗变应性鼻炎的疗效。 方法 2005年6月－2008年7月采用鼻内镜下Nd:YAG激光治疗变应性鼻炎患者384例，其中男206例，女178例；年龄13~74岁，平均31岁。病程1~33年，平均7.7年。按照2004年制定的《变应性鼻炎诊治原则及推荐方案》评分均gt;6分。术前及术后1、6、24个月时分别对患者症状和体征进行评分和分析。 结果 所有患者均获随访，随访时间1~24个月，平均22.7个月。其中术后1、6、24个月分别有384、380和358例患者获随访。统计术前及术后1、6、24个月时症状以及体征评分总分分别为（11.32±1.03）、（3.06±1.17）、（3.32±1.37）、（4.09±2.03）分，术后各时间点评分均较术前显著改善，差异有统计学意义（Plt;0.05）；术后各时间点间差异均有统计学意义（Plt;0.05），其中以术后1个月效果最好。 结论 鼻内镜下激光治疗变应性鼻炎疗效确切，但远期有一定复发率。【Abstract】 Objective To explore the clinical efficacy of operation by laser under nasal endoscope for the treatment of allergic rhinitis. Methods A total of 384 patients with allergic rhinitis undergoing operation by Nd : YAG laser under nasal endoscope from June 2005 to July 2008 were enrolled in the study, including 208 males and 178 females with their age ranged from 13 to 74 years old averaging at 31.2 years. The course of the disease ranged from 1 to 33 years averaging at 7.7 years. According to The Treatment Principle and Recommending Program for Allergic Rhinitis regulated in 2004, the scores of these cases were all higher than 6. Scoring and analysis of patients’ symptoms and body signs were performed before operation and 1, 6, and 24 months after operation. Results All the patients were followed up with the time period ranged from 1 to 24 months averaging at 22.7 months. A total of 384, 380 and 358 patients were followed up respectively 1, 6, and 24 months after operation. The general score of symptoms and body signs before operation, 1, 6, 24 months after operation were respectively 11.32±1.03, 3.06±1.17, 3.32±1.37, and 4.09±2.03. The scores after operation were significantly better than that before operation (Plt;0.05). The curative effect at the first month was the best. Conclusion Operation by laser under nasal endoscope is one of the valid, feasible methods for the treatment of allergic rhinitis, but during the long-term period, recurrence in some cases is possible.