背景:支持局部使用类固醇治疗无鼻息肉病的慢性鼻-鼻窦炎(CRSsNP)的证据尚不清楚。最近的试验描述了替代的局部类固醇给药方式,包括冲洗和呼气输送系统(EDS),有必要重新审视当前的文献。
方法:Cochrane图书馆,CINAHL,PubMed,和Scopus数据库从开始到2024年2月13日搜索安慰剂对照随机对照试验用于治疗CRSsNP的局部类固醇,包括局部喷雾,鼻腔冲洗,鼻窦导管,和EDS模式。主要结果指标包括总症状评分(TSS)(Δ)和缓解率(比值比)。
结果:纳入10项试验(N=751)进行荟萃分析,平均年龄为47.5岁(范围:18-80岁;95%置信区间[CI]:43.9-51.2岁)。通过任何方法递送的局部类固醇显著改善CRSsNP患者的TSS(Δ0.4;95%CI:0.3-0.6;p<0.0001)。当按过敏状态分层时,无过敏的CRSsNP患者在接受EDS治疗时TSS显著改善(Δ0.4;95%CI:0.1-0.7;p=0.01),但不使用局部喷雾(Δ0.04;95%CI:-0.9至1.0;p=0.94)。与安慰剂相比,使用EDS或鼻窦导管治疗的患者的反应明显更好(比值比[OR]:3.4;95%CI:1.9-6.0;p<0.0001;OR:12.4;95%CI:1.8-83.8;p<0.01),而局部喷雾治疗的患者无显著差异(OR:1.8;95%CI:0.9~4.0;p=0.12).
结论:外用类固醇可有效治疗CRSsNP,尤其是通过EDS或鼻窦导管输送时。需要在CRSsNP人群中使用经过验证的结果测量来比较类固醇递送机制的未来试验。
BACKGROUND: Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re-examination of the current literature.
METHODS: Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo-controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio).
RESULTS: Ten trials (N = 751) were included for meta-analysis, with a mean age of 47.5 years (range: 18-80 years; 95% confidence interval [CI]: 43.9-51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI: 0.3-0.6; p < 0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI: 0.1-0.7; p = 0.01), but not with topical spray (Δ0.04; 95% CI: -0.9 to 1.0; p = 0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR]: 3.4; 95% CI: 1.9-6.0; p < 0.0001; OR: 12.4; 95% CI: 1.8-83.8; p < 0.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9-4.0; p = 0.12).
CONCLUSIONS: Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.