目的 探究鼻内镜手术对真菌性鼻-鼻窦炎患者的临床疗效,分析患者手术前后免疫功能及血清炎性因子水平的变化.方法 选取152例真菌性鼻-鼻窦炎患者,均拟行手术治疗,据患者意愿选择手术方式并将其分为对照组(n=85)及观察组(n=67),对照组患者行传统手术治疗,观察组患者行鼻内镜手术治疗,两组均于术后进行常规抗感染及抗真菌治疗.检测并比较术前及术后1周2组患者免疫功能指标及血清炎性因子水平的变化;观察并比较术前及术后1个月两组患者临床症状改善情况.结果 与术前比较,术后1周2组hs-CRP、IL-4、IL-6及IL-17水平均明显降低(P<0.01),且观察组显著低于对照组(P<0.01);与术前比较,术后1周观察组CD4+T淋巴细胞比例、CD4+/CD8+比值及血浆IgG含量明显升高,且显著高于对照组(P<0.01),而观察组CD8+T淋巴细胞比例明显降低,且显著低于对照组(P<0.05);手术前后及两组间IgM均无显著性变化(P>0.05);与术前比较,术后1个月2组流涕、鼻塞、嗅觉障碍及头痛评分均显著降低(P<0.01),且观察组显著低于对照组(P<0.01).结论 鼻内镜手术可有效减轻机体炎性反应,保护机体免疫功能,进而改善患者临床症状,促进患者快速康复,疗效显著优于传统手术治疗.%Objective To explore the clinical efficacy of nasal endoscopic treatment and the changes of immune function and inflammatory factor of the patients with fungal rhinosinusitis. Methods One hundred and fifty-two cases patients with fungal rhinosinusitis were selected for surgical treatment. They were divided into control group (n=85) and study group (n=67)?according to? the?operation?way. The patients in the control group were treated with traditional surgery, and the patients in the study group were treated with nasal endoscopic surgery. Both groups were treated with routine anti-infective therapy and antifungal therapy after operation. Then the changes of levels of immune function and inflammatory factor indexes in two groups before and one week after operation were detected and compared. The improvement of symptoms in the two groups before and one month after operation were observed and compared. Results The levels of hs-CRP, IL-4, IL-6 and IL-17 in two groups were decreased significantly one week after operation (P<0.01),and the levels of study group were significantly lower than those of control group (P<0.01).The proportion of CD4+T lymphocyte,the ratio of CD4+/CD8+and the content of IgG in study group were increased significantly one week after operation, which were higher than those of control group (P<0.01). Meanwhile, the proportion of CD8+T lymphocyte in the study group was significantly lower than that of control group (P<0.05). There was no significant difference in IgM between two groups and before and after operation(P>0.05).Running nose,rhinobyon,dysosmia and headache scores of two groups were decreased significantly one month after operation (P<0.01), and the scores in the study group were lower than those of control group (P<0.01). Conclusion Nasal endoscopic surgery could effectively reduce the patients' inflammatory response and protect the immune function, thereby improve the clinical symptoms and promote rapid rehabilitation of patients. The clinical efficacy of nasal endoscopic surgery is better than that of traditional surgery.
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