探讨克拉霉素联合鼻窦内窥镜手术对慢性鼻窦炎鼻息肉患者炎症反应和免疫功能的影响。

随访研究。选取青海大学附属医院于2018年1月至2020年12月接受诊治的慢性鼻窦炎鼻息肉患者160例，均行克拉霉素联合鼻窦内窥镜手术治疗。其中男性98例，女性62例；年龄（45.4±7.9）岁（27~66岁）。于术后3个月依据鼻内镜检查和临床症状评价疗效；比较术前和术后3个月鼻内镜检查和鼻窦CT量化检查情况。采用视觉模拟评分（VAS）评价主观症状。采用鼻腔鼻窦结局测试（SNOT）-20评分量表评估患者的生活质量。检测患者在术前和术后3个月血清白细胞介素-17（IL-17）、IL-23和肿瘤坏死因子-α（TNF-α）及CD₃⁺、CD₄⁺和CD₄⁺/CD₈⁺的水平。

慢性鼻窦炎鼻息肉患者160例，治疗后治愈143例，好转17例，总有效率为100%。术后3个月Lund-Kennedy评分和Lund-Mackay评分均低于术前［分别为（2.9±0.6）分比（13.7±3.2）分、（3.0±0.7）分比（8.5±1.3）分］，差异均有统计学意义（t=42.243、44.448，均P＜0.001）。术后3个月VAS和SNOT-20评分低于术前［（2.2±0.5）分比（6.5±1.2）分、（12.3±3.4）分比（21.9±5.2）分］，差异均有统计学意义（t=41.269、19.515，均P＜0.001）。术后3个月血清IL-17、IL-23、TNF-α均低于术前，差异均有统计学意义（t=25.440、29.337、25.953，均P＜0.001）。术后3个月CD₃⁺（62.3%±3.1%）、CD₄⁺（41.5%±3.7%）、CD₄⁺/CD₈⁺（1.7±0.3）均高于术前（56.3%±3.5%、35.7%±2.9%、1.3±0.2），差异均有统计学意义（t=16.223、13.981、12.490，均P＜0.001）。

克拉霉素联合鼻窦内窥镜手术对慢性鼻窦炎鼻息肉患者临床疗效显著，可明显减轻症状，减轻炎症反应，对患者的全身免疫状态有一定影响。

To investigate the effect of clarithromycin combined with endoscopic sinus surgery on inflammatory response and immune function in patients with chronic sinusitis and nasal polyps.

A total of 160 patients with chronic sinusitis and nasal polyps who received treatment at the Affiliated Hospital of Qinghai University from January 2018 to December 2020 were selected. Of the patients, there were 98 males and 62 females with a mean age of (45.4±7.9) years (range, 27-66 years). All of them were treated with clarithromycin combined with endoscopic sinus surgery. The efficacy was evaluated by nasal endoscopy and clinical symptoms 3 months after the operation. The results of nasal endoscopic examination and quantitative sinus CT examination before and 3 months after operation were compared. Visual analog scale (VAS) was used to evaluate subjective symptoms. Quality of life was assessed using the nasal sinus outcome test (SNOT)-20 scale. Serum levels of interleukin (IL)-17, IL-23, tumor necrosis factor-α (TNF-α), CD3⁺ T cells, CD4⁺ T cells, and CD4⁺/CD8⁺ ratio were measured before and 3 months after the surgery.

Of the 160 patients with chronic sinusitis and nasal polyps included, 143 were cured and 170 had improvement of the symptoms, with a total effective rate of 100%. The Lund-Kennedy score (2.9±0.6) and Lund-Mackay score (3.0±0.7) at 3 months after surgery were lower than those before surgery (13.7±3.2 and 8.5±1.3, respectively) (t=42.243 and 44.448, respectively, P＜0.001 for both). The VAS score and SNOT-20 score at 3 months after surgery were both significantly lower than those before surgery (2.2±0.5 vs 6.5±1.2 and 12.3±3.4 vs 21.9±5.2, t=41.269 and 19.515, respectively, P＜0.001 for both). Serum IL-17, IL-23, and TNF-α at 3 months after operation were all significantly lower than those before operation (t=25.440, 29.337, and 25.953, respectively, P＜0.001 for all). Three months after operation, the percentages of CD3⁺ T cells and CD4⁺ T cells and CD4⁺/CD8⁺ ratio were significantly higher than those before operation (62.3%±3.1% vs 56.3%±3.5%, 41.5%±3.7% vs 35.7%±2.9%, and 1.7±0.3 vs 1.3±0.2, t=16.223, 13.981, and 12.490, respectively, P＜0.001 for all).

Clarithromycin combined with endoscopic sinus surgery has significant clinical effects in patients with chronic sinusitis and nasal polyps, and can significantly reduce symptoms and inflammatory reactions and exert an influence on the systemic immune status of patients.