比較肉毒桿菌素與類固醇鼻中膈注射在過敏性鼻炎治療的效用

Comparison of the Treatment Results of Septal Injection of Botulinum Toxins with Steroids in Allergic Rhinitis

陳冠瑋(Kuan-Wei Chen) ； 凃智文(Chih-Wen Twu) ； 黃弘孟(Hung-Meng Huang) ； 徐欣健(Hsin-Chien Hsu)

《台灣耳鼻喉頭頸外科雜誌》 56卷1期 (2021/03) Pp. 14-22

https://doi.org/10.6286/jtohns.202103_56(1).014

摘要

背景：以鼻中膈注射肉毒桿菌素或類固醇治療過敏性鼻炎，並比較主觀問卷－鼻炎控制評估表（rhinitis control assessment test; RCAT）、視覺類比量表（visual analogue scale; VAS）及鼻塞症狀評估表（nasal obstruction symptom evaluation; NOSE）改善程度，客觀評估則為主動式前端鼻阻力儀。方法：本研究為單盲前瞻性世代研究，收集自2016年9月起至2017年8月間，於台北市立聯合醫院和平婦幼院區，共計32名，接受肉毒桿菌素與類固醇鼻中膈注射治療，實驗組A（肉毒桿菌素）共17名，實驗組B（類固醇）共15名，對照組28名。問卷與鼻阻力儀檢查，對照組與實驗組治療前皆施行一次，另實驗組於治療後1個月、2個月及3個月各追蹤施行一次。結果：實驗組A及實驗組B與對照組治療前比較，VAS與NOSE有明顯差異（p＜0.05），在鼻阻力參數中，窄側鼻流與窄側鼻阻力有明顯差異（p＜0.05）。實驗組A與實驗組B兩者治療後的比較，在治療後3個月三項問卷皆有明顯差異（ p＜0.05）；客觀鼻阻力數據上，窄側鼻流、整體鼻流、窄側鼻阻力與整體鼻阻力在治療後3個月皆有明顯差異（p＜0.05）。實驗組A平均三項問卷分數及窄側鼻流，於治療後1個月、2個月及3個月與治療前相比皆有明顯改善（p＜0.05）。實驗組B平均三項問卷分數，於治療後1個月、2個月及3個月與治療前相比亦有改善現象（p＜0.05），鼻阻力參數治療後1個月及3個月的寬側鼻阻力及整體鼻阻力有明顯差異（p＜0.05）。結論：以鼻中膈注射肉毒桿菌素或類固醇治療過敏性鼻炎，是一個簡單快速且安全有效的方法，兩者皆能改善患者主觀症狀達3個月。

關鍵字

active anterior rhinomanometry ； botulinum toxin ； rhinitis control assessment test ； septal injection ； steroid（主動式前端鼻阻力儀 ； 肉毒桿菌素 ； 鼻炎控制評估表 ； 鼻中膈注射 ； 類固醇）

並列摘要

BACKGROUND: The present study aimed to compare the treatment results of septal botulinum toxin and steroid (dexamethasone) injection in patients with allergic rhinitis (AR) by evaluating the improvement in subjective evaluation of the rhinitis control assessment test (RCAT), visual analogue scale (VAS), and nasal obstruction symptom evaluation (NOSE) questionnaires. Active anterior rhinomanometry (RMM) was used as objective evaluation of the nasal airway. METHODS: In this single-blinded prospective cohort study, 32 patients were randomized to receive either botulinum toxins (group A; n = 17) or steroids (group B; n = 15), and another 28 patients without nasal symptoms served as controls at Taipei City Hospital during September of 2016 to August of 2017. RMM and subjective evaluation of nasal symptoms (RCAT, VAS, and NOSE) were assessed in study and control groups preoperatively. Besides, group A and B were assessed at three postoperative visits (1, 2, and 3 months post treatment). RESULTS: The mean preoperative VAS and NOSE scores in groups A and B were significantly higher than those in the control group ( p ＜ 0.05). Flow on the narrow side(NF) and nasal resistance of the narrow side (NNR) in groups A and B were significantly different than those in the control group ( p ＜ 0.05). Statistically significant differences were noted between group A and group B regarding the postoperative mean RCAT, VAS, NOSE, NF, total flow (TF), NNR and total nasal airway resistance (TNR) at 3 months post treatment ( p ＜ 0.05). Significant improvements were observed in postoperative subjective evaluations (RCAT, VAS, and NOSE) and mean NF scores at 1, 2, and 3 months post treatment in group A when compared to preoperative scores ( p ＜ 0.05). Significant improvements were also observed in postoperative subjective evaluations (RCAT, VAS, and NOSE) at 1, 2, and 3 months post treatment in group B when compared to preoperative scores ( p ＜ 0.05); significant differences were noted in nasal resistance of the wide side (WNR) and TNR at 1 month and 3 months post treatment compared to preoperative data. CONCLUSIONS: Septal botulinum toxin and steroid injection are both safe and easy treatment methods for AR, and both of them showed significant improvement of subjective symptoms of AR for 3 months post treatment.

並列關鍵字

active anterior rhinomanometry ； botulinum toxin ； rhinitis control assessment test ； septal injection ； steroid