功能性鼻内镜手术联合糠酸莫米松浸润治疗慢性鼻窦炎伴鼻息肉的临床疗效及机制探索

Clinical Efficacy and Mechanism Exploration of Functional Endoscopic Sinus Surgery Combined with Mometasone Furoate Infiltration in the Treatment of Chronic Rhinosinusitis with Nasal Polyps

摘要: 目的：探索功能性鼻内镜手术(FESS)联合糠酸莫米松浸润治疗慢性鼻窦炎伴鼻息肉(CRSwNP)的临床疗效及机制。方法：纳入2024年3月至2025年3月收治的57例CRSwNP患者，随机分为三组：观察组1双侧鼻窦术区填塞糠酸莫米松浸润纳吸棉，观察组2单侧填塞该药物浸润纳吸棉，对侧填塞生理盐水浸润纳吸棉，对照组双侧填生理盐水浸润纳吸棉，术后随访12周，评估患者主观症状、Lund-MacKay 鼻窦CT评分、Lund-Kennedy鼻内镜评分、T淋巴细胞亚群、皮质醇浓度及鼻粘膜ZO-1、Claudin1蛋白表达。结果：三组患者术后主观症状及客观评分均降低(P < 0.01)，观察组1改善最显著，观察组2次之，对照组最小。术后12周相较于观察组2和对照组，观察组1 CD4+/CD8+ T淋巴细胞增幅最大(P < 0.01)，三组血清皮质醇浓度无差异，观察组1术区黏膜ZO-1和Claudin1蛋白表达显著高于其他两组(P < 0.01)。结论：FESS术后双侧填塞糠酸莫米松浸润纳吸棉可改善FESS术后症状，促进上皮屏障修复，调节免疫平衡，且无全身激素不良反应，为术后局部用药提供新策略。

Abstract: Objective: To explore the clinical efficacy and mechanism of functional endoscopic sinus surgery (FESS) combined with mometasone furoate infiltration in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: A total of 57 CRSwNP patients admitted from March 2024 to March 2025 were enrolled and randomly divided into three groups: In the observation group 1, the bilateral sinus surgical areas were packed with NasoPore soaked in mometasone furoate. In the observation group 2, one side was packed with NasoPore soaked in this drug, and the other side was packed with NasoPore soaked in normal saline. In the control group, both sides were packed with NasoPore soaked in normal saline. The patients were followed up for 12 weeks after the operation and the subjective symptoms, Lund-MacKay sinus CT score, Lund-Kennedy nasal endoscopy score, T lymphocyte subsets, cortisol concentration, and nasal mucosal ZO-1 and Claudin1 protein expressions were evaluated. Results: The subjective symptoms and objective scores of all three groups significantly decreased after surgery (P < 0.01), with the most prominent reduction in observation group 1, followed by observation group 2, and the least significant change in control group. At 12 weeks post-operation, the increase in CD4+/CD8+ TL in observation group 1 was significantly greater than that in observation group 2 and control group (P < 0.01). There was no significant difference in serum cortisol concentration among the three groups. The expressions of ZO-1 and Claudin1 proteins in the surgical area mucosa of observation group 1 were significantly higher than those in the other two groups (P < 0.01). Conclusion: Bilateral packing of mometasone furoate-infiltrated NasoPore after FESS can improve the symptoms of CRSwNP, promote epithelial barrier repair, regulate immune balance, and has no systemic hormonal adverse reactions, providing a new strategy for local medication after surgery.