特异性免疫治疗对慢性鼻窦炎的疗效与安全性Meta分析

Meta-Analysis of the Efficacy and Safety of Specific Immunotherapy for Chronic Rhinosinusitis

摘要: 目的：系统评价特异性免疫治疗(SIT)对慢性鼻窦炎(CRS)的临床疗效与安全性，以治疗有效率作为主要评价指标。方法：系统检索PubMed、Embase、Web of Science、Cochrane Library、中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)等数据库中关于SIT治疗CRS的随机对照试验(RCT)，检索时限为建库至2026年1月13日。由两名研究者独立筛选文献、提取数据，采用Cochrane偏倚风险评估工具评价文献质量，运用RevMan 5.4软件进行Meta分析。主要结局指标为治疗有效率，次要结局指标包括视觉模拟量表(VAS)评分、鼻腔鼻窦结局测试22条(SNOT-22)评分、Lund-Kennedy鼻内镜评分和鼻窦Lund-Mackay CT评分。结果：本研究共纳入12篇RCT文献，其中9篇报告了有效率，文献质量评价显示纳入研究偏倚风险较低。Meta分析结果显示，SIT组的治疗有效率显著高于对照组[RR = 2.77, 95%CI (1.90~3.83), P < 0.00001]，表明SIT治疗CRS的有效率是对照组的2.77倍。在次要结局指标方面，SIT可显著降低患者的SNOT-22评分[MD = −5.29, 95%CI (−8.32~−2.26), P = 0.0006]和Lund-Kennedy鼻内镜评分[MD = −2.65, 95%CI (−4.31~−1.00), P = 0.002]。但在VAS评分[MD = −2.64, 95%CI (−5.62~0.34), P = 0.08]和Lund-Mackay CT评分[MD = −1.49, 95%CI (−3.54~0.56), P = 0.15]方面，两组差异无统计学意义。结论：特异性免疫治疗对慢性鼻窦炎疗效显著，且安全性良好，可改善CRS临床症状、降低复发率。

Abstract: Objective: To systematically evaluate the clinical efficacy and safety of specific immunotherapy (SIT) for chronic rhinosinusitis (CRS), with treatment response rate as the primary outcome. Method: Randomized controlled trials (RCTs) on SIT for CRS were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP databases from inception to January 13, 2026. Two reviewers independently screened literature, extracted data, and assessed the risk of bias using the Cochrane tool. Meta-analysis was performed using RevMan 5.4 software. The primary outcome was treatment response rate; secondary outcomes included Visual Analogue Scale (VAS) score, 22-item Sino-Nasal Outcome Test (SNOT-22) score, Lund-Kennedy endoscopic score, and Lund-Mackay CT score. Results: Twelve RCTs were included in the meta-analysis, of which nine reported response rates. Quality assessment indicated a low risk of bias. The SIT group had a significantly higher response rate than the control group [RR = 2.77, 95%CI (1.90~3.83), P < 0.00001], indicating that the response rate in the SIT group was 2.77 times that of the control group. For secondary outcomes, SIT significantly reduced SNOT-22 scores [MD = −5.29, 95%CI (−8.32~−2.26), P = 0.0006] and Lund-Kennedy endoscopic scores [MD = −2.65, 95%CI (−4.31~−1.00), P = 0.002]. However, no significant differences were found in VAS scores [MD = −2.64, 95%CI (−5.62~0.34), P = 0.08] and Lund-Mackay CT scores [MD = −1.49, 95%CI (−3.54~0.56), P = 0.15]. Conclusion: Specific immunotherapy demonstrates significant efficacy in CRS with favorable safety profiles, effectively alleviating clinical symptoms and reducing recurrence rates.