[分享]慢性鼻窦炎可能是空中真菌引起的免疫性疾病
发布于 2004-03-25 · 浏览 1387 · IP 湖北湖北
这个帖子发布于 21 年零 45 天前，其中的信息可能已发生改变或有所发展。
据Medscape.com2004年3月24日旧金山讯
研究人员在美国过敏、哮喘和免疫学会的年会上报告，一项小型随机临床试验表明，慢性鼻窦炎可能是由空气传播的真菌引起的免疫性疾病，抗真菌药可有效治疗。
??“我们证实慢性鼻窦炎病人用抗真菌药可以改善”，第一作者、纽约水牛大学耳鼻喉系的临时主任席利斯（David A. Sherris）告诉记者。这是他在梅欧医院时进行的一项研究。
??他和同事假设，对某些对慢性窦炎敏感的病人，空气中的真菌启动了窦内的免疫反应。因此，在他们的安慰剂对照、双盲试验中，30名慢性窦炎成年病人或接受抗真菌药两性霉素B（20mL）或安慰剂，喷鼻，每天两次。基线、6个月时病人进行了CT扫描，基线、3和6个月时还用内镜检查了炎症。最后分析了24人的资料。
??根据CT结论，研究者发现，用抗真菌药的病人炎性粘液厚度平均减少8.8%，而安慰剂组增加2.5%。同样，前组70%内镜检查结果改善，而后组没有变化。前组粘液中的白介素-5也比安慰剂组显著减少。
??本研究表明需要用抗真菌药对慢性窦炎病人进行多中心试验，席利斯说，“我们建议，一项更大规模的试验可能让ＦＤＡ批准这种治疗”。“我已经在这样药品核准标示外用药地治疗病人了”，他说，“我认为证据已够充分了。你会看到ＦＤＡ在一两年内就会进行试验”。
Chronic Rhinosinusitis May Be an Immune Disorder
March 24, 2004 (San Francisco) — Chronic rhinosinusitis, potentially an immune disorder triggered by airborne fungus, was effectively treated with antifungal medications in a small randomized clinical trial, researchers said here Tuesday at the annual meeting of the American Academy of Allergy, Asthma & Immunology.
"We demonstrated an improvement using antifungals in an objective finding for people with chronic rhinosinusitis," lead author David A. Sherris, MD, interim chair of the department of otolaryngology at the University of Buffalo in New York, told Medscape. Dr. Sherris conducted the research while at the Mayo Clinic.
The researchers hypothesized that airborne fungi initiate an immune reaction in the sinuses in certain people sensitive to chronic sinusitis.
In a randomized, placebo-controlled, double-blind study, 30 adult patients with chronic rhinosinusitis were either given 20 mL of amphotericin B, a fungicide, or a placebo squirted into the nasal cavity twice daily. Data were analyzed for 24 patients.
Researchers performed computed tomography (CT) of patients at baseline and at six months, and they conducted endoscopic examinations for inflammation at baseline, three, and six months.
Based on CT findings, the researchers found that patients receiving the antifungal had an average reduction of 8.8% in the inflammatory mucosal thickening compared with an increase of 2.5% in those receiving placebo. Similarly, 70% of the patients receiving amphotericin had an improvement in endoscopy scores, while the placebo group showed no change.
The treatment group also had significant reductions of intranasal mucus levels of interleukin-5 compared with the placebo group.
Two patients suffered an allergic reaction to the medication, with intranasal swelling.
This study indicates a need for a multicenter trial using antifungals for chronic sinusitis, Dr. Sherris said. "We advocate a larger group of patients and hopefully trials leading to [Food and Drug Administration] FDA approval of a product."
"I treat patients already with off-label use," Dr. Sherris said. "I think there's enough evidence. You'll see FDA trials within the next couple of years."
"If you believe these fungi are important in causing an immune response that promotes chronic sinusitis, this could potentially be exciting therapy," said Allen Adinoff, MD, session moderator and a clinical professor at the University of Colorado in Aurora. "A trial would be reasonable to consider. This is still controversial. We need to see where the dust settles."
The research was supported by grants from the National Institutes of Health and the Mayo Foundation for Education and Research.
AAAAI 60th Annual Meeting: Abstract 1228. Presented March 23, 2004.
研究人员在美国过敏、哮喘和免疫学会的年会上报告，一项小型随机临床试验表明，慢性鼻窦炎可能是由空气传播的真菌引起的免疫性疾病，抗真菌药可有效治疗。
??“我们证实慢性鼻窦炎病人用抗真菌药可以改善”，第一作者、纽约水牛大学耳鼻喉系的临时主任席利斯（David A. Sherris）告诉记者。这是他在梅欧医院时进行的一项研究。
??他和同事假设，对某些对慢性窦炎敏感的病人，空气中的真菌启动了窦内的免疫反应。因此，在他们的安慰剂对照、双盲试验中，30名慢性窦炎成年病人或接受抗真菌药两性霉素B（20mL）或安慰剂，喷鼻，每天两次。基线、6个月时病人进行了CT扫描，基线、3和6个月时还用内镜检查了炎症。最后分析了24人的资料。
??根据CT结论，研究者发现，用抗真菌药的病人炎性粘液厚度平均减少8.8%，而安慰剂组增加2.5%。同样，前组70%内镜检查结果改善，而后组没有变化。前组粘液中的白介素-5也比安慰剂组显著减少。
??本研究表明需要用抗真菌药对慢性窦炎病人进行多中心试验，席利斯说，“我们建议，一项更大规模的试验可能让ＦＤＡ批准这种治疗”。“我已经在这样药品核准标示外用药地治疗病人了”，他说，“我认为证据已够充分了。你会看到ＦＤＡ在一两年内就会进行试验”。
Chronic Rhinosinusitis May Be an Immune Disorder
March 24, 2004 (San Francisco) — Chronic rhinosinusitis, potentially an immune disorder triggered by airborne fungus, was effectively treated with antifungal medications in a small randomized clinical trial, researchers said here Tuesday at the annual meeting of the American Academy of Allergy, Asthma & Immunology.
"We demonstrated an improvement using antifungals in an objective finding for people with chronic rhinosinusitis," lead author David A. Sherris, MD, interim chair of the department of otolaryngology at the University of Buffalo in New York, told Medscape. Dr. Sherris conducted the research while at the Mayo Clinic.
The researchers hypothesized that airborne fungi initiate an immune reaction in the sinuses in certain people sensitive to chronic sinusitis.
In a randomized, placebo-controlled, double-blind study, 30 adult patients with chronic rhinosinusitis were either given 20 mL of amphotericin B, a fungicide, or a placebo squirted into the nasal cavity twice daily. Data were analyzed for 24 patients.
Researchers performed computed tomography (CT) of patients at baseline and at six months, and they conducted endoscopic examinations for inflammation at baseline, three, and six months.
Based on CT findings, the researchers found that patients receiving the antifungal had an average reduction of 8.8% in the inflammatory mucosal thickening compared with an increase of 2.5% in those receiving placebo. Similarly, 70% of the patients receiving amphotericin had an improvement in endoscopy scores, while the placebo group showed no change.
The treatment group also had significant reductions of intranasal mucus levels of interleukin-5 compared with the placebo group.
Two patients suffered an allergic reaction to the medication, with intranasal swelling.
This study indicates a need for a multicenter trial using antifungals for chronic sinusitis, Dr. Sherris said. "We advocate a larger group of patients and hopefully trials leading to [Food and Drug Administration] FDA approval of a product."
"I treat patients already with off-label use," Dr. Sherris said. "I think there's enough evidence. You'll see FDA trials within the next couple of years."
"If you believe these fungi are important in causing an immune response that promotes chronic sinusitis, this could potentially be exciting therapy," said Allen Adinoff, MD, session moderator and a clinical professor at the University of Colorado in Aurora. "A trial would be reasonable to consider. This is still controversial. We need to see where the dust settles."
The research was supported by grants from the National Institutes of Health and the Mayo Foundation for Education and Research.
AAAAI 60th Annual Meeting: Abstract 1228. Presented March 23, 2004.
最后编辑于 2004-03-25 · 浏览 1387
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