【作者】 马瑞颖；

【导师】 曲雁；

【作者基本信息】 河北医科大学 ， 耳鼻咽喉科学， 2010， 硕士

【摘要】 鼻窦炎是鼻窦黏膜的一种炎症症状,因其常与鼻炎并发,故现广泛认为“鼻鼻窦炎”的名称更为合适。鼻鼻窦炎以包括鼻塞、嗅觉丧失、流涕及面部压迫感在内的临床常见症状为特征。其病因复杂,临床上的综合治疗是十分必要的。糠酸莫米松作为一种具有局部抗炎作用的糖皮质激素,最初用于治疗皮肤疾患和哮喘;而近年来,它的鼻喷剂型(内舒拿)被越来越多的用于变应性鼻炎。此药物具有对持续性哮喘疗效显著,且耐受性良好,可以在提高肺功能的同时减弱过敏源引起的速发性和迟发性哮喘反应,降低气道高反应性及过敏源引起的痰液嗜酸粒细胞增多。近来有研究显示,糠酸莫米松局部应用(糠酸莫米松鼻喷剂),可以提高粘膜纤毛系统的功能,同时影响局部及全身免疫,并能促进内镜术后气道粘膜的恢复。应用糖皮质激素时,不仅要看重它的效能,安全性也不应忽视。对于局部应用的糖皮质激素,局部的高抗炎作用应与低全身暴露相一致。因此,从局部到全身的延迟再分布和快速完全的肝脏代谢——且代谢产物无活性,是很有利的。对糠酸莫米松而言,已有相关报道称,它具有极低全身生物利用度,并对人糖皮质激素受体有极高亲和力。但同时,糠酸莫米松不良的全身副反应,如下丘脑-垂体-肾上腺轴抑制,也提上日程。无论如何,所有的研究结果都不能盖棺定论,尚需进一步研究。本文汇集多方论点进行综述,以期对进一步的临床工作有所助益。更多还原

【Abstract】 Sinusitis is a symptomatic inflammation of the mucosa of paranasal sinuses. Because of it usually appears with nasal symptems, it is now widely suggested that the denomination of“rhinosinusitis”may be more rational. The most common symptoms, including nasal obstruction, smell loss, rhinorrhea, and facial pressure, have been well characterized. As the complexity of its etiology, clinical combined therapy is essential.Mometasone furoate (MF) is a corticosteroid, which originally developed as a topical anti-inflammatory agent to treat dermatologic disorders, asthma, and more recently as a nasal spray for allergic rhinitis (Nasonex). It has been shown to be efficacious and well tolerated by patients with persistent asthma; improving lung function while reducing the magnitude of allergen-induced early and late asthmatic responses, allergen-induced airway hyperresponsive- ness, and allergen-induced increases in sputum eosinophilia. New researches show that MF which is applied as a local corticosteroid(mometasone furoate nasal spray, MFNS) could improve the function of mucocililary system, as well as effect the local/systemic immunity and promote the recovery of the airway mucosa before/after endoscope surgery.Besides the efficacy of a corticosteroid, safety issues have to be taken into consideration. For topically applied glucocorticoids, the high local anti- inflammatory activity should be paralleled by a low systemic exposure. Therefore, it is favorable for a prolonged redistribution from local tissue into systemic circulation and a rapid and complete hepatic metabolism of the compounds to inactive derivatives. It has been reported that MF has a very low systemic bioavailability and very high affinity to the human glucocor- ticoid receptor has been reported. Meanwhile, the undesirable systemic side effects, such as the suppression of the hypothalamic-pituitary-adrenal(HPA) axis, have also been raised.Anyway, all of the investigate has not reached the final conclusion. Further studies are essential. This overview article has gathered many standpoints of various aspects, intending to benefit the clinical work.更多还原