术前使用度普利尤单抗治疗对慢性鼻窦炎伴鼻息肉患者鼻内镜手术疗效的影响分析

Effect of preoperative dupilumab therapy on endoscopic sinus surgery outcomes in chronic rhinosinusitis with nasal polyps

摘要:

目的 采用回顾性匹配队列研究，分析术前使用度普利尤单抗对鼻内镜下全组鼻窦开放术治疗慢性鼻窦炎伴鼻息肉（CRSwNP）患者疗效的影响。方法 收集2023—2024年在北京协和医院诊治的CRSwNP患者，选取术前接受两剂度普利尤单抗（300 mg皮下注射，每2周1次）并行鼻内镜全组鼻窦开放手术的患者（联合治疗组），与同期仅接受鼻内镜全组鼻窦开放手术的患者（单纯手术组）进行比较，两组各12例。所有患者手术后均规律使用鼻用糖皮质激素，并随访至术后12个月。主要观察指标包括鼻窦CT Lund-Mackay评分、鼻息肉评分（NPS）、鼻腔鼻窦结局测试（SNOT-22）以及相关血液学指标。结果 与单纯手术组相比，联合治疗组在术后随访12个月时显示出明显的疗效优势，无一例息肉复发，而单纯手术组50%（6例）出现复发并需使用生物制剂或口服激素挽救治疗（P=0.014）。联合治疗组在术后12个月的Lund-Mackay评分、NPS评分等方面，也显著优于单纯手术组（均P＜0.01）。结论 在CRSwNP治疗的早期阶段,术前短程采用度普利尤单抗+鼻内镜全组鼻窦开放术+术后规范鼻用激素治疗的综合策略，可显著提高长期疗效，是一种前景广阔的综合治疗模式。

Abstract:

Objective To analyze the efficacy of dupilumab combined with endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis with nasal polyps (CRSwNP) through a retrospective matched cohort study. Methods Patients with CRSwNP who were treated at Peking Union Medical College Hospital from 2023 to 2024 were collected. Patients who received two doses of Dupilumab (300 mg subcutaneous injection, once every 2 weeks) before surgery and underwent ESS were selected as the Dupilumab+ESS group, and compared with those who only underwent ESS during the same period as the simple surgery group. Each group consisted of 12 cases. All patients used intranasal corticosteroids regularly after surgery and were followed up for 12 months postoperatively. The main observation indicators included the Lund-Mackay score （LMS） on sinus CT, nasal polyp score (NPS), sino-nasal outcome test-22 (SNOT-22), and relevant hematological parameters. Results Compared with the simple surgery group, the Dupilumab+ESS group showed significant efficacy advantages at 12 months of postoperative follow-up. None of the patients in the Dupilumab+ESS group had polyp recurrence, while 50% (6 cases) of the simple surgery group had recurrence and required biological agents or oral glucocorticoids for rescue treatment (P=0.014). The LMS, NPS of the Dupilumab+ESS group were also significantly better than those of the simple surgery group at 12 months after surgery (all P<0.01). Conclusions In the early stage of treatment for CRSwNP, a comprehensive strategy of short-term preoperative use of Dupilumab+ESS+postoperative regular nasal glucocorticoid treatment can significantly improve long-term efficacy and is a promising comprehensive treatment model.