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目的探讨中耳积液中纤维蛋白原含量与分泌性中耳炎病情迁延的关系及巴曲酶治疗分泌性中耳炎的可能机制。方法用凝固法对156例分泌性中耳炎患者治疗过程中的中耳积液中纤维蛋白原含量进行动态检测。鼓室抽液2次(间隔1周),积液复发者随机分成巴曲酶组及地塞米松组,穿刺后分别用0．5 ml巴曲酶(2 BU／ml)或0．5 ml地塞米松(2 mg／ml)行鼓室内注射治疗,观察治疗效果。结果积液复发组第1、2次复发中耳积液中纤维蛋白原含量均明显高于痊愈组,且第2次复发者的中耳积液纤维蛋白原含量更高(P<0．01)。巴曲酶组治疗有效率为91．6%,较地塞米松组(有效率为62．5%)差异有统计学意义(P<0．001)。治疗后6个月巴曲酶组平均气导听阈值(0．5、1．0、2．0 kHz)变化与地塞米松组比较,治疗1周后2组中耳积液中纤维蛋白原含量差异,均有统计学意义(P<0．01)。结论纤维蛋白原可能在分泌性中耳炎发生发展中起重要作用;鼓室内注射巴曲酶比注射地塞米松治疗分泌性中耳炎,疗效差异有统计学意义,其机制可能是通过降解纤维蛋白原以解除其对咽鼓管表面活性物质的抑制作用或(和)阻止其转变成不溶性纤维蛋白聚合体。
Objective To investigate the relationship between the content of fibrinogen in middle ear effusion and the exacerbation of otitis media and the possible mechanism of batroxobin in the treatment of secretory otitis media. Methods The coagulation method was used to detect the content of fibrinogen in the middle ear effusion of 156 patients with secretory otitis media. The tympanic fluid pumping 2 times (interval 1 week), recurrence of effusion were randomly divided into batroxobin group and dexamethasone group, respectively, after puncture with 0.5 ml batroxobin (2 BU / ml) or 0.5 ml Dexamethasone (2 mg / ml) intrathecal injection therapy to observe the therapeutic effect. Results In the effusion recurrence group, the contents of fibrinogen in the first and second episodes of middle ear effusion were significantly higher than those in the recovery group, and the content of fibrinogen in the second effusion was higher in the second recurrence group (P <0.01) ). Batroxobin treatment group was 91.6%, compared with dexamethasone group (effective rate was 62.5%), the difference was statistically significant (P <0.001). At 6 months after treatment, the changes of mean air conduction threshold (0.5,1.0,2.0 kHz) in Batroxobin group were compared with that of dexamethasone group. After 1 week of treatment, fibrinogen Content differences were statistically significant (P <0.01). Conclusions Fibrinogen may play an important role in the development of secretory otitis media. The tympanic injection of batroxobin is more effective than dexamethasone in the treatment of secretory otitis media. The mechanism may be relieved by the degradation of fibrinogen Its inhibitory effect on eustachian tube surface-active substances or (and) prevents its conversion to insoluble fibrin polymers.