Study On The Effect Of SHUNTUOMIN On Mucosal Repair And Remodeling Of Rhinitis Medicamentosa

Rhinitis medicamentosa(RM)refers to the non allergic inflammatory reaction of nasal mucosa caused by long-term and excessive application of nasal decongestant.It is characterized by persistent nasal congestion.The symptoms of nasal congestion rebound rapidly after stopping the use of nasal decongestant.This makes patients increase the frequency and dose of nasal decongestant,resulting in drug dependence.The treatment methods of RM mainly include nasal spray of glucocorticoid,surgical treatment and so on.There is no good evidence-based medical evidence for drug treatment except glucocorticoid.However,some patients have hormone contraindications or resistance to hormone therapy,in addition,nasal glucocorticoids are difficult to quickly alleviate nasal congestion after patients stop using decongestant,resulting in poor compliance with follow-up medication.Therefore,it is necessary to further study the effective treatment scheme.SHUNTUOMIN(SNC)is a compound preparation.Its main ingredients include sodium chromonate(mast cell stabilizer),naphthazoline hydrochloride(blood reducing agent),chlorphenamine maleate(antihistamine).It is currently used in treating allergic rhinitis caused by hypersensitivity rhinitis,nasal congestion and sneezing,its ingredients have anti-inflammatory effects,we speculate that the drug can be used to treat RM,however,the effect of the drug in the clinical treatment of RM is not clear.Objective The aim of this study was to establish animal models of RM,and to compare the effects of SNC and mometasone furoate aqueous nasal spray(MFA)on the remodeling and repair of RM nasal mucosa,and to determine the therapeutic outcome of the nasal spray of chrogone naphthalene and to provide a new alternative for RM to replace hormone therapy.And explore the best course of treatment and mechanism of action..Methods 70 healthy male guinea pigs aged 6 ～ 7 months were randomly selected as the control group.The remaining 63 guinea pigs were nasal sprayed with naphazoline hydrochloride nasal drops to establish the animal model of RM.After 4weeks,7 guinea pigs were randomly selected as the model group of RM(RM group).Nasal endoscopy,pathological microscopy,scanning electron microscopy and remodeling related factors were used to test whether the animal model was successful The remaining 56 guinea pigs were randomly divided into four groups,14 guinea pigs in each group.The first group was treated with the SNC as the SNC group.The second group was treated with MFA as the MFA group.The third group was treated with SNC at first,and then sprayed with MFA after an interval of 15 ～ 20 minutes as the combined treatment group.The fourth group was the no treated group of RM(RM-NT)without special treatment.Seven guinea pigs were randomly selected from the four groups at the second and fourth weeks,the degree of redness and swelling of nasal mucosa and secretion were observed by nasal endoscopy,the morphology of mucosal tissue cells was observed by optical microscope and scanning electron microscope,and the expression level of remodeling and repair related factors was detected by qrt-PCR.Results1.Compared with the control group,guinea pigs in the RM group can see the redness and swelling of nasal mucosa and hypertrophy of nasal concha under nasal endoscopy.Under the pathological microscope,inflammatory cell infiltration,ciliary injury and loss,goblet cell volume increased and secretion was active in nasal mucosa.The absence and lodging of cilia were observed under scanning electron microscope,which preliminarily determined that the guinea pig model of RM was successfully established.2.Fibroblast growth factor 2(FGF-2),transforming growth factor(TGF-β1),vascular endothelial growth factor(VEGF),and matrix metalloprotein-9(MMP-9)increased significantly in the RM group.3.After treatment,compared with the RM-NT group,the recovery rate of nasal mucosa in the SNC group,MFA group and combined treatment group was faster than that in the RM-NT group.After 2 weeks of treatment,the red and swollen nasal mucosa,hypertrophy of nasal concha,infiltration of inflammatory cells and volume of goblet cells were reduced in the treatment groups of the three groups,The activity decreased and the injured cilia recovered;After 4 weeks of treatment,the nasal mucosal injury basically returned to normal,and there was no significant difference between the three treatment groups.4.The expression of MMP-9 decreased in the three treatment groups at 2 weeks of treatment.FGF-2 and TGF-β1 decreased at 4 weeks of treatment,and the expression of VEGF decreased in SNC & MFA group.Conclusion SNC may inhibit nasal mucosal remodeling and promote nasal mucosal repair by regulating the expression level of remodeling and repair related factors during RM treatment.The effect of SNC on RM for 4 weeks was better than that for 2 weeks,and there was no significant difference between SNC and MFA and their combination.Our study provides a new choice for the treatment of RM.