Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis / Eficácia da irrigação nasal com solução salina hipertônica na rinossinusite crônica: revisão sistemática e metanálise

Abstract Introduction: Currently, several different concentrations of saline are recommended for use in nasal irrigation. Increasing studies show that nasal irrigation with hypertonic saline is more effective than traditional saline in the treatment of rhinosinusitis, but there have been few systematic analyses of the effect of nasal irrigation with hypertonic saline on chronic rhinosinusitis. Objective: We sought to compare the effects of hypertonic saline and isotonic saline in the treatment of rhinosinusitis in order to provide a reference for clinical nasal irrigation for chronic rhinosinusitis treatment. Methods: Medline, cochrane library, EMBASE, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wanfang database, and other databases were searched, and the searching was supplemented by manual searches for relevant references to treatment of rhinosinusitis by saline nasal irrigation. The last retrieval date was March 2018. The included studies were evaluated for quality, and data were extracted for meta-analysis using RevMan 5.3. Results: Seven studies were included. Effects favoring hypertonic saline on nasal symptoms were greater in 4 subgroups. These were (1) patients with nasal secretion (SMD = 1.52; 95% CI: 1.04, 2.00; p < 0.01), (2) patients with congestion (SMD = 1.52; 95% CI: 1.04, 2.00; p < 0.01), (3) patients with headache (SMD = 0.82; 95% CI: 0.38, 1.26; p < 0.01), (4) patients with overall symptomatic relief (SMD = 1.63; 95% CI: 0.83, 2.44; p < 0.01). However, no difference was shown in smell improvement (SMD = 0.47; 95% CI: −0.65, 1.59; p = 0.41) and radiologic scores improvement (SMD = 2.44; 95% CI: -3.14, 8.02; p < 0.01). Besides, hypertonic saline showed greater improvement in mucociliary clearance time scores than did the isotonic saline group (SMD = 1.19; 95% CI: 0.78, 1.60; p < 0.01). Hypertonic saline brought greater minor adverse effects. Conclusion: Compared with isotonic saline, hypertonic saline nasal irrigation for the treatment of chronic rhinosinusitis is significantly more effective and has mild side effects in improving nasal symptoms and ciliary movement, but there is no significant difference in imaging findings and smell improvement. Although hypertonic saline is worthy of widespread use in clinical practice, it is still necessary to further study the exact manner and concentration of nasal irrigation.

Resumo Introdução: Atualmente, o uso de várias concentrações diferentes de solução salina é recomendado na irrigação nasal. Um número crescente de estudos mostra que a irrigação nasal com solução salina hipertônica é mais eficaz do que a solução salina tradicional no tratamento de rinossinusite, mas existem poucas análises sistemáticas do efeito da irrigação nasal com solução salina hipertônica em rinossinusite crônica. Objetivo: Comparar os efeitos da solução salina hipertônica com a solução salina isotônica no tratamento da rinossinusite, para fornecer uma referência clínica de irrigação nasal no tratamento da rinossinusite crônica. Método: Foram pesquisados os bancos de dados Medline, Cochrane Library, Embase, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wanfang database e outros, e a pesquisa foi complementada por pesquisas manuais de referências relevantes ao tratamento da rinossinusite por irrigação nasal com solução salina. A data da última recuperação de dados foi março de 2018. Os estudos incluídos foram avaliados quanto à qualidade e os dados foram extraídos para a metanálise com o software RevMan 5.3. Resultados: Sete estudos foram incluídos. Os efeitos favoráveis à solução salina hipertônica nos sintomas nasais foram maiores em quatro subgrupos. Esses foram (1) pacientes com secreção nasal (DMP = 1,52; IC95%: 1,04, 2,00; p ˂ 0,01); (2) pacientes com congestão (DMP = 1,52; IC95%: 1,04, 2,00; p ˂ 0,01); (3) Pacientes com dor de cabeça (DMP = 0,82; IC95%: 0,38, 1,26; p ˂ 0,01); (4) Pacientes com alívio sintomático geral (DMP = 1,63; IC95%: 0,83, 2,44; p ˂ 0,01). Entretanto, não houve diferença na melhoria do olfato (DMP = 0,47; IC95%: -0,65, 1,59; p = 0,41) e na melhoria dos escores radiológicos (DMP = 2,44; IC95%: -3,14, 8,02; p < 0,01). Além disso, o grupo solução salina hipertônica mostrou maior melhoria nos escores do tempo de clearence mucociliar do que o grupo solução salina isotônica (DMP = 1,19; IC95%: 0,78, 1,60; p ˂ 0,01). A solução salina hipertônica causou efeitos adversos menores. Conclusão: Em comparação com a solução salina isotônica, a irrigação nasal com solução salina hipertônica para o tratamento da rinossinusite crônica é significantemente mais eficaz e apresenta efeitos colaterais mais leves, melhoria mais acentuada dos sintomas nasais e no movimento ciliar, mas não há diferença significante nos achados de imagem e na melhoria do olfato. Embora a solução salina hipertônica seja digna de uso generalizado na prática clínica, ainda são necessários mais estudos sobre a forma de uso e a concentração ideal da solução nasal.

Angiotensin-converting enzyme gene 2350 G/A polymorphism and susceptibility to atrial fibrillation in Han Chinese patients with essential hypertension

OBJECTIVE: The angiotensin-converting enzyme gene is one of the most studied candidate genes related to atrial fibrillation. Among the polymorphisms of the angiotensin-converting enzyme gene, the 2350 G/A polymorphism (rs4343) is known to have the most significant effects on the plasma angiotensin-converting enzyme concentration. The aim of the present study was to investigate the association of the angiotensin-converting enzyme 2350 G/A polymorphism with atrial fibrillation in Han Chinese patients with essential hypertension. METHODS: A total of 169 hypertensive patients were eligible for this study. Patients with atrial fibrillation (n = 75) were allocated to the atrial fibrillation group, and 94 subjects without atrial fibrillation were allocated to the control group. The PCR-based restriction fragment length polymorphism technique was used to assess the genotype frequencies. RESULTS: The distributions of the angiotensin-converting enzyme 2350 G/A genotypes (GG, GA, and AA, respectively) were 40.43%, 41.49%, and 18.08% in the controls and 18.67%, 46.67%, and 34.66% in the atrial fibrillation subjects (p = 0.037). The frequency of the A allele in the atrial fibrillation group was significantly greater than in the control group (58.00% vs. 38.83%, p = 0.0007). Compared with the wild-type GG genotype, the GA and AA genotypes had an increased risk for atrial fibrillation. Additionally, atrial fibrillation patients with the AA genotype had greater left atrial dimensions than the patients with the GG or GA genotypes (p<0.01 and p<0.05, respectively). CONCLUSIONS: The results obtained in this study indicate that the angiotensin-converting enzyme 2350 G/A polymorphism is associated with atrial fibrillation and that the A allele shows an increased risk for atrial fibrillation in Han Chinese patients with essential hypertension. .