山东大学耳鼻喉眼学报 ›› 2017, Vol. 31 ›› Issue (3): 80-83.doi: 10.6040/j.issn.1673-3770.0.2016.302

• 论著 • 上一篇    下一篇

慢性鼻-鼻窦炎伴鼻息肉复发的相关影响因素分析

伦杰,张亚楠   

  1. 山东省警官总医院, 山东 济南 250002
  • 收稿日期:2016-07-07 出版日期:2017-06-16 发布日期:2017-06-16
  • 通讯作者: 张亚楠. E-mail:zyn2005315@sohu.com

Analysis on the factors related to the recurrence of chronic rhinosinusitis with nasal polyps.

LUN Jie, ZHANG Ya′nan   

  1. Police General Hospital in Shandong Province, Jinan 250002, Shandong, China
  • Received:2016-07-07 Online:2017-06-16 Published:2017-06-16

摘要: 目的 探讨慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)复发的相关影响因素。 方法 选取2011年2月至2014年3月就诊的CRSwNP患者206例,收集临床资料,鼻息肉组织病理学检查,所有患者手术治疗后进行随访,记录患者术后鼻息肉复发情况。 结果 CRSwNP患者随访中,115例(55.8%)患者出现复发,91例(44.2%)患者未出现复发,复发组患者合并哮喘比例、外周血Eos比例、流涕评分、头/面疼痛评分、嗅觉损伤、Lund-Mackay评分和组织嗜酸性粒细胞(Eos)比例均高于未复发组,而外周血中性粒细胞(Neu)比例、组织Neu比例、组织淋巴细胞比例和组织浆细胞比例均低于未复发组,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,组织嗜酸性粒细胞(Eos)比例是影响CRSwNP复发的独立危险因素(P<0.001);ROC曲线分析显示,组织Eos比例在预测CRSwNP复发时,曲线下面积0.948(95%CI:0.923~0.974),当组织Eos比例为18.9%时,灵敏度75.8%,特异度98.3%。 结论 组织Eos比例是影响CRSwNP复发的独立危险因素,当组织Eos比例为18.9%时,具有最佳的诊断价值。

关键词: 复发, 慢性鼻-鼻窦炎, 影响因素, 鼻息肉

Abstract: Objective To investigate the factors related to the recurrence of chronic rhinosinusitis with nasal polyps(CRSwNP). Methods A total of 206 patients with CRSwNP hospitalized in our department From February 2011 to March 2014 were enrolled in this study. The clinical data were collected. The histopathological examinations of nasal polyps were taken. All the patients were followed up after the operation. Results In the following up, 115(55.8%)patients with CRSwNP were recurred and 91(44.2%)were not. The proportion of asthmatic, the proportion of Eos in peripheral blood, runny nose score, head/face pain score, olfactory damage, Lund-Mackay score and the proportion of eosinophil(Eos)in tissues in the recurrence group were higher than those in the non-recurrence group, while the proportion of neutrophils(Neu)in peripheral blood, the proportion of Neu in tissues, the proportion of lymphocytes in tissues and the proportion of plasma cells in the tissues in the recurrence group were lower than those in the non-recurrence group(P<0.05). Multivariate Logistic regression analysis showed that the proportion of eosinophils(Eos)in tissues was an independent risk factor for recurrence of CRSwNP(P<0.001). The ROC curve showed that the proportion of Eos in tissues in predicting the recurrences of CRSwNP, the area under the curve was 0.948(95% CI: 0.923-0.974). When the proportion of Eos was 18.9%, the sensitivity was 75.8% and the specificity was 98.3%. Conclusion The proportion of Eos in tissues was independent risk factor for recurrence of CRSwNP, and when the proportion of Eos in tissues was 18.9%, it had the best diagnostic value.

Key words: Nasal polyps, Chronic rhinosinusitis, Recurrence, Influencing factors

中图分类号: 

  • R765.4
[1] 王明婕, 周兵, 李云川, 等. 外周血嗜酸粒细胞比例在慢性鼻-鼻窦炎伴鼻息肉分类中的作用[J]. 中华耳鼻咽喉头颈外科学杂志, 2013, 48(8):650-653. WANG Mingjie, ZHOU Bing, LI Yunchuan, et al. The role of peripheral blood eosinophil percentage in classification of chronic rhinosinusitis with nasal polyps[J]. Chin J Otorhinolaryngol Head Neck Surgery, 2013, 48(8):650-653.
[2] 高振峰, 陶谦, 蔡晓岚. ERK5蛋白在鼻息肉细胞中的表达和意义[J]. 山东大学耳鼻咽喉眼学报, 2016, 30(1):40-42, 46. GAO Zhenfeng, TAO Qian, CAI Xiaolan. Expression and significance of ERK5 protain in nasal polys cells[J]. J Otolaryngol Ophthal Shandong Univ, 2016, 30(1):40-42, 46.
[3] 中华耳鼻咽喉头颈外科杂志编委会, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 慢性鼻-鼻窦炎诊断和治疗指南(2008年,南昌)[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(1):6-7. Guidelines for diagnosis and treatment of chronic rhinitis and nasal sinusitis(2008, Nanchang)[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2009, 44(1):6-7.
[4] 董晓斌, 柏正群, 李曼. 鼻内镜手术治疗复发性鼻息肉鼻窦炎的临床疗效分析[J]. 现代诊断与治疗, 2016, 27(2):370-371. DONG Xiaobin, BAI Zhengqun, LI Man. Clinical analysis of endoscopic sinus surgery for recurrent nasal polyps[J]. Mod Diagn Treat, 2016, 27(2):370-371.
[5] 陈晓栋, 李晓媛, 石照辉, 等. 鼻内镜手术治疗后鼻孔息肉[J]. 中国耳鼻咽喉头颈外科, 2015, 22(3):125-127. CHEN Xiaodong, LI Xiaoyuan, SHI Zhaohui, et al. Endoscopic approach with choanal polyps[J]. Chin Arch Otolaryngol Head Neck Surg, 2015, 22(3):125-127.
[6] Tosun F, Arslan HH, Karslioglu Y, et al. Relationship between postoperative recurrence rate and eosinophil density of nasal polyps[J]. Ann Otol Rhinol Laryngol, 2010, 119(7):455-459.
[7] 陈建文, 孙敬武, 汪银凤. 变应性因素与慢性鼻窦炎及鼻息肉的相关性研究[J]. 安徽医科大学学报, 2015, 50(1):122-123, 124. CHEN Jianwen, SUN Jingwu, WANG Yinfeng. Study on the relationship between allergic factors and chronic sinusitis and nasal polyps[J]. Acta Universitatis Medicinalis Anhui, 2015, 50(1):122-123, 124.
[8] 崔昕燕, 程雷. 慢性鼻-鼻窦炎—从基础研究到临床实践[J]. 中国中西医结合耳鼻咽喉科杂志, 2013, 21(5):322-324. CUI Xinyan, CHENG Lei. Chronic rhinosinusitis-from basic research to clinical practice[J]. Chin J Otorhinolaryngol Integ Med, 2013, 21(5):322-324.
[9] Chen D, Mao M, Bellussi LM, et al. Increase of high mobility group box chromosomal protein 1 in eosinophilic chronic rhinosinusitis with nasal polyps[J]. Int Forum Allergy Rhinol, 2014, 4(6):453-462.
[10] Fokkens WJ, Lund VJ, Mullol J, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists[J]. Rhinology, 2012, 50(1):1-12.
[11] 王成硕, 娄鸿飞, 孟一帆, 等. 组织嗜酸粒细胞增多对慢性鼻-鼻窦炎伴鼻息肉复发的预测价值研究[J]. 中华耳鼻咽喉头颈外科学杂志, 2016, 51(4):268-272. WANG Chengshuo, LOU Hongfei, MENG Yifan, et al. Predictive significance of tissue eosinophilia for nasal polyp recurrence[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(4):268-272.
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