山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (3): 181-188.doi: 10.6040/j.issn.1673-3770.0.2021.535

• 临床研究 • 上一篇    下一篇

鼻呼出一氧化氮对慢性鼻窦炎诊断的临床应用价值

梁旭1,2,金鹏1,赵莉1,于克娜1,訾晓雪1,袁光美1,臧以冉1,张勤勤1,张海令1,史丽1,2,张红萍1   

  1. 1. 山东大学第二医院 耳鼻咽喉头颈外科, 山东 济南 250033;
    2. 山东大学附属山东省耳鼻喉医院 耳鼻咽喉头颈外科, 山东 济南 250023
  • 发布日期:2022-06-15
  • 通讯作者: 张红萍. E-mail:tydzhp@sohu.com
  • 基金资助:
    国家自然科学基金面上项目(81873692);国家自然科学基金青年科学基金项目(81800885);国家自然科学基金青年科学基金项目(82101195);山东省重大科技创新工程项目(2018CXGC1214);吴阶平医学基金会临床科研专项资助基金(320675018237);中华国际医学交流基金会-2017敏识博览研究基金

Role of nasal nitric oxide in diagnosis of chronic sinusitis

LIANG Xu1,2, JIN Peng1, ZHAO Li1, YU Kena1, ZI Xiaoxue1, YUAN Guangmei1, ZANG Yirang1, ZHANG Qinqin1, ZHANG Hailing1, SHI Li1,2, ZHANG Hongping1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Jinan 250033, Shandong, China;
    2. Department of Otorhinolaryngology & Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan 250023, Shandong, China
  • Published:2022-06-15

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摘要： 目的 探讨鼻呼出一氧化氮(nNO)在慢性鼻窦炎(CRS)临床诊断中的应用价值。 方法 回顾性分析135例CRS患者及40例非CRS患者的临床资料,包括患者nNO水平的差异,nNO水平与年龄、BMI、外周血嗜酸性粒细胞计数及百分比、CT Lund-Mackay评分及E/M比值的相关性,通过Logistic回归及ROC曲线分析nNO在CRS中的诊断应用价值。 结果 CRS组、CRSsNP组及CRSwNP组的nNO水平显著低于非CRS组(P<0.001),CRSwNP组的nNO水平显著低于CRSsNP组(P<0.001);eCRSwNP组及non-eCRSwNP组患者的nNO水平显著低于非CRS组患者(P<0.001),eCRSwNP组的nNO水平显著低于non-eCRSwNP组患者(P<0.05)。CRS组和CRSwNP组nNO水平均与E/M比值及Lund-Mackay评分呈显著负相关性(r=-0.423, P<0.001;r=-0.650, P<0.001;r=-0.434, P<0.001;r=-0.608, P<0.001)。Logistic回归分析发现nNO水平与CRS分型显著相关(P<0.01)。nNO对鉴别非CRS与CRS、CRSsNP及CRSwNP具有中度预测价值(AUC=0.849,P<0.001;AUC=0.771,P<0.001;AUC=0.894,P<0.001),对鉴别CRSsNP与CRSwNP具有中度预测价值(AUC=0.776,P<0.01)。对鉴别非CRS与non-eCRSwNP具有中度预测价值(AUC=0.861,P<0.001),eCRSwNP具有高度预测价值(AUC=0.910,P<0.001)。 结论 nNO水平对CRS、CRSsNP和CRSwNP、eCRSwNP和non-eCRSwNP的初步诊断以及鼻息肉病变范围的预测具有一定的临床应用价值。

关键词: 鼻窦炎, 鼻息肉, 一氧化氮, 嗜酸性粒细胞, 过敏

Abstract: Objective To investigate the clinical value of nasal nitric oxide(nNO)in the diagnosis of chronic sinusitis(CRS). Methods The clinical characteristics of 135 CRS patients with or without nasal polyps(wNP and sNP, respectively), and 40 non-CRS patients were analyzed. The retrospective analyses included the differences of nNO levels, correlation between nNO and age, body mass index(BMI), peripheral blood eosinophils count and percentage, computed tomography Lund–Mackay score, and the ethmoid sinus/maxillary sinus(E/M)CT ratio. The diagnostic value of nNO in CRS was determined by receiving operating curve(ROC)curve and logistic regression model analyses. Results The level of nNO in CRSsNP and CRSwNP patients was significantly lower than in non-CRS patients(P<0.001). The level of nNO in CRSwNP patients was significantly lower than in CRSsNP patients(P<0.001). The level of nNO in patients with eosinophilic CRSwNP was lower than that in the non-eosinophilic CRSwNP patients(P<0.001). The nNO levels in the CRS and CRSwNP groups were significantly negatively correlated with E/M ratio and Lund-Mackay score(r=-0.423, P<0.001; r=-0.650, P<0.001; r=-0.434, P<0.001; and r=-0.608, P<0.001, respectively). Logistic regression analysis revealed the significant correlation between nNO level and CRS typing(P<0.01). nNO had moderate predictive value in distinguishing non-CRS from CRSsNP and CRSwNP(area under the ROC curve(AUC=0.849,P<0.001; AUC=0.771,P<0.001; AUC=0.894,P<0.001, respectively). nNO also had moderate predictive value in distinguishing CRSsNP from CRSwNP,(AUC=0.776, P<0.01). nNO had moderate predictive value in distinguishing non-CRS from non-eCRSwNP,(AUC=0.861, P<0.001)and high predictive value in distinguishing non-CRS from eCRSwNP(AUC=0.910,P<0.001). Conclusion nNO has clinical value in the preliminary diagnosis of CRS, distinguishing CRSsNP from CRSwNP, predicting eCRSwNP and non-eCRSwNP, and predicting lesions of nasal polyps.

Key words: Sinusitis, Nasal polyps, Nitric oxide, Eosinophils, Allergic

中图分类号: 

  • R765.4
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