山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (1): 46-53.doi: 10.6040/j.issn.1673-3770.0.2023.202

• 论著 • 上一篇    

慢性鼻窦炎伴鼻息肉复发手术时临床及组织病理学特征变化

王文晴1,张丹1,朱梦迪2,王路阳3,杨培培1,孙思思1,张秋敏1,周慧1   

  1. 1.苏州大学附属第一医院 耳鼻咽喉科, 江苏 苏州 215006;
    2.苏州市市立医院 耳鼻咽喉科, 江苏 苏州 215006;
    3.安徽医科大学第一附属医院 普外科, 安徽 合肥 230031
  • 发布日期:2025-01-17
  • 通讯作者: 周慧. E-mail:zhouhui666f@163.com

Changes of clinical and histopathological characteristics in recurrent chronic rhinosinusitis with nasal polyps

WANG Wenqing1, ZHANG Dan1, ZHU Mengdi2, WANG Luyang3, YANG Peipei1, SUN Sisi2, ZHANG Qiumin1, ZHOU Hui1   

  1. 1. Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu,  China2. Department of Otorhinolaryngology, Suzhou Municipal Hospital, Suzhou 215006, Jiangsu, China3. General Surgery Department, the First Affiliated Hospital of Anhui Medical University, Hefei 230031, Anhui, China
  • Published:2025-01-17

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3

摘要： 目的 探讨慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps, CRSwNP)患者初发和复发手术时临床及鼻息肉组织病理学特征的差异。 方法 回顾性分析139例CRSwNP患者的临床资料,其中初发组70例,复发组69例。根据伴或不伴嗜酸性鼻窦炎(eosinophilic CRSwNP, ECRS)、支气管哮喘(bronchial asthma, BA)和变应性鼻炎(allergic rhinitis, AR)分别将初发组和复发组进一步分为不同的亚组。 结果 与初发组相比,复发组鼻息肉组织中总炎性细胞计数和基底膜厚度降低(P=0.04,P=0.016),中性粒细胞百分比、术后3个月未完全上皮化率和1年内CRS症状再现率升高(P=0.047,0.003,0.019)。ECRS复发组外周血嗜酸性粒细胞(Eos)计数及组织总炎细胞计数低于ECRS初发组,组织中性粒细胞百分比及腺体增生评分高于ECRS初发组(P<0.05);BA复发组外周血Eos计数低于BA初发组(P<0.05);AR复发组组织总炎细胞计数较AR初发组降低(P<0.001);BA+AR+ECRS复发组外周血Eos计数及百分比低于AS+AR+ECRS初发组,组织中Eos百分比及腺体增生评分高于初发组(P<0.05);年长复发组基底膜厚度评分低于年长初发组。 结论 伴BA或ECRS的复发患者可出现一定程度的全身嗜酸性炎症负荷减轻,局部嗜酸性炎症无变化。而同时伴有BA、AR和ECRS的复发患者局部嗜酸性炎症负荷增加,组织重塑进一步恶化。该研究结果有可能为复发性鼻窦炎患者术后的个体化治疗提供依据。

关键词: 慢性鼻窦炎伴鼻息肉, 功能性鼻内窥镜手术, 复发, 炎症负荷, 组织重塑

Abstract: Objective To investigate the differences in clinical and histopathological characteristics between the initial and recurrent operations for chronic rhinosinusitis with nasal polyps(CRSwNP). Methods Retrospective analysis of clinical data from 139 patients with CRSwNP, including 70 in the initial group and 69 in the recurrent group. The initial and the recurrent groups were further divided into different subgroups based on the presence of eosinophilic chronic rhinosinusitis(ECRS), bronchial asthma(BA), and allergic rhinitis(AR). Results In the tissue of nasal polyps, the total inflammatory cell count and the thickness of the basement membrane were decreased(P=0.04,0.016), whereas the percentage of neutrophils, the incomplete epithelialization rate at 3 months after surgery, and the recurrence rate of CRS symptoms within 1 year were increased when comparing the recurrent group with the initial group(P=0.047, 0.003, 0.019). The peripheral blood eosinophils(Eos)count and total inflammatory cell count in the ECRS recurrence group were both lower than those in the ECRS initial group, while the tissue neutrophil percentage and glandular hyperplasia score were both higher than those in the ECRS initial group(P<0.05). The peripheral blood Eos count in the BA recurrent group was lower than that in the BA initial group(P<0.05). The total inflammatory cell count in the AR recurrent group was lower than that in the AR initial group(P<0.001). The peripheral blood Eos count and percentage in the BA+AR+ECRS recurrent group were lower than those in the BA+AR+ECRS initial group, while the tissue Eos percentage and glandular hyperplasia score were higher than those in the BA+AR+ECRS initial group(P<0.05). Basement membrane thickness in the elderly recurrent group was lower than that in the elderly initial group. Conclusion Recurrent patients with BA or ECRS can experience a certain degree of reduction in systemic eosinophilic inflammatory load with no change in local eosinophilic inflammation, whereas recurrent patients with BA, AR, and ECRS, present an increased local eosinophilic inflammatory load and worse tissue remodeling. These research results may provide a basis for personalized treatment of patients with recurrent sinusitis after surgery.

Key words: Chronic sinusitis with nasal polyps, Functional nasal endoscopic surgery, Recurrence, Inflammatory load, Tissue remodeling

中图分类号: 

  • R765.4
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