“互联网+”医疗模式下慢性鼻窦炎患者FESS术后疗效评估及预后影响因素分析

doi:10.6040/j.issn.1673-3770.0.2025.446

摘要/Abstract

摘要： 目的分析慢性鼻窦炎患者术前及术后的临床指标,评价鼻窦炎术后疗效,探讨可能影响慢性鼻窦炎预后的相关因素,为临床精准治疗、改善患者预后提供相应参考。方法回顾性分析100例慢性鼻窦炎手术患者的临床资料,采用统一的慢性鼻窦炎综合治疗方案,并采用“远程+线下+医学交互”的“互联网+”医疗模式,治疗12周后进行随访来评价短期疗效,并对所有患者随访至18个月,分析可能影响慢性鼻窦炎预后的因素。结果各量表治疗后的效应量>0.50,且差异均有统计学意义(P<0.05)。性别(P=0.674)、年龄(P=0.527)、患病侧别(P=0.369)、病程(P=0.430)、合并高血压(P=0.094)、合并冠心病或心梗(P=0.144)、外周血中性粒细胞/淋巴细胞值(neutrophil-to-lymphocyte ratio, NLR。P=0.514)及血小板/淋巴细胞值(platelet-to-lymphocyte ratio, PLR。P=0.635)各组之间与慢性鼻窦炎预后无明显相关性,差异无统计学意义;罹患糖尿病(HR=2.879, P=0.037)、合并过敏性鼻炎(OR=4.240, P=0.013)、伴有鼻息肉(HR=0.203, P=0.042)、外周血EOS百分比(OR=0.243, P=0.046)为预后不良的独立危险因素,且术前Lund-Mackay得分(OR=1.166, P=0.016)、术前鼻腔-鼻窦结局测试-22(sino-nasal outcome test-22, SNOT-22)得分(OR=1.340, P<0.001)、术前视觉模拟评分(visual analogue scale, VAS)(OR=2.046, P<0.001)及术前Lund-Kennedy得分(OR=1.441, P=0.008),各组之间慢性鼻窦炎的预后差异均有统计学意义。线性混合效应模型显示,SNOT-22得分、VAS得分及Lund-Kennedy得分在治疗后各时间点均显著下降(P均<0.05)。结论慢性鼻窦炎的预后与性别、年龄、患病侧别、病程、合并高血压、合并冠心病及心梗、外周血中性粒细胞/淋巴细胞值(neutrophil-to-lymphocyte ratio, NLR)及血小板/淋巴细胞值(platelet to lymphocyte ratio, PLR)无关;与罹患糖尿病、合并过敏性鼻炎、伴有鼻息肉、外周血EOS百分比有关,且术前Lund-Mackay得分、术前SNOT-22得分、术前VAS得分及术前Lund-Kennedy得分是慢性鼻窦炎预后良好的正性因素。罹患糖尿病、合并过敏性鼻炎及鼻息肉的患者,预后更差,故临床上要重视调控患者血糖、及时联用抗过敏抗炎药物,改善患者预后。

关键词: 慢性鼻窦炎, 实验室指标, 量表, 预后, 疗效

Abstract: Objective To investigate preoperative and postoperative clinical parameters in patients with chronic sinusitis, evaluate surgical outcomes, analyze potential prognostic factors, and provide a reference for precise clinical management to improve patient prognosis. Methods We conducted a retrospective analysis of clinical data from 100 patients who underwent surgery for chronic sinusitis. A standardized comprehensive treatment protocol for chronic sinusitis was implemented, utilizing an ‘Internet Plus’ healthcare model that integrated remote, in person, and interactive medical services. Short-term efficacy was evaluated through follow-up assessments 12 weeks after treatment, and all patients were followed for 18 months to analyze factors that may influence the prognosis of chronic sinusitis. Results The effect sizes for all scales after treatment were >0.50, and the differences were all statistically significant(P<0.05). Gender(P=0.674), age(P=0.527), affected side(P=0.369), duration of illness(P=0.430), concomitant hypertension(P=0.094), concomitant coronary heart disease or myocardial infarction(P=0.144), peripheral blood neutrophil-to-lymphocyte ratio(NLR)(P=0.514), and platelet-to-lymphocyte ratio(PLR)(P=0.635)did not show a significant association with the prognosis of chronic sinusitis between groups, and the differences were not statistically significant; however, diabetes(HR=2.879, P=0.037), concomitant allergic rhinitis(OR=4.240, P=0.013), the presence of nasal polyps(HR=0.203, P=0.042), and the percentage of eosinophils in peripheral blood(OR=0.243, P=0.046)were independent risk factors for poor prognosis. Additionally, the preoperative Lund-Mackay score(OR=1.166, P=0.016), the preoperative SNOT-22 score(OR=1.340, P<0.001), preoperative VAS score(OR=2.046, P<0.001), and the preoperative Lund-Kennedy score(OR=1.441, P=0.008). The differences in the prognosis of chronic sinusitis among the groups were all statistically significant. The linear mixed-effects model showed that SNOT-22 scores, VAS scores, and Lund-Kennedy scores all decreased significantly at all post-treatment time points(all P<0.05). Conclusion The prognosis of chronic sinusitis is not associated with gender, age, affected side, duration of the disease, concomitant hypertension, coronary heart disease, or hematological indices such as NLR and PLR. It is significantly influenced by diabetes mellitus, concomitant allergic rhinitis, the presence of nasal polyps, and the percentage of eosinophils in peripheral blood. Preoperative Lund-Mackay, SNOT-22, VAS, and Lund-Kennedy scores serve as positive prognostic factors. Patients with diabetes, allergic rhinitis, or nasal polyps tend to have a less favorable prognosis. Therefore, clinical management should emphasize stringent glycemic control and timely administration of combined anti-allergic and anti-inflammatory therapy to mitigate the risk of a poor outcome.

Key words: Chronic rhinosinusitis, Laboratory indicators, Scales, Prognosis, Therapeutic efficacy

中图分类号:

R765.41

吴波,闫斌,汤勇. “互联网+”医疗模式下慢性鼻窦炎患者FESS术后疗效评估及预后影响因素分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(5): 94-102.

WU Bo, YAN Bin, TANG Yong. Evaluation of postoperative efficacy and analysis of prognostic factors in chronic sinusitis patients undergoing functional endoscopic sinus surgery in the "internet+"medical model[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2026, 40(5): 94-102.

参考文献

[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. DOI:10.3760/cma.j.issn.1673-0860.2019.02.001
[2] Piccirillo JF. JAMA otolaryngology-head & neck surgery: the year in review, 2020[J]. JAMA Otolaryngol Head Neck Surg, 2021, 147(5): 415. DOI:10.1001/jamaoto.2021.0083
[3] 蔡灿辉, 朱忠寿. 慢性鼻-鼻窦炎上皮细胞损伤与 AMPK/m TOR 激活的相关性[J]. 分子诊断与治疗杂志, 2024, 16(8): 1559-1563. DOI:10.3969/j.issn.1674-6929.2024.08.039
[4] Sedaghat AR, Kuan EC, Scadding GK. Epidemiology of chronic rhinosinusitis: prevalence and risk factors[J]. J Allergy Clin Immunol Pract, 2022, 10(6): 1395-1403. DOI:10.1016/j.jaip.2022.01.016
[5] 罗向前. 中国慢性-鼻窦炎患者多中心临床特征调查[D]. 广州: 中山大学, 2014: 108-109
[6] Castillo Vizuete JA, Sastre J, Del Cuvillo Bernal A, et al. Asthma, rhinitis, and nasal polyp multimorbidities[J]. Arch Bronconeumol, 2019, 55(3): 146-155. DOI:10.1016/j.arbres.2018.09.001
[7] Stevens WW, Peters AT, Hirsch AG, et al. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease[J]. J Allergy Clin Immunol Pract, 2017, 5(4): 1061-1070.e3. DOI:10.1016/j.jaip.2016.12.027
[8] Lee WH, Kim JW, Lim JS, et al. Chronic rhinosinusitis increases the risk of hemorrhagic and ischemic stroke: a longitudinal follow-up study using a national sample cohort[J]. PLoS One, 2018, 13(3): e0193886. DOI:10.1371/journal.pone.0193886
[9] Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011[J]. Allergy, 2016, 71(8): 1170-1180. DOI:10.1111/all.12874
[10] Chen FH, Luo XQ, Xu R, et al. Evaluation of airway hyperresponsiveness in chronic rhinosinusitis: values of sinus computed tomography[J]. Ann Allergy Asthma Immunol, 2014, 113(6): 609-613. DOI:10.1016/j.anai.2014.09.006
[11] Dietz de Loos D, Lourijsen ES, Wildeman MAM, et al. Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology[J]. J Allergy Clin Immunol, 2019, 143(3): 1207-1214. DOI:10.1016/j.jaci.2018.12.986
[12] Liu DT, Phillips KM, Houssein FA, et al. Dedicated olfaction and taste items do not improve psychometric performance of the SNOT-22[J]. Laryngoscope, 2022, 132(8): 1644-1651. DOI:10.1002/lary.30120
[13] Racette SD, Schneider AL, Ganesh M, et al. CRS-PRO and SNOT-22 correlations with type 2 inflammatory mediators in chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2022, 12(11): 1377-1386. DOI:10.1002/alr.23002
[14] Zhang QQ, Zhang C, Chen JN, et al. Correlation between Lund-Mackay computed tomography score and subjective symptoms in Chinese patients with nasal polyps[J]. Acta Otolaryngol, 2025, 145(1): 59-65. DOI:10.1080/00016489.2024.2412720
[15] Chen FH, Liu Y, Guo YY, et al. Impact of sinus CT severity score on the outcomes of endoscopic sinus surgery in eosinophilic CRSwNP[J]. Laryngoscope, 2025, 135(3): 1021-1028. DOI:10.1002/lary.31846
[16] Taheri A, Hasani S, Saberi Esfeedvajani M, et al. Sino-nasal outcome Test-22 and Lund-Mackay CT score to select endoscopic sinus surgery in chronic rhinosinusitis[J]. World J Otorhinolaryngol Head Neck Surg, 2024, 10(3): 200-205. DOI:10.1002/wjo2.112
[17] 杜伟嘉, 赵闪光, 韦新, 等. 慢性鼻窦炎伴鼻息肉患者FESS术后嗅觉功能转归的前瞻性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(7): 542-549. DOI:10.13201/j.issn.2096-7993.2023.07.007
[18] Kang XR, Chen B, Chen YS, et al. A prediction modeling based on SNOT-22 score for endoscopic nasal septoplasty: a retrospective study[J]. PeerJ, 2020, 8: 9890. DOI:10.7717/peerj.9890
[19] Cohen J. A power primer[J]. Psychol Bull, 1992, 112(1): 155-159. DOI:10.1037/0033-2909.112.1.155
[20] Ho J, Alvarado R, Rimmer J, et al. Atopy in chronic rhinosinusitis: impact on quality of life outcomes[J]. Int Forum Allergy Rhinol, 2019, 9(5): 501-507. DOI:10.1002/alr.22272
[21] 李静, 施心怡, 杨瑶, 等. 慢性鼻窦炎的临床病理与预后关系的探讨[J]. 临床耳鼻咽喉头颈外科杂志,2021, 35(10): 914-919. DOI: 10.13201/j.issn.2096-7993.2021.10.011
[22] Kim BY, Lee S, Jeon J, et al. Characteristics of atypical orbital complications of sinusitis[J]. J Craniofacial Surg, 2020, 31(5): e435-e439. DOI:10.1097/scs.0000000000006409
[23] 孙群, 李浩, 汪琼, 等. 微信在预防鼻窦炎术后复发中的应用[J]. 现代医院, 2020, 20(7): 1039-1042. DOI: 10.3969/j.issn.1671-332X.2020.07.030
[24] 朱朗, 刘志奇. 移动医疗提供的真实世界数据在变应性鼻炎治疗方案中的参考[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 135-139. DOI:10.6040/j.issn.1673-3770.0.2023.073
[25] 吕威. 人工智能在慢性鼻窦炎精准诊疗中的研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2025, 31(3): 1-6. DOI:10.11798/j.issn.1007-1520.202525077
[26] Ferraiolo PN, Dortas SDJ, Cruz FCD, et al. Development of a mobile app for the evaluation of patients with chronic rhinosinusitis[J]. Braz J Otorhinolaryngol, 2024, 90(2): 101375. DOI:10.1016/j.bjorl.2023.101375
[27] Yuan X, Meng L, Liu LY, et al. Hyperglycemia and type 2 diabetes mellitus associate with postoperative recurrence in chronic rhinosinusitis patients[J]. Eur Arch Oto Rhino Laryngol, 2025, 282(3): 1289-1299. DOI:10.1007/s00405-024-09109-7
[28] Zhang Z, Adappa ND, Lautenbach E, et al. The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome[J]. Int Forum Allergy Rhinol, 2014, 4(4): 315-320. DOI:10.1002/alr.21269
[29] Hajjij A, Mace JC, Soler ZM, et al. The impact of diabetes mellitus on outcomes of endoscopic sinus surgery: a nested case-control study[J]. Int Forum Allergy Rhinol, 2015, 5(6): 533-540. DOI:10.1002/alr.21495
[30] Kariyawasam HH, Chandrasekharan DP, Jacques T, et al. Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis[J]. Rhinology, 2023, 61(2): 98-107. DOI:10.4193/Rhin22.412
[31] Toro MDC, Antonio MA, Alves Dos Reis MG, et al. Achieving the best method to classify Eosinophilic Chronic Rhinosinusitis: a systematic review[J]. Rhinology, 2021, 59(4): 330-339. DOI:10.4193/Rhin20.512
[32] 潘泽如, 陈红先, 詹淑洁. 慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后鼻息肉复发的影响因素[J]. 医学综述, 2021, 27(13): 2695-2699. DOI:10.3969/j.issn.1672-0369.2022.16.006
[33] 杨旭东. 慢性鼻窦炎伴息肉嗜酸性粒细胞浸润程度与术后转归的临床分析[J]. 辽宁医学杂志, 2020, 34(4): 35-38
[34] 王琴. 全组鼻窦炎伴鼻息肉的手术策略选择及预后相关因素分析[D]. 衡阳: 南华大学, 2022: 17
[35] 孙燕, 罗志强. 嗜酸性粒细胞与慢性鼻-鼻窦炎伴鼻息肉的相关性研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(1): 104-108. DOI:10.11798/j.issn.1007-1520.201901022
[36] Gorgulu O, Kosar MN. Retrospective evaluation of the effects of sugammadex and neostigmine on the IgE and eosinophil cationic protein in morbid obese patients[J]. North Clin Istanb, 2020, 7(6): 572-578. DOI:10.14744/nci.2020.21298
[37] 姚爽, 娄鸿飞. 慢性鼻窦炎的内在型研究进展及精准医疗[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 20-29. DOI:10.6040/j.issn.1673-3770.0.2021.561
[38] Gevaert P, Han JK, Smith SG, et al. The roles of eosinophils and interleukin-5 in the pathophysiology of chronic rhinosinusitis with nasal polyps[J]. Int Forum Allergy Rhinol, 2022, 12(11): 1413-1423. DOI:10.1002/alr.22994
[39] 刘虎山, 李静, 罗丽丽. 外周血嗜酸粒细胞百分比联合鼻窦CT评分在慢性鼻窦炎伴鼻息肉诊断中的应用价值[J]. 基层医学论坛, 2025, 29(4): 24-27. DOI:10.19435/j.1672-1721.2025.04.007
[40] 廖红明. SNOT-22量表对慢性鼻—鼻窦炎患者生活质量的适用性评估[D]. 吉林: 延边大学, 2018: 17

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed