嗜酸性粒细胞与非嗜酸性粒细胞慢性鼻-鼻窦炎患者鼻窦CT特征比较

doi:10.6040/j.issn.1673-3770.0.2022.050

摘要/Abstract

摘要： 目的探讨嗜酸性粒细胞慢性鼻-鼻窦炎(ECRS)患者与非嗜酸性粒细胞慢性鼻-鼻窦炎(NECRS)患者鼻窦CT特征。方法纳入2015年10月~2021年6月于武汉大学人民医院进行手术治疗的1 010例慢性鼻-鼻窦炎(CRS)患者作为研究对象,根据组织嗜酸性粒细胞与炎性细胞数量比值(Eos%)≥10%将患者分为ECRS组(n=458)和NECRS组(n=552)。对两组患者Lund Mackay评分、鼻窦累及率和鼻窦病变类型进行差异分析,并探讨不同年龄段ECRS和NECRS组的Lund Mackay评分和鼻窦病变类型是否存在差异及筛窦与上颌窦评分比值(E/M)在预测ECRS中的价值。结果 ECRS组前组筛窦、后组筛窦、额窦、蝶窦、窦口鼻道复合体(OMC)和总分评分均高于NECRS(P<0.01),而上颌窦评分低于NECRS组(P<0.01);ECRS组前组筛窦、后组筛窦、蝶窦和额窦的累及率也高于NECRS组;ECRS组(P=0.786)和NECRS组(P=0.634)在不同年龄段的评分无明显差异;全组鼻窦炎、筛窦为主和非筛窦为主三种CRS类型在ECRS和NECRS组占比依次为:39.08%、37.24%、23.58%和26.45%、8.88%、64.67%;成年患者随着年龄增长,全组鼻窦炎在ECRS中占比逐渐增高(P=0.04)。以E/M>2为截断值时,其预测所有患者ECRS的AUC为0.67,而预测非全组鼻窦炎的AUC为0.75。结论 (1) ECRS的筛窦、额窦和蝶窦病变程度较NECRS重,而上颌窦病变较NECRS轻,筛窦、蝶窦和额窦也较NECRS易受累;(2) ECRS以筛窦病变为主和全组鼻窦炎为主,而NECRS则主要表现为非筛窦为主的病变和全组鼻窦炎;(3) 随着年龄增加,成年ECRS患者患全组鼻窦炎比例更高;(4) E/M>2对全组鼻窦炎ECRS预测价值有限。

关键词: 嗜酸性粒细胞, 鼻窦炎, 上颌窦, 筛窦, 蝶窦, 额窦, 计算机体层摄影

Abstract: Objective To investigate the characteristics of sinus computed tomography in patients with eosinophil chronic nasosinusitis(ECRS)and non-eosinophil chronic nasosinusitis(NECRS). Methods A total of 1010 patients with chronic rhinosinusitis(CRS)were enrolled and divided into the ECRS(n=458)and NECRS(n=552)groups according to the eosinophil to inflammatory cell count ratio(Eos%)in tissue, with a cut off limit of Eos%≥10%. The Lund Mackay score, sinus lesion rate, and sinus lesion type were analyzed between the two groups. The Lund Mackay score and sinus lesion type were analyzed between the ECRS and NECRS groups at different ages, and the value of ethmoid sinus to maxillary sinus score(E/M)in predicting ECRS was also investigated. Results In the ECRS group, the ethmoid sinus, frontal sinus, sphenoid sinus, ostiomeatal complex(OMC)and total scores were higher(P<0.01), while the maxillary sinus scores were lower than those in the NECRS group(P<0.01). The lesion rates of anterior ethmoid sinus, posterior ethmoid sinus, sphenoid sinus, and frontal sinus in the ECRS group were also higher than those in the NECRS group. There was no significant difference in Lund Mackay scores between the ECRS(P=0.786)and NECRS(P=0.634)groups at different ages. The proportions of full set of sinusitis, ethmoid sinus lesion dominant, and non-ethmoid sinus lesion dominant CRS types in ECRS and NECRS groups were 39.08%, 37.24%, 23.58% and 26.45%, 8.88%, 64.67%, respectively. In addition, with the increase of age, the proportion of full set of sinusitis in ECRS in adult patients increased gradually(P=0.04). When E/M>2 was used as the cut-off value, the AUC for predicting ECRS in all patients was 0.67, while that in patients without a full set of sinusitis was 0.75. Conclusions The ethmoid sinus, frontal sinus, and sphenoid sinus lesions in ECRS are more severe than those in NECRS, while the maxillary sinus lesions are less severe. Furthermore, the ethmoid sinus, sphenoid sinus, and frontal sinus are more easily involved in ECRS than in NECRS. ECRS comprises mainly ethmoid sinus lesions with full set of sinusitis, while NECRS comprises mainly non-ethmoid sinus lesions with full set of sinusitis. The incidence of full set of sinusitis in adult ECRS patients increases with age. E/M > 2 has limited predictive value for ECRS in patients with full set of sinusitis.

Key words: Eosinophils, Sinusitis, Maxillary sinus, Ethmoid sinus, Sphenoid sinus, Frontal sinus, Computer tomography

中图分类号:

R765.4

万霞,孔勇刚,陈始明,华红利,魏媛媛,曾曼丽. 嗜酸性粒细胞与非嗜酸性粒细胞慢性鼻-鼻窦炎患者鼻窦CT特征比较[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 275-280.

WAN Xia, KONG Yonggang, CHEN Shiming, HUA Hongli, WEI Yuanyuan, ZENG Manli. Comparison of sinus computed tomography characteristics in patients with eosinophil and non-eosinophil chronic nasosinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 275-280.

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