外周血嗜酸粒细胞对慢性鼻-鼻窦炎综合治疗预后评估的价值

廖波; 曾明; 刘金鑫; 郭翠莲; 刘争

doi:10.13201/j.issn.1001-1781.2019.01.002

外周血嗜酸粒细胞对慢性鼻-鼻窦炎综合治疗预后评估的价值

- 华中科技大学同济医学院附属同济医院耳鼻咽喉-头颈外科(武汉, 430022)
基金项目:
国家自然科学基金青年基金(No:81700893)

详细信息

通讯作者: 刘争,E-mail:zhengliuent@hotmail.com

中图分类号: R765.21

收稿日期: 2018-11-12

The assessment value of peripheral blood eosinophils for treatment prognosis of chronic rhinosinusitis

- Department of Otorhinolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

More Information

Corresponding author: LIU Zheng, E-mail: zhengliuent@hotmail.com

Received Date: 12 November 2018

摘要

摘要: 目的:探索影响慢性鼻-鼻窦炎治疗效果的相关因素,研究鼻内镜术后口服糖皮质激素治疗患者临床症状及相关实验室检测指标的变化趋势。方法:选取鼻内镜术后的48例慢性鼻-鼻窦炎患者,分为病情未控制组(14例)及病情控制组(34例),分析外周血白细胞、嗜酸粒细胞、中性粒细胞、单核细胞、淋巴细胞计数及临床评分(视觉模拟量表评分、鼻内镜评分、CT评分)的差异并做相关性分析;病情未控制组患者口服糖皮质激素治疗20d后再进行上述资料分析。结果:病情未控制组外周血嗜酸粒细胞计数显著高于病情控制组(P=0.028),变应性鼻炎(P=0.035)、哮喘(P=0.024)、变应性体质(P=0.042)的伴发率也显著增高,血嗜酸粒细胞计数与总视觉模拟量表评分呈正相关(R=0.410,P=0.007);病情未控制组患者经口服糖皮质激素治疗后血嗜酸粒细胞计数(P=0.007)、总视觉模拟量表评分(P<0.001)、总鼻内镜评分(P=0.001)显著降低。结论:伴有变应性鼻炎、哮喘、变应性体质、外周血嗜酸粒细胞增高是导致慢性鼻-鼻窦炎病情难以控制的危险因素,口服糖皮质激素可以显著减少鼻内镜术后病情未控制的慢性鼻-鼻窦炎患者外周血嗜酸粒细胞计数,而外周血嗜酸粒细胞计数是患者预后的重要预测指标。
- 鼻窦炎 /
- 嗜酸粒细胞 /
- 治疗效果
Abstract: Objective:The purposes of present study were to explore the relative factors affecting treatment outcomes of chronic rhinosinusitis (CRS), and investigated the clinical manifestation changes of CRS patients after post-operative treatment of oral glucocorticoid.Method:Forty-eight CRS subjects including 14 illness un-controlled group, and 34 illness controlled group were enrolled, and peripheral blood leukocytes, eosinophils, neutrophils, mononuclear cells, lymphocytes were detected and clinical features comprised of VAS, endoscopy and CT scan scores were recorded;20 days' oral glucocorticoid was prescribed to the patients in illness un-controlled group and the data described above were analyzed.Result:Compared to illness controlled group, illness un-controlled subjects had higher peripheral blood eosinophils count (P=0.028), and complicated with higher rate of allergic rhinitis (P=0.035), asthma (P=0.024), atopy patients (P=0.042);the eosinophils was positively correlated with total VAS scores (R=0.410, P=0.007);the eosinophils count (P=0.007), total VAS scores (P<0.001), total endoscopy scores (P=0.001) were significant decreased after oral glucocorticoid treatment. Conclusion:Allergic rhinitis, asthma, atopy, and elevated eosinophils counts were risk factors of the prognosis of CRS, oral glucocorticoid treatment showed additional benefit to the illness un-controlled CRS subjects, and blood eosinophils count was an important predictive factor for clinical manifestation of CRS.
- sinusitis /
- eosinophils /
- therapeutic efficacy

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参考文献(18)

[1]	FOKKENS W J, LUND V J, MULLOL J, et al.European Position Paper on Rhinosinusitis and Nasal Polyps 2012[J].Rhinol Suppl, 2012, 23:1-298.
[2]	MELTZER E O, HAMILOS D L, HADLEY J A, et al.Rhinosinusitis:establishing definitions for clinical research and patient care[J].J Allergy Clin Immunol, 2004, 114:155-212.
[3]	HOPKINS C, SLACK R, LUND V, et al.Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis[J].Laryngoscope, 2009, 119:2459-2465.
[4]	刘争, 崔永华.嗜酸粒细胞性和非嗜酸粒细胞性鼻息肉[J].临床耳鼻咽喉头颈外科杂志, 2013, 27 (5):225-226.
[5]	POLZEHL D, MOELLER P, RIECHELMANN H, et al.Distinct features of chronic rhinosinusitis with and without nasal polyps[J].Allergy, 2006, 61:1275-1279.
[6]	VAN ZELE T, CLAEYS S, GEVAERT P, et al.Differentiation of chronic sinus diseases by measurement of inflammatory mediators[J].Allergy, 2006, 61:1280-1289.
[7]	CAO P P, LI H B, WANG B F, et al.Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese[J].J Allergy Clin Immunol, 2009, 124:478-484.
[8]	NAKAYAMA T, YOSHIKAWA M, ASAKA D, et al.Mucosal eosinophilia and recurrence of nasal polyps-new classification of chronic rhinosinusitis[J].Rhinology, 2011, 49:392-396.
[9]	HU Y, CAO P P, LIANG G T, et al.Diagnostic significance of blood eosinophil count in eosinophilic chronic rhinosinusitis with nasal polyps in Chinese adults[J].Laryngoscope, 2012, 122:498-503.
[10]	BATEMAN E D, HURD S S, BARNES P J, et al.Global strategy for asthma management and prevention:GINA executive summary[J].Eur Respir J, 2008, 31:143-178.
[11]	LIAO B, LIU J X, LI Z Y, et al.Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes[J].Allergy, 2018, 73:1459-1469.
[12]	LIU Z, LU X, ZHANG X H, et al.Clara cell 10-kDa protein expression in chronic rhinosinusitis and its cytokine-driven regulation in sinonasal mucosa[J].Allergy, 2009, 64:149-157.
[13]	DEAL R T, KOUNTAKIS S E.Significance of nasal polyps in chronic rhinosinusitis:symptoms and surgical outcomes[J].Laryngoscope, 2004, 114:1932-1935.
[14]	LUND V J, KENNEDY D W.Staging for rhinosinusitis[J].Otolaryngol Head Neck Surg, 1997, 117:35-40.
[15]	WEN W, LIU W, ZHANG L, et al.Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy[J].J Allergy Clin Immunol, 2012, 129:1522-1528.
[16]	EBBENS F A, TOPPILA-SALMI S, DE GROOT E J, et al.Predictors of post-operative response to treatment:a double blind placebo controlled study in chronic rhinosinusitis patients[J].Rhinology, 2011, 49:413-419.
[17]	HONG H, CHEN F, SUN Y, et al.Nasal IL-25predicts the response to oral corticosteroids in chronic rhinosinusitis with nasal polyps[J].J Allergy Clin Immunol, 2018, 141:1890-1892.
[18]	JONSTAM K, WESTMAN M, HOLTAPPELS G, et al.Serum periostin, IgE, and SE-IgE can be used as biomarkers to identify moderate to severe chronic rhinosinusitis with nasal polyps[J].J Allergy Clin Immunol, 2017, 140:1705-1708.