Correlation analysis between modified nasal endoscopic score and ELR value and subtype of chronic sinusitis with nasal polyps
-
摘要: 目的 分析改良鼻内镜评分及ELR值等相关检查指标与慢性鼻窦炎(CRS)伴鼻息肉亚分型的相关性。方法 回顾性分析119例CRS伴鼻息肉患者的临床资料，根据术后病理结果分为嗜酸粒细胞性CRS伴鼻息肉(eCRSwNP)组及非嗜酸粒细胞性CRS伴鼻息肉(neCRSwNP)组。对所有患者进行改良鼻内镜检查评分，结合临床及解剖特征分别进行中鼻道区和嗅裂区评分；同期记录哮喘、AR病史及血常规中嗜酸细胞百分比(EO%)、嗜酸细胞绝对值(EO#)、中性粒细胞绝对值(N)、淋巴细胞绝对值(R)、总IgE，并计算中性粒细胞与淋巴细胞比率(NLR)、嗜酸粒细胞与淋巴细胞比率(ELR)。采用SPSS 19.0软件对相关数据进行统计学分析。结果 根据改良的鼻内镜评分标准，相比neCRSwNP组，eCRSwNP组嗅裂区评分显著较高而中鼻道区评分显著较低；ELR值、EO%及EO#在eCRSwNP组中明显高于neCRSwNP组，而NLR值及N值在neCRSwNP组中更高(P < 0.05)；2组年龄、性别、R值、总IgE比较差异无统计学意义。ELR值与EO#比较，具有稳定性、敏感度更高等优点。因此，嗅裂区息肉及ELR值对预诊断的意义更大。结论 改良鼻内镜评分及ELR值与CRSwNP的亚分型具有明显相关性，鼻内镜下鼻息肉发生于嗅裂区，其ELR值升高、NLR值降低，且伴发AR、哮喘等，可作为有创病理、CT检查前eCRSwNP的预诊断指标。Abstract: Objective To analyze the correlation between the modified nasal endoscopic score and ELR value and the subtype of chronic sinusitis with nasal polyps.Method The clinical data of 119 patients of chronic sinusitis with nasal polyps were retrospectively analyzed. According to the postoperative pathological results, they were divided into two groups: eosinophilic chronic sinusitis with nasal polyps(eCRSwNP) and non-eosinophilic chronic sinusitis with nasal polyps(neCRSwNP). All patients underwent modified nasal endoscopic examination scores, according to clinical features and anatomical features into the part of the middle nasal meatus and the part of olfactory fissure, and the scores were calculated in two areas respectively; History of asthma, allergic rhinitis and the percentage of eosinophils(EO%), the absolute value of eosinophils(EO#), the absolute neutrophil(N), the absolute lymphocyte(R), the total IgE were recorded at the same time. Calculate the NLR value and ELR value. This study used SPSS 19.0 for statistical analysis of relevant data.Result According to the modified nasal endoscopic scoring criteria, the eCRSwNP group had significantly higher olfactory fissure area scores while middle nasal meatus area scores were significantly lower than the neCRSwNP group; ELR value, EO% and EO# were significantly higher in the eCRSwNP group than in the control group, while NLR value and N value were higher in the neCRSwNP group(P < 0.05); There was no significant difference in age, gender, R value and total IgE between the two groups. Compared with EO#, the ELR value was more stability and sensitivity. Therefore, the olfactory fissure area polyps and ELR value are more significant for pre-diagnosis.Conclusion The modified nasal endoscopic score and ELR value are more correlated with the subtype of CRSwNP. Higher ELR value, lower NLR value, and association with allergic rhinitis, asthma can be used as prediagnostic indicators for eCRSwNP before invasive pathological results and CT examination.
-
Key words:
- sinusitis /
- nasal polyps /
- eosinophils /
- nasal endoscopic score /
- ELR value /
- pre-diagnosis
-
-
表 1 2组患者临床指标比较
临床指标 eCRSwNP组 neCRSwNP组 x±s P 年龄/岁 49.82±15.30 47.67±16.00 48.90±15.50 0.456 嗜酸细胞百分比/% 6.86±10.89 3.08±2.76 5.24±8.25 0.005 嗜酸细胞绝对值/(×109·L-1) 0.37±0.34 0.18±0.16 0.29±0.29 0.000 中性粒细胞绝对值/(×109·L-1) 3.76±1.53 4.37±1.53 4.02±1.55 0.034 淋巴细胞绝对值/(×109·L-1) 1.92±0.65 1.82±0.58 1.88±0.62 0.396 NLR 2.15±1.12 2.63±1.30 2.36±1.22 0.033 ELR 0.20±0.20 0.11±0.11 0.16±0.17 0.001 总IgE/(IU·mL-1) 1.80±0.91 1.55±0.81 1.71±0.88 0.204 
下载: 导出CSV
表 2 2组患者基本临床资料比较分析
例(%) 组别 性别 哮喘 AR 男 女 有哮喘 无哮喘 有 无 eCRSwNP组 47 21 13(19.1) 55(80.9) 52(76.5) 16(23.5) neCRSwNP组 33 18 3(5.9) 48(94.1) 27(52.9) 24(47.1) P 0.612 0.036 0.007
下载: 导出CSV
表 3 2组患者改良鼻内镜评分比较
鼻内镜评分指标 eCRSwNP组 neCRSwNP组 x±s P 均差 中鼻道区(总分) 3.40±1.08 3.84±0.90 3.59±1.03 0.019 -0.45 中鼻道息肉 1.31±0.55 1.61±0.53 1.44±0.56 0.004 -0.30 水肿 1.47±0.68 1.61±0.49 1.53±0.61 0.204 -0.14 脓性分泌物 0.62±0.49 0.63±0.49 0.62±0.49 0.914 -0.01 嗅裂区(总分) 2.50±1.37 1.35±1.47 2.01±1.52 0.000 1.15 嗅裂区息肉 1.21±0.84 0.41±0.73 0.87±0.88 0.000 0.79 水肿 1.13±0.71 0.76±0.79 0.97±0.76 0.009 0.37 脓性分泌物 0.16±0.37 0.18±0.39 0.17±0.38 0.834 -0.01
下载: 导出CSV
表 4 预诊断指标
检查指标 cut-off值 敏感度 特异度 约登指数 AUC P 嗜酸细胞百分比 2.35 77.9 58.8 0.367 0.688 0.000 嗜酸细胞绝对值 0.18 75.0 66.7 0.417 0.717 0.000 ELR 0.08 79.4 60.8 0.402 0.695 0.000 嗅裂区(总分) 0.50 91.4 41.2 0.353 0.723 0.000 嗅裂区(嗅裂区息肉) 0.50 73.5 72.5 0.460 0.745 0.000 嗅裂区(水肿) 0.50 80.9 45.1 0.260 0.631 0.014
下载: 导出CSV
表 5 排除诊断指标
检查指标 cut-off值 敏感度 特异度 约登指数 AUC P 中性粒细胞绝对值 5.58 0.745 0.529 0.274 0.619 0.027 NLR 1.84 0.765 0.471 0.236 0.628 0.017 中鼻道区(总分) 3.50 0.706 0.485 0.191 0.615 0.032 中鼻道区(中鼻道息肉) 1.50 0.627 0.647 0.274 0.639 0.010
下载: 导出CSV
-
[1] 孟一帆, 娄鸿飞, 王成硕, 等. 鼻窦CT在诊断嗜酸粒细胞性慢性鼻-鼻窦炎伴鼻息肉中的价值[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(2): 93-98. doi: 10.3760/cma.j.issn.1673-0860.2017.02.004
[2] Tojima I, Shimizu T. Group 2 innate lymphoid cells and eosinophilic chronic rhinosinusitis[J]. Curr Opin Allergy Clin Immunol, 2019, 19(1): 18-25. doi: 10.1097/ACI.0000000000000496
[3] Snidvongs K, Dalgorf D, Kalish L, et al. Modified Lund Mackay Postoperative Endoscopy Score for defining inflammatory burden in chronic rhinosinusitis[J]. Rhinology, 2014, 52(1): 53-59. doi: 10.4193/Rhino13.056
[4] Brescia G, Barion U, Zanotti C, et al. Pre-and postoperative blood neutrophil-to-lymphocyte and eosinophil-to-lymphocyte ratios in patients with sinonasal polyps: A preliminary investigation[J]. Allergy Asthma Proc, 2017, 38(5): 64-69. doi: 10.2500/aap.2017.38.4068
[5] Brescia G, Pedruzzi B, Barion U, et al. Are neutrophil-, eosinophil-, and basophil-to-lymphocyte ratios useful markers for pinpointing patients at higher risk of recurrent sinonasal polyps?[J]. Am J Otolaryngol, 2016, 37(4): 339-345. doi: 10.1016/j.amjoto.2016.02.002
[6] Yenigün A. Assessment of patients with nasal polyposis by the neutrophil-to-lymphocyte ratio and eosinophil-to-lymphocyte ratio[J]. Kulak Burun Bogaz Ihtis Derg, 2015, 25(4): 193-199. doi: 10.5606/kbbihtisas.2015.10734
[7] Cao PP, Li HB, Wang BF, et al. Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese[J]. J Allergy Clin Immunol, 2009, 124(3): 478-484. doi: 10.1016/j.jaci.2009.05.017
[8] Psaltis AJ, Li G, Vaezeafshar R, et al. Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures[J]. Laryngoscope, 2014, 124(10): 2216-2223. doi: 10.1002/lary.24654
[9] 赵松花, 孙绍辉, 陈娜, 等. 嗜酸细胞性慢性鼻-鼻窦炎嗅觉障碍与嗜酸粒细胞的关系[J]. 武警医学, 2015, 26(4): 350-352. https://www.cnki.com.cn/Article/CJFDTOTAL-WJYX201504008.htm
[10] 肖仪, 罗慧文, 吴健, 等. 非嗜酸粒细胞及嗜酸粒细胞型慢性鼻窦炎伴鼻息肉的临床特征研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(7): 607-610. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201907008.htm
[11] Sakuma Y, Ishitoya J, Komatsu M, et al. New clinical diagnostic criteria for eosinophilic chronic rhinosinusitis[J]. Auris Nasus Larynx, 2011, 38(5): 583-588. doi: 10.1016/j.anl.2011.01.007
[12] Demir F, Karadeniz C, Özdemir R, et al. Usefulness of Neutrophil to Lymphocyte Ratio in Prediction of Coronary Artery Lesions in Patients with Kawasaki Disease[J]. Balkan Med J, 2015, 32(4): 371-376. doi: 10.5152/balkanmedj.2015.151108
[13] Kara A, Guven M, Yilmaz MS, et al. Are neutrophil, platelet and eosinophil-to-lymphocyte ratio and red blood cell distribution width can be used for nasal polyposis?[J]. Eur Arch Otorhinolaryngol, 2018, 275(2): 409-413. doi: 10.1007/s00405-017-4821-3
[14] Yenigün A. Assessment of patients with nasal polyposis by the neutrophil-to-lymphocyte ratio and eosinophil-to-lymphocyte ratio[J]. Kulak Burun Bogaz Ihtis Derg, 2015, 25(4): 193-199. doi: 10.5606/kbbihtisas.2015.10734
[15] Yenigun A, Sezen S, Calim OF, et al. Evaluation of the eosinophil-to-lymphocyte ratio in pediatric patients with allergic rhinitis[J]. Am J Rhinol Allergy, 2016, 30(2): e21-e25. doi: 10.2500/ajra.2016.30.4296
[16] Wongrakpanich S, George G, Chaiwatcharayut W, et al. The Prognostic Significance of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Patients With Multiple Myeloma[J]. J Clin Lab Anal, 2016, 30(6): 1208-1213. doi: 10.1002/jcla.22004
[17] Rachidi S, Wallace K, Wrangle JM, et al. Neutrophil-to-lymphocyte ratio and overall survival in all sites of head and neck squamous cell carcinoma[J]. Head Neck, 2016, 38(Suppl 1): E1068-E1074.
-
图(4)
表(5)
计量
- 文章访问数: 1579
- PDF下载数: 1566
- 施引文献: 0