Predictive factors of asymptomatic airway hyperresponsiveness in chronic rhinosinusitis with nasal polyps
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摘要: 目的 探讨慢性鼻窦炎伴鼻息肉(CRSwNP)患者出现无症状气道高反应(AAHR)的预测因素及价值, 为临床评估气道高反应提供理论依据。方法 回顾性分析2016年5月-2020年10月在山西医科大学附属汾阳医院耳鼻咽喉科住院治疗并已行支气管激发试验检查的CRSwNP患者76例, 其中AAHR 40例, 无气道高反应(NAHR)36例。对患者的临床症状、鼻窦CT评分、外周血及鼻息肉组织嗜酸粒细胞(EOS)计数进行对比分析。应用Logistic回归分析AAHR的危险因素, 应用受试者工作特征曲线判断参数的预测价值。结果 与NAHR组比较, AAHR组患者张口呼吸、鼻后滴漏症状更多, 鼻窦CT筛窦、蝶窦、嗅裂评分及总分更高, 外周血及鼻息肉组织EOS计数更高, 差异均有统计学意义(P < 0.05)。外周血与鼻息肉组织EOS计数呈正相关(r=0.324, P < 0.01)。鼻后滴漏、高后组筛窦评分及鼻息肉组织EOS计数是发生AAHR的危险因素。鼻息肉组织EOS计数较后组筛窦评分预测价值高(AUC分别为0.786和0.685)。当后组筛窦评分≥1.5时, 敏感度为80.0%, 特异性为55.6%;当鼻息肉组织EOS计数≥5.67/HPF时, 敏感度为82.5%, 特异性为66.7%。结论 CRSwNP患者出现AAHR与临床症状、鼻窦CT评分、外周及鼻息肉组织EOS计数有关, 后组筛窦评分及鼻息肉组织EOS计数可用于预测AAHR, 其中鼻息肉组织EOS预测价值更高。Abstract: Objective To explore the predictive factors for asymptomatic airway hyperresponsiveness(AAHR) in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods A total of 76 CRSwNP patients who were hospitalized in the Department of Otorhinolaryngology of Fenyang Hospital affiliated to Shanxi Medical University from May 2016 to October 2020 were retrospectively analyzed, including 40 patients in AAHR group and 36 patients in non-airway hyperresponsiveness(non-airway hyperresponsiveness, NAHR) group. The clinical symptoms, CT score of paranasal sinuses, eosinophil(EOS) count in peripheral blood and nasal polyp tissue were compared and analyzed. Logistic regression was used to analyze the risk factors of AAHR, and receiver operating characteristics curve was used to judge the predictive value of the parameters.Results Compared with NAHR group, AAHR group had more symptoms of mouth breathing and postnasal drip, higher total score of CT in ethmoid sinus, sphenoid sinus, olfactory cleft, and more EOS count in peripheral blood and nasal polyp tissue. The differences were statistically significant. There was a positive correlation between EOS count in peripheral blood and in nasal polyp tissue(r=0.324, P < 0.01). Postnasal drip, high posterior ethmoid sinus(PE) score and nasal polyp tissue EOS count were risk factors for AAHR. The predictive value of nasal polyp tissue EOS count was higher than that of PE score(AUC=0.786 and 0.685, respectively). When the PE score was ≥1.5, the sensitivity was 80.0% and the specificity was 55.6%. When the nasal polyp tissue EOS count was ≥5.67/HPF, the sensitivity was 82.5% and the specificity was 66.7%.Conclusion The occurrence of AAHR in patients with CRSwNP was related to clinical symptoms, paranasal sinus CT score, peripheral and nasal polyp tissue EOS count. PE score and nasal polyp tissue EOS count can be used to predict AAHR, however nasal polyp tissue EOS has higher predictive value.
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Key words:
- sinusitis /
- nasal polyps /
- airway hyperresponsiveness /
- asthma /
- eosinophil
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表 1 AAHR组和NAHR组基本资料、临床症状及外周血检测比较
项目 AAHR组(n=40) NAHR组(n=36) χ2(Z) P 男/女 27/13 17/19 3.196 0.074 年龄/岁，M[P25，P75] 51[35, 57] 50[40, 57] (-0.177) 0.860 吸烟/例(%) 17(42.5) 11(30.6) 1.162 0.281 吸烟指数/(M[P25，P75]) 0[0, 500] 0[0, 505] (-1.017) 0.309 饮酒/例(%) 17(42.5) 9(25.0) 2.578 0.108 变应性鼻炎/例(%) 9(22.5) 6(16.7) 0.407 0.523 病程/月，M[P25，P75] 30[12, 60] 24[7, 57] (-0.676) 0.499 鼻塞/例(%) 40(100.0) 35(97.2) — 0.474a) 嗅觉减退/例(%) 27(67.5) 20(55.6) 1.146 0.284 头部胀痛/例(%) 8(20.0) 12(33.3) 1.737 0.188 流涕/例(%) 36(90.0) 35(97.2) 0.648 0.205 张口呼吸/例(%) 16(40.0) 6(16.7) 5.015 0.025 鼻后滴漏/例(%) 14(35.0) 5(13.9) 4.504 0.034 打喷嚏/例(%) 13(32.5) 8(22.2) 1.001 0.317 血EOS计数/(×109/L) 0.23[0.08，0.45] 0.10[0.03，0.22] (-2.389) 0.018 注：a)Fisher确切概率法。 
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表 2 改良Lund-Mackay鼻窦CT评分对比
各组鼻窦及总分 改良Lund-Mackay评分 Z P AAHR组(n=40) NAHR组(n=36) 上颌窦 2.00[2.00，3.00] 2.00[2.00，3.00] -0.222 0.824 前组筛窦 4.00[2.25，4.00] 2.00[1.00，3.00] -3.396 0.001 后组筛窦 2.00[2.00，4.00] 1.00[0.00，2.00] -2.876 0.004 蝶窦 2.00[0.00，2.00] 0.00[0.00，1.75] -2.440 0.015 额窦 2.00[1.00，4.00] 2.00[0.25，3.00] -1.139 0.255 窦口鼻道复合体 4.00[4.00，4.00] 4.00[2.00，4.00] -1.580 0.114 嗅裂 2.00[1.00，4.00] 1.00[0.00，2.00] -2.323 0.020 总分 18.50[12.00，23.00] 13.50[8.00，19.75] -2.573 0.010
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表 3 多因素二元Logistic回归分析
预测因子 P值 OR 95%CI 鼻后滴漏 0.029 4.390 1.164~16.555 血EOS计数 0.424 0.999 0.995~1.002 鼻息肉组织EOS计数 0.005 1.103 1.030~1.182 前组筛窦 0.642 1.234 0.510~2.988 后组筛窦 0.049 1.498 1.001~2.243 蝶窦 0.535 1.222 0.649~2.300 嗅裂 0.403 0.674 0.267~1.698 总分 0.873 1.188 0.145~9.725
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