The relationship between clinical pathology and prognosis of chronic rhinosinusitis
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摘要: 目的 探讨慢性鼻窦炎(CRS)的病理类型、临床特征以及与预后的关系。方法 对2017年1月—2018年12月在南京医科大学附属江宁医院行鼻内镜手术的135例CRS患者进行回顾性研究。通过对病理切片逐一阅片, 将患者分为4型, 即嗜酸粒细胞型CRS(eCRS)、淋巴细胞和/或浆细胞型CRS、中性粒细胞型CRS和混合型CRS, 后三者统称为非eCRS(non-eCRS)。于2021年1—2月进行随访, 分析比较不同病理类型的分布、临床特征及预后差异。结果 ① 135例CRS患者中, eCRS共42例(31.1%), non-eCRS共93例(68.9%), 其中淋巴细胞和/或浆细胞型76例(56.3%)、中性粒细胞型4例(3.0%)、混合型13例(9.6%), 组间构成比的差异有统计学意义(n=135, P < 0.001)。②eCRS患者术前外周血嗜酸粒细胞(EOS)绝对值及百分比均较non-eCRS者高, 差异有统计学意义(n=125, P绝对值=0.030, P百分比=0.033)。受试者工作特征曲线分析结果显示EOS绝对值及百分比对eCRS均有预测价值, 截断值为EOS绝对值大于0.325×109/L, 百分比大于2.750%。术前外周血降钙素原在各组间的差异无统计学意义(n=69, P=0.647)。③eCRS患者术前鼻窦CT双侧筛窦评分与双侧上颌窦评分的比值(E/M值)为2.03±1.23, 而non-eCRS患者为1.47±0.96, 差异有统计学意义(n=112, P=0.009)。④101例有效随访患者中, eCRS共34例, 控制7例(20.6%)、部分控制18例(52.9%)、未控制9例(26.5%); non-eCRS共67例, 控制32例(47.8%)、部分控制26例(38.8%)、未控制9例(13.4%)。non-eCRS组疗效明显优于eCRS组(χ2=7.499, P=0.024)。结论 术前血常规检查EOS绝对值大于0.325×109/L或百分比大于2.750%时可初步预测eCRS, 但准确性偏低。eCRS患者CT多表现为筛窦炎症为主的影像学特征, 通常E/M>2。术后2~4年, eCRS组的疗效较non-eCRS差。Abstract: Objective To explore the pathological type, clinical features and their relationship with prognosis of chronic rhinosinusitis(CRS).Methods A retrospective study of 135 patients with CRS who underwent surgical treatment in the Affiliated Jiangning Hospital of Nanjing Medical University from January 2017 to December 2018. Review the pathological slices retrospectively and divide the CRS into 4 types, eosinophilic type(eCRS), lymphocyte or(and) plasma cell type, neutrophil type and mixed type, the latter three are collectively referred to as "non-eosinophil type(non-eCRS)". Follow-up was conducted between January and February 2021 to analyze the distribution, clinical features, and differences in prognosis of the different endotypes.Results ① Among the 135 CRS patients, 42 cases(31.1%) were eCRS and 93 cases(68.9%) were non-eCRS(76 cases[56.3%] of lymphocyte or plasma cell type, 4 cases[3.0%] of neutrophil type and 13 cases[9.6%] of mixed type). The difference in composition ratio between the groups was statistically significant(n=135, P < 0.001). ②The absolute value and percentage of preoperative peripheral blood eosinophils(EOS) in eCRS patients were higher than those of non-eCRS patients, and the difference was statistically significant(n=125, P(absolute value) =0.030, P(percentage) =0.033). The results of receiver operating characteristic curve showed that both absolute value and percentage have predictive value, and cut-off value was 0.325×109/L(absolute value) or 2.750%(percentage). There was no statistically significant difference in preoperative peripheral blood procalcitonin among the groups(n=69, P=0.647). ③The ratio(E/M value) of the bilateral ethmoid sinus scores and bilateral maxillary sinus scores of the preoperative paranasal sinus CT in eCRS patients was 2.03±1.23, while the non-eCRS patients was 1.47±0.96, and the difference was statistically significant(n=112, P=0.009). ④In total, 101 cases were effectively followed up, including 34 cases of eCRS(7 cases[20.6%] of control, 18 cases[52.9%] of partial control), 9 cases[26.5%] of non-control and 67 cases of non-eCRS(32 cases[47.8%] of control, 26 cases[38.8%] were partially controlled, 9 cases[13.4%] were not controlled), and the efficacy of the non-eCRS group was significantly better than that of the eCRS group(χ2=7.499, P=0.024).Conclusion When the absolute value of EOS in the preoperative blood examination is greater than 0.325×109/L or the percentage is greater than 2.750%, eCRS can be predicted, but the accuracy is low. CT of patients with eCRS is mostly characterized by inflammation of the ethmoid sinus and usually E/M>2. The efficacy of eCRS group is worse than that of the non-eCRS group 2—4 years after surgery.
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Key words:
- sinusitis /
- nasal polyps /
- eosinophils /
- pathology /
- prognosis
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表 1 eCRS及non-eCRS患者人口学特征及临床特征
eCRS non-eCRS T P 各类型比例/% 31.1 68.9 19.267 <0.001 年龄/岁 49.26±12.81 45.9±14.42 1.295 0.197 EOS绝对值/(×109/L) 0.18±0.19 0.12±0.16 2.195 0.030 EOS百分比/% 2.56±2.69 1.56±1.83 2.180 0.033 降钙素原/(ng·mL-1) 0.04±0.04 0.05±0.06 -0.460 0.647 E/M值 2.03±1.23 1.47±0.96 2.650 0.009 
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表 2 EOS绝对值及百分比对于eCRS预测价值的AUC及最佳截断值
AUC面积 标准误 P 截断值 敏感度 特异度 1-特异度 约登指数 EOS绝对值 0.631 0.053 0.015 0.325 ×109/L 0.190 0.946 0.054 0.137 EOS百分比 0.615 0.054 0.033 2.750 0.381 0.839 0.161 0.220
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