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摘要: 目的 探讨鼻呼气一氧化氮(nNO)能否用来鉴别原发弥漫性慢性鼻窦炎(CRS)的主要临床表型以及能否反映鼻窦黏膜病变的严重程度。方法 共纳入57例原发弥漫性CRS患者，根据外周血嗜酸粒细胞(EOS)百分比分为EosCRS组和non-EosCRS组，同期选取32例健康志愿者为对照组。根据鼻内镜下是否伴有鼻息肉，将EosCRS组分为EosCRSwNP组和EosCRSsNP组，non-EosCRS组分为non-EosCRSwNP组和non-EosCRSsNP组。采用10 mL/s流速的单鼻孔抽气同时软腭关闭的方法检测nNO水平；用Lund-Mackay评分评估鼻窦病变严重程度。用秩和检验比较nNO水平的差异，Pearson相关性分析方法分析nNO水平与Lund-Mackay评分的相关性。结果 ① EosCRS组[315.00(88.00，446.50)×10-9]和non-EosCRS组[419.00(181.00，469.00)×10-9]的nNO水平均明显低于对照组[457.00(431.00，493.75)×10-9]，差异有统计学意义(P＜0.01)。②EosCRSwNP组的nNO水平[260.00(71.75，391.50)×10-9]显著低于EosCRSsNP组[557.00(442.50，619.75)×10-9]，non-EosCRSwNP组的nNO水平[210.00(159.75，434.25)×10-9]显著低于non-EosCRSsNP组[455.00(425.00，481.00)×10-9]，差异有统计学意义(P＜0.05)。③EosCRS组nNO水平与Lund-Mackay评分总分之间存在中强度的负相关关系(r=-0.567，P＜0.01)。结论 nNO不能用来鉴别原发弥漫性CRS的主要临床表型，但其水平测定可用于判定原发弥漫性CRS是否伴有鼻息肉及反映鼻窦黏膜病变的严重程度。
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关键词:
- 鼻窦炎 /
- 鼻息肉 /
- 鼻呼气一氧化氮 /
- 嗜酸粒细胞 /
- Lund-Mackay评分
Abstract: Objective This study aimed to investigate whether nasal nitric oxide(nNO) could be used to identify the main clinical phenotypes of primary diffuse chronic sinusitis(CRS) and reflect the severity of sinus mucosal lesions.Methods A total of 57 patients with primary diffuse CRS were included as the case group in this study. And the patients were divided into eosinophilic CRS(EosCRS) group and non-EosCRS group according to the percentage of eosinophils in peripheral blood. At the same time, 32 healthy volunteers were selected as the control group. According to whether there is nasal polyps under nasal endoscopy, the EosCRS group was classified into EosCRS with nasal polyps(EosCRSwNP) and EosCRS without nasal polyps(EosCRSsNP). In the same way, the non-EosCRS group was assigned to non-EosCRS with nasal polyps(non-EosCRSwNP) and non-EosCRS without nasal polyps(non-EosCRSsNP). The levels of nNO were detected by single nostril air extraction with 10 mL/s flow rate and soft palate closure. The severity of sinus lesions were evaluated by Lund-Mackay score. The difference of nNO levels were compared by the Rank sum test. The correlation between nNO levels and Lund-Mackay score was analyzed by Pearson correlation analysis.Results ① The levels of nNO in EosCRS group [315.00(88.00, 446.50) ×10-9] and non-EosCRS group [419.00(181.00, 469.00) ×10-9] were significantly lower than those in the control group [457.00(431.00, 493.75) ×10-9](P < 0.01). ②The levels of nNO in EosCRSwNP group [260.00(71.75, 391.50) ×10-9] were significantly lower than that in EosCRSsNP group [557.00(442.50, 619.75) ×10-9], and that in non-EosCRSwNP group [210.00(159.75, 434.25) ×10-9] were significantly lower than non-EosCRSsNP group [455.00(425.00, 481.00) ×10-9](P < 0.05). ③There was a medially negative correlation between the levels of nNO and the total score of Lund-Mackay score in the EosCRS group(r=-0.567, P < 0.01).Conclusion The levels of nNO can be used to determine whether primary diffuse CRS is accompanied by nasal polyps and reflect the severity of nasal sinus mucosal lesions, instead of identifying the main clinical phenotypes of primary diffuse CRS.-
Key words:
- sinusitis /
- nasal polyps /
- nasal nitric oxide /
- eosinophil /
- Lund-Mackay score
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表 1 EosCRS组、non-EosCRS组和对照组的临床特征比较
变量 对照组 EosCRS组 non-EosCRS组 P值 性别 0.32 男 20(62.5) 27(79.4) 16(69.6) 女 12(37.5) 7(20.6) 7(30.4) 年龄/岁 37.06±10.18 43.44±13.52 39.00±16.56 0.14 是否伴鼻息肉 0.02 不伴 - 4(11.8) 9(39.1) 伴 - 30(88.2) 14(60.9) EOS百分比/% 2.20(1.33，2.48)1) 7.10(5.60，8.40) 2.30(1.65，3.55)1) ＜0.01 EOS绝对值/(×109·L-1) 0.12(0.08，0.16)1) 0.42(0.30，0.55) 0.15(0.09，0.24)1) ＜0.01 Lund-Mackay评分总分 - 14.00(10.00，17.50) 14.00(8.00，15.00) 0.21 nNO水平/(×10-9) 457.00(431.00，493.75) 315.00(88.00，446.50)2) 419.00(181.00，469.00)2) ＜0.01 与EosCRS组比较，1)P＜0.01；与对照组比较，2)P＜0.01。 
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