变应性因素在慢性鼻窦炎鼻息肉发病中的作用

Role of allergy in chronic rhinosinusitis with nasal polyps

目的探讨变应性因素与慢性鼻窦炎鼻息肉的临床表现和病理生理改变的关系。方法回顾性分析81例慢性鼻窦炎鼻息肉患者，根据是否存在变应性因素，将其分为为菲变应性因素组和变应性因素组，比较两组症状VAS评分、鼻息肉主观评分、鼻窦CT Lund-MacKay评分、嗅觉功能、鼻阻力等指标问的差异。结果81例患者中，非变应性因素组45例，变应性因素组36例。两组问症状VAS评分和鼻息肉主观评分无显著性差异（t=0．87，P=0．40：t=0．58，P=0.64）。鼻窦CT的Lund—MacKay评分，变应性因素组的前组筛窦病变程度较非变应性因素组严重，存在显著性差异（f=2．11，P=0．03），而其余各鼻窦及OMC区均无显著性差异。两组间嗅觉功能以及双侧鼻腔总阻力亦无显著性差异（t=0．15，P=0.88：t=0．57，P=0．61）。结论变应性因素在慢性鼻窦炎鼻息肉的发病中不起主导作用，对临床症状、鼻息肉大小、嗅觉功能和鼻阻力等方面没有显著影响，但可能与前组筛窦的病变程度存在一定相关性。

OBJECTIVE This article was to explore the correlation between allergic factors and chronic rhinosinusitis with nasal polyps and discuss the effect of allergy on the symptom and pathophysiologic changes. METHODS In this retrospective research, 81 cases were selected to detect the potential effect of allergic factors on visual analog scale （VAS） , size of nasal polyps, Lund-Mackay CT system scoring, olfactory function and resistance of nose. The patients were divided into two groups, with or without allergic factors. RESULTS Of 81 patients, 36 cases were with allergic factors and 45 cases were without allergic factors. There was no significant difference in the VAS scoring, size of nasal polyps, olfactory function and resistance of nose between two groups （P=0.40, 0.64, 0.88, 0.61） . Lurid- MacKay CT scores of anterior ethmoid in the cases with allergic factors were significantly higher than those without allergic factors （t=2.11, P=0.03） , while in other regions of paranasal sinus there was no significant difference between the cases with and without allergic factors. CONCLUSION The results suggest that allergic factors do not play a major role in the pathogenesis of CRS, but make a positive effect on the severity of CRS in anterior ethmoid. Meanwhile, allergy does not significantly influence the symptom severity, size of nasal polyps, olfactory function, and resistance of the nose.