165例慢性鼻-鼻窦炎患者变应性相关临床资料分析

Clinical analysis of allergic factors and their impact on 165 cases of patients suffering from chronic sinusitis with or without nasal polyps

目的探讨变应性因素在慢性鼻-鼻窦炎伴或不伴鼻息肉患者中的分布特点及其临床意义。方法随机选取慢性鼻-鼻窦炎(CRS)患者165例,其中伴息肉组(CRSwNP)98例及不伴息肉组(CRSsNP)67例,均应用阿罗格体内诊断试剂,进行常规变应原点刺检测(SPT),探讨CRS组内变应原阳性率及其分布特点,且与同期门诊以变应性鼻炎(AR)症状来诊的患者的变应原阳性率及其分布的差别进行比较;并统计CRSwNP的鼻息肉病理切片中嗜酸性细胞浸润程度与变应原检查结果,变应性因素史及既往手术史的相关性。结果①发现本组165例CRS患者变应原SPT阳性率为47.3%;CRSwNP组阳性率为50.0%,高于CRSsNP组阳性率,差异没有显著性(P=0.49);但二者均低于AR症状患者(86.8%),差异有显著性(P<0.01);②阳性变应原种类及分布特点:CRS患者变应原阳性者中多为混合变应原致敏,单一变应原致敏者较少;主要为吸入组变应原,其中最多见的是常年性变应原粉尘螨和屋尘螨;吸入组变应原分布CRS组内及与AR患者组间无差异(P>0.05);③CRSwNP患者鼻息肉组织病理切片显示有嗜酸性细胞浸润明显增多的占51.0%;随着嗜酸性粒细胞浸润程度的增加患者人群中变应原阳性及变应性因素史阳性的比例有增加趋势(P<0.01),但与既往手术史无相关性(P=0.872)。结论变应性因素是促进CRSwNP或CRSsNP疾病发生发展因素之一,对患病人群中变应性因素的必要检测可增加对疾病转归的可控性,具有重要临床意义。

Objective To analyze the clinical significance of allergic factors in patients suffering from chronic sinusitis with or without nasal polyps. Methods A cohort of 165 patients suffering from chronic sinusitis was randomly selected in this study, in which 98 belonged to CRSwNP, while the other 67 belonged to CRSsNP. All patients were subjected to skin prick test（ SPT）, and the positive allergens and their distribution features were compared within the CRS groups with 53 patients complaining of allergic rhinitis symptoms. Also, the infiltrating degrees of eosinophil cells in nasal pol- yp specimens from CRSwNP were analyzed for allergic history, SPT results and past operation history. Results There was no statistical significance between CRSwNP and CRSsNP for the rate of positive allergen, whereas, there existed a significant difference between the CRS and AR＇s. On the other hand, the differences of the distribution feature in these three were not significant. The higher the degree of eosinophil infiltration in the local polyps, the higher the positive rate of SPT and the allergic factor history, but with no relationship to patients＇ past operation history. Condusion Allergic factors have great impacts on both CRSsNP and CRSwNP. It is necessary to test their allergic conditions in patients with CRSsNP and CRSwNP, which is helpful for early evaluation, therapy and prognosis of these patients.