慢性鼻-鼻窦炎伴双侧鼻息肉患者不同表型的临床特征

Different phenotypes in patients with chronic sinusitis with bilateral nasal polyps

目的:探讨慢性鼻-鼻窦炎伴双侧鼻息肉(CRSwBNP)患者不同表型的临床特征,以及临床资料之间的相关性。方法:对134例CRSwBNP患者进行回顾性研究。根据病理组织学结果,将患者分为嗜酸性CRSwBNP(ECRSwBNP)组和非嗜酸性CRSwBNP(non-ECRSwBNP)组。通过病史采集、皮肤点刺试验、鼻腔分泌物检查、血清总IgE水平、外周血检测、鼻内镜检查、鼻窦CT检查分析并比较2种表型之间的临床特征。结果:ECRSwBNP组和non-ECRSwBNP组伴哮喘(19.0%,0)、特应性(26.6%,9.1%)、复发率(54.4%,30.9%)、外周血EOS比例(4.8%,1.9%)、鼻腔分泌物EOS比例(10.0%,2.0%)、血清总IgE水平(82.15IU/L,25.80IU/L),差异均有统计学意义(P<0.05)。鼻窦CT评分中2组后组筛窦(2.0,1.0)、筛窦(5.0,4.0)、蝶窦(3.0,2.0)、嗅裂(OC)(4.0,2.0)、筛窦/上颌窦之比(2.0,1.0),差异均有统计学意义(P<0.05),而其余差异均无统计学意义。OC分数、外周血EOS比例、后筛/前筛之比、筛窦/上颌窦之比均对CRSwBNP患者是否为嗜酸型具有辅助诊断意义(AUC>0.5),但OC分数曲线下面积最大,具有最高诊断价值。当OC分数为3或更高时,预测价值特异性为80.9%,敏感性为52.1%。结论:CRSwBNP患者有一定比例合并哮喘和特应性,这些患者易复发,其中以组织中嗜酸粒细胞浸润为主的鼻息肉更容易出现上述情况。临床中应考虑根据表型针对性治疗。

Objective:To investigate the clinical features of patients with chronic sinusitis with bilateral nasal polyps.Method:The data of 134 patients with chronic sinusitis with bilateral nasal polyps were analyzed,retrospectively.Based on the results of the histopathological examination,patients were divided into eosinophilic chronic sinusitis with bilateral nasal polyps(ECRSwBNP)group and non-eosinophilic chronic sinusitis with bilateral nasal polyps(non-ECRSwBNP)group.The clinical data including medical history collection,skin prick test,nasal secretion examination,serum total IgE level,peripheral blood test,nasal endoscopy,and sinus CT examination were analyzed and compared.Result:The rate of concomitant with asthma(19.0%,0),atopy(26.6%,9.1%),NP recurrence rate(54.4%,30.9%),the ratio of EOS in peripheral blood(4.8%,1.9%),the ratio of EOS in nasal secretions(10.0%,2.0%)and total serum IgE levels(82.15 IU/L,25.80 IU/L)were significantly(P<0.05)different between two groups.In the sinus CT score,posterior ethmoid sinus(2.0,1.0),total ethmoid sinus(5.0,4.0),sphenoid sinus(3.0,2.0),Olfactory cleft(OC)(4.0,2.0),the ratio of thee thmoid sinus/maxillary sinus(2.0,1.0)was statistically significant(P<0.05),while the rest were not statistically significant.The OC score,the ratio of EOS in peripheral blood,the ratio of the posterior ethmoid sinus/anterior ethmoid sinus,and the ratio of the ethmoid sinus/maxillary sinus can be used for subtype in CRSwBNP patients(AUC>0.5),while the OC score under the ROC curve is the largest area with the highest diagnostic value.When the OC score is 3 or higher,the predicted value specificity is 80.9% and the sensitivity is 52.1%.Conclusion:Patients with chronic sinusitis with bilateral nasal polyps often comorbid asthma and atopy,while these patients are trend to recurrence.The patients with ECRSwBNP comorbid asthma mainly characterized by eosinophil infiltration in tissues are more likely to recurrence.Targeted treatment based on phenotype should be considered in the clinic.