慢性鼻-鼻窦炎患者嗅觉障碍影响因素分析

Factors influencing olfactory dysfunction in patients with chronic rhinosinusitis

目的:探讨慢性鼻-鼻窦炎(CRS)患者嗅觉障碍的影响因素。方法:采用视觉模拟量表(VAS)对270例诊断明确的CRS患者的嗅觉障碍程度进行评分,分为嗅觉障碍影响生活质量组(VAS>5)及未影响生活质量组(VAS≤5)。通过对患者年龄、性别、伴鼻息肉、伴变应性鼻炎、有吸烟史及前期鼻部手术史等临床因素及血清总IgE水平、外周血嗜酸粒细胞和单个核细胞个数等进行分析,在组间进行Mann-Whitney U分析,采用多变量Logistic回归模型对嗅觉障碍的影响因素进行相关性分析。结果:在嗅觉障碍影响生活质量组中伴鼻息肉、伴变应性鼻炎、有前期手术史的患者数量及血清总IgE水平、水肿评分均明显高于未影响生活质量组(均P<0.05);性别、年龄、吸烟史、伴鼻中隔偏曲及外周血嗜酸粒细胞数、单个核细胞数在2组患者之间差异无统计学意义(P>0.05)。多因素Logisitic分析发现血清总IgE增高、水肿评分高是影响嗅觉的危险性因素(OR=1.003、2.483,均P<0.01);而前期鼻部手术史是一个保护因素(OR=0.408,P<0.01)。结论:严重的鼻腔水肿、血清总IgE增高是患者出现严重嗅觉障碍的危险因素,前期鼻部手术则是保护性因素。

Objective：To evaluate the relative factors influencing olfactory dysfunction in patients with chronic rhinosinusitis （CRS）. Method^Visual analogue scale （VAS） was applied to measure the severity of olfactory dys- function of 270 patients with CRS. Patients were divided into two groups, one was that the quality of life （QOL） of patients was affected by olfactory dysfunction （VAS15）, the other was that without QOL affected by olfactory dysfunction （VAS15）. The association between age, gender, nasal polyps, allergic rhinitis, smoking history, early nasal surgery history and other clinical factors, and serum total IgE level, peripheral blood eosinophil count, peripheral blood mononuclear cell count and olfactory dysfunction was analyzed. Result： The number of patients with nasal polyps, allergic rhinitis, previous nasal surgeries, the level of serum total IgE, and the severity of edema were significantly increased in patients with impaired QOL associated with olfactory dysfunction （P〈0.05）. Sex distribution, age, smoking history, deviation of nasal septum, eosinophil and mononuclear cell count did no statistically differ between the groups with and without impaired QOL associated with olfactory dysfunctions （P〉 0. 05）. Serum total IgE increased （OR=1. 003,P〈0.01） and severe edema （OR=2. 483,P〈0.01） were the risk factors for the impairment of olfactory function, more notably for edema; whereas previous nasal surgeries was a protective factor （OR= 0. 408,P〈0.01）. Conclusion.. Sever edema and increased serum total IgE are risk factors, whereas previous nasal surgeries history is a protective factor for the olfactory dysfunction.