变应性因素对慢性鼻-鼻窦炎病变严重程度及术后疗效的影响

Allergic factors affect on severity of chronic rhinosinusitis and postoperative outcomes

目的:探讨变应性因素对慢性鼻-鼻窦炎病变严重程度有无影响,为进一步研究变应性鼻炎与慢性鼻-鼻窦炎之间的关系提供依据。方法:对103例经保守治疗无效后接受功能性鼻内镜下鼻窦手术患者的临床资料进行回顾性分析。将患者分为慢性鼻-鼻窦炎伴变应性鼻炎组与慢性鼻-鼻窦炎不伴变应性鼻炎组,比较2组的鼻窦炎症状VAS评分、术前鼻内镜Lund and Kennedy评分、术前Lund-Mackay CT评分是否存在差异,并比较对不同变应原敏感的患者慢性鼻-鼻窦炎症状是否存在区别。应用SPSS 17.0统计软件,依据VAS评分、Lund and Kennedy内镜评分系统及Lund-Mackay CT系统评分数值分布不同,分别采用t检验及秩和检验方法,率的比较应用χ2检验。结果:皮肤点刺试验及特异性IgE阳性与皮肤点刺试验及特异性IgE阴性的慢性鼻-鼻窦炎患者相比,病史、术前鼻塞症状VAS评分、术前鼻内镜Lund and Kennedy评分、术前Lund-Mackay CT评分均差异无统计学意义(均P>0.05)。慢性鼻-鼻窦炎患者嗅觉丧失、头面部胀闷感术前VAS评分,皮肤点刺试验及特异性IgE阳性组较阴性组高。不伴变应性因素的慢性鼻-鼻窦炎伴鼻息肉患者,术前流脓涕症状VAS评分较高。无论皮肤点刺及特异性IgE阳性还是阴性的慢性鼻-鼻窦炎患者,手术前后慢性鼻-鼻窦炎症状均有所改善,阴性组较阳性组鼻塞症状改善明显,术后其余鼻窦炎症状改善情况二者无显著区别。皮肤点刺及特异性IgE阳性的患者,术后清水样涕、阵发性喷嚏、鼻痒症状改善均明显,与慢性鼻-鼻窦炎伴鼻息肉患者相比,不伴鼻息肉者对于蟑螂过敏的例数较多(P<0.05)。结论:变应性因素对于保守治疗无效的慢性鼻-鼻窦炎的病变严重程度影响不大,仅对慢性鼻-鼻窦炎患者嗅觉丧失、头面部胀闷感以及流黏脓性鼻涕症状有所影响。不同变应原在慢性鼻-鼻窦炎伴鼻息肉患者及慢性鼻-鼻窦炎不伴鼻息肉患者中的分布不同。变应性因素对于功能性鼻内镜手术后6个月疗效的影响不大,变应性因素可能导致患者术后鼻塞症状缓解不明显。

Objective：To investigate whether the allergic factors impact the severity of chronic rhinosinusitis or not, further more, to explore the relationship between allergic rhinitis and chronic rhinosinusitis. Method.. A retrospective review was done on 103 patients. All of these patients were under functional intranasal endoscopic sinus surgery after expectant treatment is ineffective. We devided the patients into different groups according to the result of skin prick and specific IgE and if there is difference in VAS score, Lund and Kennedy endoscopic score, Lund-Mackay CT score between the groups. We also analysed the symptoms in different chronic rhinosinusitis patients allerged to variant kinds of allergen. The SPSS 17.0 software was used to analyze the data. Statistical analy- sis was performed by t-test, rank order test or Xz test. Result The duration of the disease, VAS score of nasal blockage, score of Lund-Mackay CT and Lund and Kennedy endoscopic before the operation were in no statistical sense after when compared with the two groups of patients with chronic rhinosinusitis who grouped according the result of skin prick and specific IgE. The VAS score of facial pressure and loss of smell was higher in patients with chronic rhinosinusitis which the skin prick and specific IgE were positive. The VAS score of nasal discharge was higher in patients with chronic rhinosinusitis who got negative skin prick and specific IgE result. The symptoms of chronic rhinosinusitis improved with operation no matter the group of skin prick and specific IgE positive or nega-tive and VAS score of nasal blockage improved significantly in negative group. The symptoms of sneezing, rhinor- rhoea and rbinocnesmus improved after operation among the chronic rhinosinusitis patients with skin prick and specific IgE. The number of cockroach allergy is larger among the patients with chronic rhinosinusitis without pol- yps than the one among the patients with chronic rhinosinusitis with polyps. Conclusion：Allergic factor didn＇t im- pact much the severity of chronic rhinosinusitis patients who were failed in expectant treatment,besidesthe postoperative outcomes showed that only influence the severity of nasal discharge, facial pressure and loss of smell. Dif- ferent kinds of allergen were found between the patients of chronic rhinosinusitis with or without polyps. No sig- nificantly functional endoscopic sinusitis sugrery outcome were related to the allergic factor. But the allergic factor may interfere the remission of nasal discharge aftesurgery.