CT扫描鼻窦骨炎在预诊断嗜酸粒细胞性慢性鼻-鼻窦炎中的作用探讨

To explore the role of CT scan in the diagnosis of eosinophilic chronic rhinosinusitis

目的:探讨CT扫描鼻窦骨炎在预诊断嗜酸粒细胞性慢性鼻-鼻窦炎(ECRS)中的作用,从而更好地指导临床与治疗。方法:收集行初次手术的慢性鼻-鼻窦炎患者127例,其中ECRS 52例,非ECRS(NonECRS)75例,对患者的术前鼻窦CT进行GOSS骨炎评分。用Mamn-Whitney U分析比较两组间的GOSS骨炎评分。对差别有统计学意义的指标进行二元Logistic回归分析,找到有预测意义的GOSS骨炎评分指标。对有意义的指标进行受试者工作特征(ROC)曲线分析,分析分界值与灵敏度和特异度的关系,找到最佳截断值。结果:骨炎评判指标GOSS骨炎总分、筛窦骨炎评分(GOSS-E)、筛窦骨炎评分与上颌窦骨炎评分相比(GOSS-E/M)、后组筛窦骨炎评分与前组筛窦骨炎评分相比(GOSS-PE/AE)、前组筛窦骨炎评分(GOSS-AE)、后组筛窦骨炎评分(GOSSPE)、蝶窦骨炎评分(GOSS-S),ECRS较NonECRS更高(均P<0.05);进行二元Logistic回归分析、ROC曲线分析,得出当筛窦骨炎评分截断值>4.5时(曲线下面积为0.690),相应的灵敏度和特异度分别为62%和71%。结论:运用鼻窦CT得出筛窦骨炎评分>4.5时,临床上可初步诊断为ECRS。

Objective：We explored the role of CT scan in the diagnosis of eosinophilic chronic rhinosinusitis（ECRS）in sinus osteitis for a better guidance of clinic and treatment.Method：A total of 127 patients with chronic rhinosinusitis who underwent primary surgery were collected（52 patients were ECRS）.Seventy-five patients with NonECRS performed global osteitis scoring scale（GOSS）osteitis score on the patient＇s preoperative sinus CT.Mamn-Whitney U analysis was used to compare the GOSS osteitis scores between the two groups.A binary logistic regression analysis was performed on the statistically significant indicators to find predictive GOSS osteitis scores.Receiver operating characteristic curve（ROC curve）analysis was performed on meaningful indicators to analyze the relationship among the cutoff values the sensitivity and the specificity to find the best cutoff value.Result：The osteitis evaluation index GOSS osteitis total score,ethmoid osteitis scores（GOSS-E）,ethmoid osteitis score compared with the maxillary osteitis score（GOSS-E/M）,posterior group ethmoid sinus osteitis score compared with the former group ethmoid sinus osteitis score（GOSS-PE/AE）,anterior ethmoid osteitis scores（GOSSAE）,posterior ethmoid osteitis scores（GOSS-PE）,sphenoid osteitis scores（GOSS-S）,ECRS significantly higher than NonECRS（P〈0.05）;binary logistic regression analysis and ROC curve analysis were performed.When the cut-off value of the ethmoid osteitis score was〉4.5（area under the curve was 0.690）,the corresponding sensitivity and specificity were 62% and 71%,respectively.Conclusion：When the ethmoid sinus CT is used to obtain a ethmoid osteitis score of〉4.5,the ECRS can be diagnosed clinically.