鼻窦CT评分在评估慢性鼻-鼻窦炎嗅觉障碍中的应用

Application of sinonasal computed tomographic scores in diagnosis of olfactory dysfunction in patients with chronic rhinosinusitis

目的探讨分析鼻窦CT评分在慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者嗅觉功能评估的价值。方法回顾性分析92例确诊为CRS患者的临床资料,其中嗜酸性粒细胞性慢性鼻-鼻窦炎(eosinophi chronic rhinosinu sitis,ECRS)组患者28例,非嗜酸性粒细胞性慢性鼻-鼻窦炎(non eosinophi chronic rhinosinu sitis,nECRS)组患者64例。排除鼻部手术史和其他可能影响嗅觉功能的因素,进行病史采集、嗅觉功能检测和鼻窦CT评分,采用χ^2和t检验比较两组间患者临床资料;采用Mann-Whitney U检验比较两组鼻窦CT评分;采用Spearman相关分析对鼻窦CT评分和嗅觉功能进行相关性分析;采用ROC曲线分析鼻窦CT评分在嗅觉障碍中的预测评估价值。结果 ECRS组双侧炎症(26/28),筛窦上额窦总和差,(EM差)值3.32±2.25;nECRS组双侧炎症(48/64),EM差值1.81±2.33,两组患者比较差异均具有统计学意义(P<0.05)。在CT评分方面,CRS患者的EM差值与嗅觉功能相关性更强(r=0.634),具有更高的预测评估价值,其曲线下面积为0.827。当EM差截断值取2.5时,诊断嗅觉障碍的敏感度为76.9%,特异度为79.2%。结论与其他鼻窦CT评分相比,筛窦上颌窦总和差值对于CRS患者嗅觉障碍有更好的预测诊断价值。

Objective To analyze the value of sinonasal computed tomographic(CT) scores in evaluating the olfactory function in patients with chronic rhinosinusits(CRS). Methods 92 patients with CRS were enrolled in this study. Of them, 28 suffered from eosinophilic CRS(ECRS) and 64 suffered from non-eosinophilic CRS(nECRS). The patients with prior nasal surgery or other diseases affecting the olfaction were excluded. Detailed medical histories were collected, sinonasal CT scan and olfactory detection were performed to all the patients.χ^2and t test were used to compare the medical history. Mann-Whitney U analysis was used to compare the Lund-Mackay scores of the two groups. Spearman rank correlations were used to examine correlations between olfactory acuity and CT score. Receiver operating characteristic(ROC) curve was used to analyze the predictive diagnostic value of CT score in olfactory function.Results The difference of the CT scores between the ethmoid sinus and maxillary sinus(EM difference) and bilateral inflammation of the ECRS group were significantly higher than those of the nECRS group(3.32±2.25 vs 1.81±2.33, 26/28 vs 48/64, both P<0.05). Compared with other CT scores, EM difference showed stronger relationship with olfactory acuity(r=0.634,P<0.01). EM difference had a better predictive value, with an area under the ROC curve(AUC) value of 0.827. The cutoff point of 2.5 for EM difference demonstrated a sensitivity of 76.9% and a specificity of 79.2% for olfactory dysfunction in CRS.Conclusion Compared to other CT scores, EM difference has a better predictive value for the diagnosis of olfactory dysfunction in CRS patients.