哮喘与阿司匹林哮喘影响慢性鼻窦炎的临床研究

Clinical study on asthma and aspirin asthma affecting chronic rhinosinusitis

目的:观察哮喘及阿司匹林哮喘对慢性鼻窦炎(CRS)的影响,探讨相应的临床价值。方法:分析2015-03-2018-01期间门诊治疗的86例CRS伴哮喘患者,根据哮喘与阿司匹林哮喘分成哮喘组(52例)和阿司匹林哮喘组(34例)。采用症状VAS评分、鼻窦CT Lund-Mackay评分及经鼻内镜Lund-Kennedy评分分析2组患者的临床症状,同时比较2组患者不同肺功能情况下的评分情况,ELISA检测2组患者鼻窦分泌物中炎性指标IL-5、IL-17、IFN-γ及TNF-α水平。结果:鼻窦CT结果显示,与阿司匹林哮喘组相比,哮喘组患者鼻窦内各鼻甲不规则,鼻甲偏大。2组患者在症状VAS评分中的前额和(或)面部疼痛或胀痛、鼻窦CT Lund-Mackay评分及经鼻内镜Lund-Kennedy评分中均差异有统计学意义(均P<0.05)。2组患者在小气道轻度阻塞呼吸功能障碍和肺通气阻塞性障碍中的肺功能级别分布方面差异有统计学意义(P<0.05)。阿司匹林哮喘组患者的IL-5、IL-17、IFN-γ及TNF-α平均水平显著低于哮喘组(均P<0.05)。结论:阿司匹林诱导CRS产生哮喘症状比传统哮喘症状严重,但诱导产生的局部炎症反应相对更弱,发生机制可能与IL-5、IL-17、IFN-γ及TNF-α水平密切相关。

Objective:The aim of this study is to observe the effects of asthma and aspirin asthma on chronic rhinosinusitis and to explore the corresponding clinical value.Method:Eighty-six patients with CRS and asthma who were treated in the outpatient clinic during March 2015 to January 2018 were divided into asthma group(52 cases)and aspirin asthma group(34 cases)according to asthma and aspirin asthma.The clinical symptoms of the two groups were analyzed by symptomatic VAS score,Lund-Mackay score of sinus CT,and Lund-Kennedy score by nasal endoscopy.The scores of the two groups were compared under different lung function.Enzyme-linked immunosorbent assay the levels of inflammatory markers IL-5,IL-17,IFN-γand TNF-αin the sinus secretions of the two groups were detected.Result:There were no significant differences in age,gender,smoking history,allergy history,surgical history and course of disease between the two groups(P<0.05),suggesting that the data were comparable.The sinus CT results showed that compared with the aspirin asthma group,the asthmatic group had irregular turbinates and a large turbinate,as shown in Figure 1.There were significant differences between the two groups in VAS score,Lund-Mackay score of sinus CT and Lund-Kennedy score by nasal endoscopy.The difference was statistically significant(P<0.05).And the forehead and/or facial pain or pain in the symptomatic VAS score(P<0.05),the Lund-Mackay score of the sinus CT(P<0.05),and intranasal.The difference in the Lund-Kennedy score(P<0.05)was statistically significant.here were significant differences in the distribution of lung function levels between the two groups of patients with mild airway obstructive respiratory dysfunction and pulmonary ventilation obstructive disorder(P<0.05).The average levels of IL-5,IL-17,IFN-γand TNF-αin the aspirin asthma group were significantly lower than those in the asthma group(P<0.05).Conclusion:Aspirin-induced CRS produces asthma symptoms more severely than traditional asthma symptoms,but the induced local inflammatory response is relatively weak,and the mechanism may be closely related to IL-5,IL-17,IFN-γand TNF-αlevels.