嗜酸粒细胞性慢性鼻-鼻窦炎临床预测诊断指标的对比研究

Comparison of clinical indexes in predicting eosinophilic chronic rhinosinusitis

目的·在同一体系中比较嗜酸粒细胞性慢性鼻-鼻窦炎(eosinophilic chronic rhinosinusitis,ECRS)预测诊断的临床评估指标。方法·回顾性分析于上海交通大学医学院附属仁济医院行内镜下鼻腔鼻窦开放手术的89例慢性鼻-鼻窦炎患者的临床特征。以术中所取组织病理检查结果为金标准,诊断ECRS患者35例,非ECRS(non-ECRS)患者54例。分别比较2组患者外周血嗜酸性粒细胞(eosinophil,EOS)绝对值、外周血EOS百分比(EOS%)、E/M比值(筛窦与上颌窦Lund-Mackay评分比值)和日本难治性鼻窦炎流行病学调查研究协会(Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis,JESREC)评分。用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)来比较各预测指标的优劣。结果·①ECRS患者的外周血EOS绝对值、外周血EOS%、E/M比值和JESREC评分显著高于non-ECRS患者(均P<0.01)。②JESREC评分的ROC曲线下面积(area under curve,AUC)为0.893,外周血EOS%的AUC为0.877,外周血EOS绝对值的AUC为0.870,E/M比值的AUC为0.724。结论·①采取JESREC评分、外周血EOS%、外周血EOS绝对值、E/M比值这些临床指标对于ECRS均有一定的预测诊断价值。②同一体系中比较,JESREC评分、外周血EOS%、外周血EOS绝对值具有较高的预测效率。

Objective·To evaluate clinical indexes in predicting eosinophilic chronic rhinosinusitis(ECRS)in the one system.Methods·In this retrospective study,89 chronic rhinosinusitis patients who underwent endoscopic sinus surgery in Renji Hospital,Shanghai Jiao Tong University School of Medicine were studied.Thirty-five patients were diagnosed as having ECRS,54 having non-ECRS according to pathology.Peripheral blood eosinophil(EOS)absolute counts,peripheral blood EOS percentages(EOS%),E/M ratios(Lund-Mackay score ratio of ethmoid sinus to maxillary sinus)and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis(JESREC)scores were compared between the two groups.Receiver operating characteristic curves were constructed to assess the advantages and disadvantages of each predictive diagnostic index.Results·①The peripheral blood EOS absolute count and percentage,E/M ratio and JESREC score were higher in ECRS group than those in non-ECRS(P<0.01).②AUC value of JESREC score was 0.893,peripheral blood EOS%was 0.877,peripheral blood EOS absolute count was 0.870,and E/M ratio was 0.724.Conclusion·①JESREC score,peripheral blood EOS absolute count and percentage,and E/M ratio can be applied to predict ECRS.②JESREC score,peripheral blood EOS absolute count and peripheral blood EOS%show higher predicting efficiency.