慢性鼻-鼻窦炎伴与不伴鼻息肉患者临床特征的比较

Comparison of clinical characteristics of chronic rhinosinusitis with and without nasal polyps

目的比较慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)与不伴鼻息肉(chronic rhinosinusitis without nasal polyps,CRSsNP)的临床特征,为制定合理治疗策略提供依据.方法回顾性分析2018年11月~2019年12月住院手术的苏皖地区225例慢性鼻-鼻窦炎(CRS)患者术前血常规、血生化、血清总IgE(total IgE,tIgE)、特异性IgE(specific IgE,sIgE)、鼻窦CT及术后病理检查等临床资料,进行统计学分析.结果225例中,CRSwNP组148例(65.8%),CRSsNP组77例(34.2%).患者的性别、年龄、住院时间、外周血白细胞及分类、血生化指标在两组间差异无统计学意义(P>0.05).CRSwNP和CRSsNP患者中至少1种变应原阳性分别占34.5%和40.3%,其中尘螨过敏最多见,阳性率分别为23.0%和26.0%,两组间差异均无统计学意义(P>0.05).血清tIgE阳性率、20种变应原slgE浓度等级和阳性率、吸入性及食物性变应原阳性率在两组间差异也均无统计学意义(P>0.05).鼻窦CT扫描Lund-Mackay评分中,两组各鼻窦、窦口鼻道复合体及CT总分CRSwNP组都高于CRSsNP组,差异均有统计学意义(P<0.05).在病理组织中,两组患者淋巴细胞及浆细胞浸润均为60%以上,但嗜酸性粒细胞(Eos)在CRSwNP组的阳性率为43.2%,显著高于CRSsNP组的阳性率22.1%,差异有统计学意义(P<0.05).结论本地区CRS患者目前仍以淋巴细胞/浆细胞性炎症为主,但CRSwNP息肉组织中Eos阳性率达43.2%,需引起重视并进一步关注.CRSwNP和CRSsNP患者变应原阳性率分别为34.5%和40.3%,两者无明显差异,尘螨为主要致敏原.

Objective To compare the clinical characteristics of chronic rhinosinusitis(CRS)with nasal polyps(CRSwNP)and without nasal polyps(CRSsNP),and to provide evidence for formulating rational treatment strategies.Methods The clinical data of 225 patients suffering from CRS in Jiangsu and Anhui provinces who were hospitalized for endoscopic sinus surgery from November 2018 to December 2019,which included the preoperative blood routine,blood biochemistry,serum total IgE(tlgE),allergen specific IgE(sIgE),paranasal sinus CT,and postoperative histopathological examinations,were retrospectively analyzed for statistical analysis.Results Of the 225 patients,148(65.8%)were in the CRSwNP group and 77(34.2%)in the CRSsNP group.There were no significant differences in gender,age,length of hospital stay,differential leucocyte counts and biochemical indexes in peripheral blood between the two groups(P>0.05).In patients with CRSwNP and CRSsNP,the positive rate of serum slgE against at least one of allergen was 34.5% and 40.3% respectively(P>0.05),among which dust mites were most common with a positive rate of 23.0% and 26.0%respectively(P>0.05).There were also no statistically significant differences in positive rates of serum tlgE and slgE against 20 common allergens,as well as inhaled and ingested allergens between the CRSwNP and CRSsNP groups(P>0.05).In addition,no significant difference was found in distribution of serum allergeslgE concentrations between these two groups(P>0.05).However,the Lund-Mackay scores of paranasal sinus CT scans were significantly higher in the CRSwNP group than those in the CRSsNP group in terms of the sinuses,ostiomeatal complex and the total scores(P<0.05).Moreover,the positive rate of lymphocyte and plasma cell infiltration in the tissue were more than 60%in both groups,while eosinophil infiltration was significantly higher in the CRSwNP group(43.2%)than that in the CRSsNP group(22.1%;P<0.05).Conclusion At present,lymphocyte and plasma cell inflammation is still dominant in patients with CRS in this region.However,the positive rate of eosinophil infiltration in polyp tissues was 43.2%in patients with CRSwNP,which needs to arouse our recognition and further attention.The total positive rate of allergen sensitization in CRSwNP and CRSsNP patients was 34.5%and 40.3%respectively,with no significant difference.And the major allergen is dust mites.