慢性鼻窦炎伴鼻息肉患者嗅觉障碍的影响因素分析

Analysis of factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps

目的分析慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者嗅觉障碍的影响因素。方法回顾性分析2014—2018年就诊于北京安贞医院行内镜鼻窦手术治疗的CRSwNP患者88例,男性22例,女性66例,年龄(48.1±11.3)岁(±s,下同)。所有入选患者均于术前行Sniffin′Sticks嗅觉测试、Lund-Mackay评分及改良鼻窦CT嗅区评分、鼻阻力及声反射检查、血常规及血生化等实验室检测、血清特异性IgE检测;术中取鼻息肉组织进行嗜酸粒细胞计数。根据Sniffin′Sticks嗅觉测试结果将患者分成嗅觉功能正常组和嗅觉功能障碍组,两组之间进行临床基线资料比较,根据单因素分析结果,结合临床有意义的指标进一步行多因素Logistic回归模型分析,并初步建立CRSwNP嗅觉障碍的预测模型。设P<0.05为差异有统计学意义。结果88例CRSwNP患者中,嗅觉正常32例(36.4%),嗅觉障碍56例(63.6%),其中嗅觉下降40例(45.5%)、失嗅16例(18.2%)。单因素分析发现,两组间组织嗜酸粒细胞数、血嗜酸粒细胞百分比、血尿素的差异存在统计学意义[12.7[2.0,52.3]个/高倍视野(M[P25,P75],下同)比38.6[16.2,87.0]个/高倍视野、2.75[1.60,4.80]%比4.35[2.50,6.60]%、(5.56±1.15)mmol/L比(4.98±1.33)mmol/L,P值均<0.05];改良鼻窦CT嗅区评分、除窦口鼻道复合体评分外的Lund-Mackay评分的差异均存在统计学意义(P值均<0.05)。多因素Logistic回归模型分析发现,改良鼻窦CT双侧嗅区总分和血尿素的差异具有统计学意义,其中双侧嗅区总分是嗅觉功能的危险因素(OR=2.108,95%CI:1.407~3.159,P<0.001);一定浓度的血尿素是嗅觉功能的保护因素(OR=0.461,95%CI:0.240~0.884,P=0.020)。进一步研究发现,由组织嗜酸粒细胞计数、血嗜酸粒细胞百分比、改良鼻窦CT双侧嗅区总分、总吸气、血尿素组成的预测模型受试者工作特征(ROC)曲线下面积(AUC)的值为0.888(P<0.01),对CRSwNP嗅觉障碍预测效果较好。结论改良鼻窦CT嗅区评分与CRSwNP患者的嗅觉障碍密切相关,一定程度的血尿素升高可能对CRSwNP患者的嗅觉功能有保护作用。

Objective To analyze the factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods This was a retrospective analysis.Eighty-eight patients with CRSwNP who underwent endoscopic sinus surgery in Beijing Anzhen Hospital from 2014 to 2018 were enrolled,including 22 males and 66 females,with the age of(48.1±11.3)years old(Mean±SD).Sniffin′Sticks olfactory test,Lund-Mackay score and modified sinus CT olfactory cleft score,nasal resistance and acoustic reflex examination,blood routine and blood biochemistry test,serum specific IgE test were performed before surgery and nasal polyps of all patients were collected for eosinophil count during surgery.According to bilateral total TDI score,the patients were divided into normal olfactory function group and olfactory disfunction group.The clinical baseline data were compared between the two groups.According to the results of single factor analysis,factors which were significant different between the two groups and clinically useful indicators were further included in the multivariate Logistic regression model analysis,then a model predicting olfactory disfunction in patients with CRSwNP was initially established.P<0.05 was considered statistically significant.Results Among 88 patients with CRSwNP,32(36.4%)patients were with normal olfaction and 56(63.6%)patients were with olfactory disfunction,including 40(45.5%)of hyposmia and 16(18.2%)of anosmia.Tissue eosinophil count,blood eosinophil percentage and blood urea concentration had significant difference between the two groups(12.7[2.0,52.3]/HP(M[P25,P75])vs 38.6[16.2,87.0]/HP,2.75[1.60,4.80]%vs 4.35[2.50,6.60]%,(5.56±1.15)mmol/L vs(4.98±1.33)mmol/L,all P<0.05).Modified sinus CT olfactory cleft score and Lund-Mackay score except for ostiomeatal complex score were statistically significant between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that the bilateral and total olfactory cleft score and blood urea concentration were statistically significant,in addition,the bilateral and total olfactory cleft score was a risk factor(OR=2.108,95%CI:1.407-3.159,P<0.001)and blood urea within a certain concentration was a protective factor(OR=0.461,95%CI:0.240-0.884,P=0.020).Further studies found that the area under the ROC curve of the model with tissue eosinophil count,blood eosinophil percentage,bilateral and total olfactory cleft score,total inspiratory volume and blood urea concentration was 0.888(P<0.01),which had good predictive value for olfactory disorders in CRSwNP.Conclusions The modified sinus CT olfactory cleft score is closely related to the olfactory disorders in patients with CRSwNP.A certain degree of elevated blood urea concentration may have a protective effect on the olfactory function of patients with CRSwNP.