慢性鼻窦炎与慢性阻塞性肺疾病相关性研究

A study on the correlation between chronic rhinosinusitis and chronic obstructive pulmonary disease

目的探讨慢性鼻窦炎(chronic rhinosinusitis, CRS)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)在气道炎症方面的相关性。方法选取2019年1—12月首都医科大学附属北京同仁医院呼吸科门诊就诊的稳定期COPD患者126例,根据患者鼻部症状及鼻窦CT检查结果,分为COPD合并CRS组(61例),单纯COPD组(65例)。采集患者病史及一般资料,调查患者近1年内COPD急性加重(AECOPD)次数,计算患者COPD评估测试(COPD assessment test, CAT)评分,检测外周血嗜酸性粒细胞百分比和CRP水平。所有患者均接受呼出气一氧化氮(fractional exhaled nitric oxid, FeNO)检测及肺功能检查。60例健康志愿者作为正常对照组。结果 3组间年龄、性别及BMI比较,差异无统计学意义;COPD合并CRS组和单纯COPD组吸烟指数比较,差异无统计学意义,两组均高于对照组(P<0.05)。COPD合并CRS组与单纯COPD组比较,第1秒用力呼气容积(FEV1)占预计值百分比、FEV1/用力肺活量(FVC)的差异无统计学意义,两组均显著低于对照组(P<0.05)。COPD合并CRS组过去1年AECOPD次数及CAT评分,显著高于单纯COPD组(P<0.05)。COPD合并CRS组FeNO水平及外周血嗜酸性粒细胞百分比显著高于单纯COPD组和对照组(P<0.05);3组间CRP水平比较,差异无统计学意义。COPD合并CRS组,FeNO水平与外周血嗜酸性粒细胞百分比、过去1年内AECOPD次数及CAT评分呈正相关(P<0.05);与CRP、肺功能指标(FEV1/FVC、FEV1占预计值百分比)无明显相关性。单纯COPD组,FeNO水平与外周血嗜酸性粒细胞百分比、过去1年内AECOPD次数、CAT评分、CRP及肺功能指标(FEV1/FVC、FEV1占预计值百分比)均无明显相关性。结论 COPD与CRS的发生发展过程中,均有嗜酸性粒细胞参与,特别是合并CRS的COPD患者,其气道内的嗜酸性粒细胞性炎症反应更加明显。对CRS进行积极干预,有利于减少AECOPD的次数,改善COPD患者生活质量。FeNO及外周血嗜酸性粒细胞的测定,对监测气道炎症控制情况、预测AECOPD频率及制定个性化治疗方案均具有重要的应用价值。

Objective To study the correlation between chronic rhinosinusitis(CRS) and chronic obstructive pulmonary disease(COPD). Methods There were 126 patients with COPD in the study, who were divided into COPD group(n =61) and COPD without CRS group(n = 65) according to nasal symptoms and the features of sinus CT scan. The medical history and general information, the frequency of acute exacerbations of COPD(AECOPD) in the past one year, COPD assessment test(CAT) score, the percentage of eosinophil in peripheral blood were all analyzed. All patients received the detection of fractional exhaled nitric oxid(FeNO) and lung function. Sixty volunteers served as the normal control group. Results There were no significant differences in terms of age, gender and BMI among COPD patients with and without CRS, and normal control subjects. The smoking index was significantly higher, while the ratio of forced the first second of expiratory volume to forced vital capacity(FEV1/FVC), and FEV1(% of pred) were significantly lower in COPD patients when compared with the control subjects(P<0.05). However, the smoking index, FEV1/FVC and FEV1(% of pred) were comparable between COPD patients with and without CRS. Notably, the frequency of AECOPD and CAT score were remarkably higher in COPD patients with CRS than those without CRS(P<0.05). Furthermore, the FeNO level and percentage of eosinophil in the peripheral blood of COPD patients with CRS were significantly higher than those of COPD patients without CRS and the normal control subjects(P<0.05). However, there were no differences in the peripheral level of CRP among these patients. In COPD patients with CRS, FeNO level was positively correlated with the percentage of blood eosinophil, the frequency of AECOPD in the past one year and CAT score, while no relationship was found between FeNO level and CRP, FEV1/FVC, and FEV1(% of pred). In contrast, the FeNO level wasn’t correlated with the percentage of blood eosineophil, the frequency of AECOPD in the past one year, CAT score, CRP, FEV1/FVC, and FEV1(% of pred) in COPD patients without CRS. Conclusions Eosinophil is involved in the initiation and evolution of COPD and CRS. In COPD patients with CRS, airway inflammatory mediated by eosinophil is even more obvious. Timely intervention of CRS is beneficial to reduce the frequency of AECOPD and improves the quality of life of COPD patients. The assessment of FeNO and eosinophils in peripheral blood provides great insight in monitoring airway inflammation control, predicting the frequency of AECOPD and guiding the personalized treatment.