鼻呼出一氧化氮对慢性鼻窦炎诊断的临床应用价值

Role of nasal nitric oxide in diagnosis of chronic sinusitis

目的探讨鼻呼出一氧化氮(nNO)在慢性鼻窦炎(CRS)临床诊断中的应用价值。方法回顾性分析135例CRS患者及40例非CRS患者的临床资料,包括患者nNO水平的差异,nNO水平与年龄、BMI、外周血嗜酸性粒细胞计数及百分比、CT Lund-Mackay评分及E/M比值的相关性,通过Logistic回归及ROC曲线分析nNO在CRS中的诊断应用价值。结果CRS组、CRSsNP组及CRSwNP组的nNO水平显著低于非CRS组(P<0.001),CRSwNP组的nNO水平显著低于CRSsNP组(P<0.001);eCRSwNP组及non-eCRSwNP组患者的nNO水平显著低于非CRS组患者(P<0.001),eCRSwNP组的nNO水平显著低于non-eCRSwNP组患者(P<0.05)。CRS组和CRSwNP组nNO水平均与E/M比值及Lund-Mackay评分呈显著负相关性(r=-0.423,P<0.001;r=-0.650,P<0.001;r=-0.434,P<0.001;r=-0.608,P<0.001)。Logistic回归分析发现nNO水平与CRS分型显著相关(P<0.01)。nNO对鉴别非CRS与CRS、CRSsNP及CRSwNP具有中度预测价值(AUC=0.849,P<0.001;AUC=0.771,P<0.001;AUC=0.894,P<0.001),对鉴别CRSsNP与CRSwNP具有中度预测价值(AUC=0.776,P<0.01)。对鉴别非CRS与non-eCRSwNP具有中度预测价值(AUC=0.861,P<0.001),eCRSwNP具有高度预测价值(AUC=0.910,P<0.001)。结论nNO水平对CRS、CRSsNP和CRSwNP、eCRSwNP和non-eCRSwNP的初步诊断以及鼻息肉病变范围的预测具有一定的临床应用价值。

Objective To investigate the clinical value of nasal nitric oxide(nNO)in the diagnosis of chronic sinusitis(CRS).Methods The clinical characteristics of 135 CRS patients with or without nasal polyps(wNP and sNP,respectively),and 40 non-CRS patients were analyzed.The retrospective analyses included the differences of nNO levels,correlation between nNO and age,body mass index(BMI),peripheral blood eosinophils count and percentage,computed tomography Lund–Mackay score,and the ethmoid sinus/maxillary sinus(E/M)CT ratio.The diagnostic value of nNO in CRS was determined by receiving operating curve(ROC)curve and logistic regression model analyses.Results The level of nNO in CRSsNP and CRSwNP patients was significantly lower than in non-CRS patients(P<0.001).The level of nNO in CRSwNP patients was significantly lower than in CRSsNP patients(P<0.001).The level of nNO in patients with eosinophilic CRSwNP was lower than that in the non-eosinophilic CRSwNP patients(P<0.001).The nNO levels in the CRS and CRSwNP groups were significantly negatively correlated with E/M ratio and Lund-Mackay score(r=-0.423,P<0.001;r=-0.650,P<0.001;r=-0.434,P<0.001;and r=-0.608,P<0.001,respectively).Logistic regression analysis revealed the significant correlation between nNO level and CRS typing(P<0.01).nNO had moderate predictive value in distinguishing non-CRS from CRSsNP and CRSwNP(area under the ROC curve(AUC=0.849,P<0.001;AUC=0.771,P<0.001;AUC=0.894,P<0.001,respectively).nNO also had moderate predictive value in distinguishing CRSsNP from CRSwNP,(AUC=0.776,P<0.01).nNO had moderate predictive value in distinguishing non-CRS from non-eCRSwNP,(AUC=0.861,P<0.001)and high predictive value in distinguishing non-CRS from eCRSwNP(AUC=0.910,P<0.001).Conclusion nNO has clinical value in the preliminary diagnosis of CRS,distinguishing CRSsNP from CRSwNP,predicting eCRSwNP and non-eCRSwNP,and predicting lesions of nasal polyps.