慢性鼻窦炎伴鼻息肉不同组织病理类型的临床特点及预后

Clinical features and prognosis of different histopathological types of chronic sinusitis with nasal polyps

目的探讨慢性鼻窦炎伴鼻息肉(CRSwNP)不同组织病理类型的临床特点及预后。方法选取2020年1月~2021年6月我院收治的CRSwNP患者136例,收集患者临床及病理检查资料,根据病理结果将其分为嗜酸粒细胞性CRSwNP组(EOS CRSwNP组,n=36)和非嗜酸粒细胞性CRSwNP组(NONEOS CRSw NP组,n=100)。比较两组临床特点、CT评分系统(Lund-Mackay Scale)评分及预后情况。结果136例患者中EOS CRSwNP患者占26.5%(36/136),NONEOS CRSw NP患者占73.5%(100/136);两组在性别、年龄、病程方面比较差异无统计学意义(P>0.05);在外周血嗜酸粒细胞率、术前VAS评分和鼻腔鼻窦结局测试22(SNOT-22)评分比较,EOS CRSwNP组显著高于NONEOS CRSw NP组(P<0.05);术前CT评分系统Lund-Kennedy内镜黏膜形态评分比较,两组差异无统计学意义(P>0.05);术前鼻窦Lund-Mackay评分比较,EOS CRSwNP组前组筛窦、后组筛窦、蝶窦、窦口鼻道复合体评分显著高于NONEOS CRSw NP组,上颌窦评分显著低于NONEOS CRSw NP组,差异均有统计学意义(P<0.05);术后随访:EOS CRSwNP组术后12个月视觉模拟评分法(VAS)评分显著高于NONEOS CRSw NP组,术后6个月、12个月Lund-Kennedy内镜黏膜形态评分显著高于NONEOS CRSwNP组,差异均有统计学意义(P<0.05)。术后随访12个月,EOS CRSwNP组鼻息肉复发2例,NONEOS CRSw NP组无复发,两组比较差异无统计学意义(P>0.05)。结论术前对CRSw NP患者进行病情评分及CT评分有助于预判分型,且不同分型患者预后存在差异,EOS CRSwNP患者预后较差。

Objective To discuss the clinical features and prognosis of different histopathological types of chronic sinusitis with nasal polyps(CRSwNP).Methods A total of 136 patients with CRSwNP admitted to our hospital from January 2020 to June 2021 were selected.The clinical and pathological data of the patients were collected and divided into eosinophil CRSwNP group(EOS CRSwNP group,n=36)and non acidophilic granulocyte CRSwNP group(NONEOS CRSw NP group,n=100).The clinical features,Lund-Mackay Scale score and prognosis of the two groups were compared.Results Among the 136 patients,26.5%(36/136)were EOS CRSwNP patients and 73.5%(100/136)were NONEOS CRSwNP patients.There were no statistically significant difference in terms of gender,age,course(P>0.05).Rate of peripheral blood eosinophilia granulocyte,preoperative VAS score and nasal sinuses end test 22(SNOT-22)score were significantly higher in EOS CRSwNP group than that of NONEOS CRSw NP(P<0.05).About two groups of preoperative CT grading system Lund-Kennedy,there was no statistically significant difference(P>0.05).The scores of anterior ethmoid sinus,posterior ethmoid sinus,sphenoid sinus,and sinooronasal tract complex in EOS CRSwNP group were significantly higher than those in NONEOS CRSwNP group.EOS CRSwNP group of maxillary sinus score was significantly lower than NONEOS CRSw NP group,the differences were statistically significant(P<0.05).The visual analogue scale(VAS)score of EOS CRSwNP group was significantly higher than that of NONEOS CRSwNP group 12 months after operation.EOS CRSwNP group after 6 months,12 months Lund-Kennedy endoscopic mucosal morphology score was significantly higher than NONEOS CRSwNP group,the differences were statistically significant(P<0.05).Postoperative follow-up of 12 months,EOS CRSwNP group of recurrent nasal polyps 2 cases,there was no statistically significant difference(P>0.05).Conclusion Before surgery,the competent disease score and CT score of CRSw NP patients can help predict the classification,and the prognosis of patients with different classifications is different,and the prognosis of EOS CRSwNP patients is poor.