合并真菌感染对慢性鼻窦炎伴鼻息肉患者内窥镜术后嗅觉障碍的影响

Effect of Combined Mycotic Infection on Postoperative Olfactory Dysfunction in Patients with Chronic Rhinosinusitis with Nasal Polyp Undergoing Endoscopic Surgery

目的 探讨合并真菌感染对慢性鼻窦炎伴鼻息肉(CRSwNP)患者内窥镜术后嗅觉障碍的影响。方法 选取2021年6月至2022年6月郑州大学附属郑州中心医院收治的113例CRSwNP患者为研究对象,取患者的鼻甲表面黏膜组织进行切片检验,统计真菌感染情况。所有患者均接受内窥镜手术治疗,采用Sniffin’Stickers嗅棒测试患者术后1个月的嗅觉障碍严重程度。采用点二列相关性分析真菌感染与CRSwNP患者内窥镜术后嗅觉障碍的关系,采用logistic回归分析CRSwNP患者内窥镜术后嗅觉障碍的影响因素。结果 经表面黏膜组织切片检查发现,CRSwNP患者中有83例患者真菌检验呈阴性,占比73.45%,有30例患者真菌检验呈阳性,占比26.55%,其中感染曲霉菌20例,白念珠菌6例,毛霉菌4例。真菌感染组内窥镜术后1个月嗅觉障碍(TDI)评分低于真菌未感染组(P<0.05)。真菌感染组中有11例(36.67%)患者发生嗅觉障碍,高于真菌未感染组[4例(4.82%)],差异有统计学意义(P<0.05)。嗅觉障碍组和嗅觉正常组年龄、性别、体重指数(BMI)、病程、吸烟情况、饮酒情况比较,差异无统计学意义(P>0.05);嗅觉正常组临床分期、Lund-Mackay评分与嗅觉障碍组比较,差异有统计学意义(P<0.05);经点二列相关性分析,结果显示,真菌感染与CRSwNP患者内窥镜术后TDI评分呈负相关(r=-0.417,P<0.001),经logistic回归分析,结果显示,真菌感染、Lund-Mackay评分是CRSwNP患者内窥镜术后嗅觉障碍的危险因素(OR>1,P<0.05)。结论 合并真菌感染的CRSwNP患者嗅觉障碍严重,合并真菌感染、Lund-Mackay评分高是CRSwNP患者内窥镜术后嗅觉障碍的危险因素。

Objective To investigate the effect of mycotic infection on postoperative olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyp(CRSwNP)undergoing endoscopic surgery.Methods A total of 113 CRSwNP patients admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2021 to June 2022 were selected as the research subjects,and the nasal turbinate surface mucosa of the patients was taken for biopsy,and the mycotic infection was counted.All patients underwent endoscopic surgery,and the severity of olfactory dysfunction was tested using Sniffin’s Stickers olfactory stick one month after surgery.The relationship between mycotic infection and postoperative olfactory dysfunction in CRSwNP patients was analyzed using point binary correlation,and the influencing factors of postoperative olfactory dysfunction in CRSwNP patients were analyzed using logistic regression.Results Through surface mucosal tissue section examination,it was found that 83 patients with CRSwNP had negative fungal tests,accounting for 73.45%,while 30 patients had positive fungal tests,accounting for 26.55%.Among them,20 were infected with Aspergillus,6 with Candida albicans,and 4 with Mucor.The olfactory dysfunction(TDI)score in the mycotic infection group was lower than that in the non mycotic infection group at 1 month after endoscopic surgery(P<0.05).Among the mycotic infection group,11 patients(36.67%)developed olfactory dysfunction,which was higher than that of the non mycotic infection group[4 cases(4.82%)],and the difference was statistically significant(P<0.05).There was no statistical significant difference in age,gender,body mass index(BMI),course of disease,smoking status,and alcohol consumption between the olfactory dysfunction group and the olfactory normal group(P>0.05).The difference in clinical staging and Lund-Mackay score between the normal olfactory group and the olfactory dysfunction group was statistically significant(P<0.05).Through point two column correlation analysis,the results showed a negative correlation between mycotic infection and postoperative TDI score in CRSwNP patients(r=-0.417,P<0.001).Through logistic regression analysis,the results showed that mycotic infection and Lund-Mackay score were risk factors for postoperative olfactory dysfunction in CRSwNP patients after endoscopic surgery(OR>1,P<0.05).Conclusion The severity of olfactory dysfunction is more severe in CRSwNP patients with combined mycotic infections,and the combination of mycotic infection and high Lund-Mackay score are risk factors for postoperative olfactory dysfunction in CRSwNP patients undergoing endoscopic surgery.