嗜酸粒细胞计数与鼻息肉患者鼻内镜手术治疗后复发的相关性分析

Correlation analysis of eosinophilic cell count and recurrence in patients with nasal polyps after nasal endoscopic surgery

目的探讨嗜酸粒细胞(Eos)计数与鼻息肉(NP)患者鼻内镜手术后复发的相关性。方法选取2020年6月-2022年6月该院行鼻内镜手术的NP患者189例,随访截止至2023年6月,根据NP复发的定义,分为复发组(n=68)和未复发组(n=121)。比较两组患者人口学分布和临床特征;采用多因素Logistic回归模型,分析影响NP患者鼻内镜手术后复发的独立危险因素,并进一步逐步回归筛选;采用限制性立方样条模型,分析Eos计数与NP患者鼻内镜手术后复发的相关性;建立预测NP患者鼻内镜手术后复发的模型。结果复发组的病变程度(多发性鼻息肉)、哮喘史、变应性鼻炎史、病变部位(鼻中隔偏曲)、Eos型鼻息肉、术后感染、术腔粘连、心理状态(不良)、Lund-Mackay评分、嗅裂前区评分(≥1分)、嗅裂后区评分(≥1分)、Eos计数和长期应用鼻减充血剂高于未复发组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,多发性鼻息肉(OR=9.92,95%CI:4.70~20.94)、哮喘史(OR=2.20,95%CI:1.05~4.63)、变应性鼻炎史(OR=3.16,95%CI:1.50~6.66)、Eos型鼻息肉(OR=4.06,95%CI:2.17~7.61)、术后感染(OR=8.35,95%CI:2.94~23.74)、术腔粘连(OR=5.08,95%CI:2.67~9.67)、Lund-Mackay评分≥15分(OR=3.46,95%CI:1.05~6.49)、嗅裂前区评分≥1分(OR=2.29,95%CI:1.25~4.22)、嗅裂后区评分≥1分(OR=2.60,95%CI:1.40~4.82)、Eos计数≥0.47×10^(9)/L(OR=4.19,95%CI:1.56~8.74)和长期应用鼻减充血剂(OR=3.10,95%CI:1.63~5.87),是影响NP患者鼻内镜手术后复发的独立危险因素(P<0.05);进一步逐步回归分析显示,这11个临床因素与NP患者鼻内镜手术后复发关联最紧密。NP患者鼻内镜手术治疗后复发的风险计算公式:Logit(P)=1-1/(1+e^(1.69-病变程度×2.29-哮喘史×0.79+变应性鼻炎史×1.15-Eos型鼻息肉×1.40-术后感染×2.12-术腔粘连×1.63-Lund-Mackay评分×1.24-嗅裂前区评分×0.83-嗅裂后区评分×0.95-Eos计数×1.43-长期应用鼻减充血剂×1.13))。根据NP患者鼻内镜手术后复发的风险公式,计算出NP患者鼻内镜手术后复发的可能性;概率为0.80时,Youden指数最高,预测效果相对最好。结论多发性鼻息肉、哮喘史、变应性鼻炎史、Eos型鼻息肉、术后感染、术腔粘连、高Lund-Mackay评分、嗅裂前后区评分高、Eos计数增加和长期应用鼻减充血剂,与NP患者鼻内镜手术后复发有关,建立的风险预测模型,对NP患者鼻内镜手术后复发风险,具有一定的预测价值。

Objective To investigate the correlation between eosinophils(Eos)and the recurrence of nasal polyps(NP)after nasal endoscopic surgery.Methods 189 patients with NP who underwent nasal endoscopic surgery from June 2020 to June 2022 were selected and followed up until June 2023.According to the definition of NP recurrence,they were divided into a recurrence group(n=68)and a non-recurrence group(n=121).The demographic distribution and clinical characteristics of the two groups were compared.Using the multivariate Logistic regression model,analyzed the independent risk factors for recurrence after nasal endoscopic surgery in NP patients,and further stepwise regression filter;Using restricted cubic spline model,analyzed the correlation between the Eos count and NP recurrence after nasal endoscopic surgery;Then establishing a model to predict the recurrence of NP after nasal endoscopic surgery.Result In the recurrent group,the degree of lesion(multiple nasal polyps),history of asthma,history of allergic rhinitis,lesion site(nasal septal deviation),Eos type nasal polyps,postoperative infection,intraoperative cavity adhesions,psychological status(adverse),Lund-Mackay score,pre-olfactory fissure score(≥1),post-olfactory fissure score(≥1),Eos count,and long-term use of nasal decongestants,all of them were higher than those in non-recurrence group(P<0.05).Multivariate Logistic regression analysis showed that multiple nasal polyps(OR^=9.92,95%CI:4.70~20.94),history of asthma(OR^=2.20,95%CI:1.05~4.63),history of allergic rhinitis(O R^=3.16,95%CI:1.50~6.66),Eos type nasal polyp(O R^=4.06,95%CI:2.17~7.61),postoperative infection(OR^=8.35,95%CI:2.94~23.74),intraoperative adhesions(OR^=5.08,95%CI:2.67~9.67),Lund-Mackay score≥15 points(OR^=3.46,95%CI:1.05~6.49),pre-olfactory fissure score≥1 point(OR^=2.29,95%CI:1.25~4.22),post-olfactory fissure score≥1 point(OR^=2.60,95%CI:1.40~4.82),Eos count≥0.47×10^(9)/L(OR^=4.19,95%CI:1.56~8.74)and long-term use of nasal decongestants(O R^=3.10,95%CI:1.63~5.87)were all independent risk factors for recurrence in NP patients after nasal endoscopic surgery(P<0.05).And further stepwise regression analysis showed that these 11 clinical factors were most closely associated with postoperative recurrence in NP patients after nasal endoscopic surgery.The formula for calculating the risk of recurrence after nasal endoscopic surgery in NP patients was as follows:Logit(P)=1-1/(1+e^(1.69-lesion degree×2.29-history of asthma×0.79-history of allergic rhinitis×1.15-Eos type nasal polyp×1.40-postoperative infection×2.12-intraoperative cavity adhesion×1.63-Lund-Mackay score×1.24-pre-olfactory fissure score×0.83-post-olfactory fissure score×0.95-Eos count×1.43-long-term use of nasal decongestants×1.13)).According to the formula,the probability of recurrence of NP patients after nasal endoscopic surgery was calculated.When probability was 0.80,Youden index was the highest and the prediction effect was relatively best.Conclusion Multiple nasal polyps,history of asthma,history of allergic rhinitis,Eos type nasal polyps,postoperative infection,surgical adhesions,high Lund Mackay score,high score in the pre-and post olfactory fissure area,as well as increased Eos count and longterm use of nasal decongestants are associated with recurrence after nasal endoscopic surgery in NP patients.The established risk prediction model has certain predictive value for the risk of recurrence in NP patients undergoing nasal endoscopic surgery.