Effect of nursing intervention on rehabilitation of patients with chronic sinusitis and nasal polyps after nasal endoscopy

BACKGROUND Chronic sinusitis is a kind of chronic suppurative inflammation of the sinus mucosa.Nasal endoscopy is a good method to treat nasal polyps.However postoperative rehabilitation and care should not be neglected.AIM To investigate the Effect of nursing intervention on the rehabilitation of patients with chronic sinusitis and nasal polyps(CSNPS)after nasal endoscopy.METHODS A total of 129 patients with CSNPS hospitalized from February 2017 to February 2019 were studied.Using the digital parity method,we investigated nursing cooperation strategies for endoscopic surgery.The comparison group(64 cases):Surgical nursing was carried out with traditional nursing measures;experimental group(65 cases):Surgical nursing was carried out by traditional nursing countermeasures+comprehensive nursing measures.We compared postoperative recovery rates,nursing satisfaction rates,and nasal cavity ratings between the two groups.RESULTS Experimental group patients with CSNPS had a significantly higher recovery rate(98.46%)compared to the control group(79.69%).This difference was statistically significant(χ2=11.748,P<0.05).Additionally,the satisfaction rate with treatment was also significantly higher in the experimental group(98.46%)compared to the control group(79.69%),with a statistically significant difference(χ2=11.748,P<0.05).Before nursing,there was no significant difference in sinus nasal cavity scores between the experimental group(20.29±7.25 points)and the control group(20.30±7.27 points)(t=0.008,P>0.05).However,after nursing,the sinus nasal cavity score in the experimental group(8.85±3.22 points)was significantly lower than that in the control group(14.99±5.02 points)(t=8.282,P<0.05).CONCLUSION Comprehensive nursing intervention in patients with CSNPS can significantly improve the total recovery rate after endoscopic surgery.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Dysregulation of E-cadherin in Chronic Rhinosinusitis with Nasal Polyps

E-cadherin is a key epithelial protein and adhesive molecule. This study detected the E-cadherin expression in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and controls, and analyzed its possible role in the pathogenesis of CRSwNP. The expression of E-cadherin was detected by using Western blotting and immunohistochemistry in controls and patients with CRSwNP. Computed tomography (CT) scan findings were scored. The results showed that the E-cadherin expression was up-regulated in patients with CRSwNP as compared with controls (P=0.039) and the positive staining was predominantly localized on the epithelial cell membrane. E-cadherin level was correlated negatively with Lund-Mackay scores in patients with CRSwNP (r=–0.604, P=0.005). It is suggested that E-cadherin may be involved in the pathogenesis of CRSwNP and correlated with disease severity.

Utilization of RNA sequencing to investigate olfactory dysfunction in chronic rhinosinusitis without nasal polyps:A pilot study

Objectives:Prior research on olfactory dysfunction in chronic rhinosinusitis(CRS)has focused on patients with polyps and suggests that direct inflammation of the olfactory cleft mucosa plays a contributory role.The purpose of this study was to evaluate gene expression in superior turbinate mucosal specimens,comparing normosmic and dysosmic CRS patients without polyps(CRSsNP).Methods:Tissue samples were obtained from the superior turbinates of patients with CRSsNP at the time of endoscopic sinus surgery.Samples subsequently underwent RNA sequencing and functional analysis to investigate biological pathways associated with differentially expressed genes between dysosmic(n=7)and normosmic(n=4)patients.Results:Differential gene expression analysis comparing dysosmic and normosmic CRSsNP patients showed upregulation of 563 genes and downregulation of 327 genes.Using stringent criteria for multiple comparisons,one upregulated gene(Immediate Early Response 3[IER3])had an false discovery rate(FDR)correction adjustedP value considered statistically significant(P<0.001,fold change 2.69).Reactome functional analysis revealed eight biological pathways significantly different between dysosmic and normosmic patients(P<0.05,FDR correction)including IL-4 and IL-13 signaling,IL-10 signaling,and rhodopsin-like receptors.Conclusions:RNA sequencing of the superior turbinates in patients with CRSsNP can provide valuable information regarding biological pathways and genes involved in olfactory dysfunction.This study supports literature suggesting that Type 2 inflammation may play a role in olfactory dysfunction in at least some patients with CRSsNP.This study also prompts questions regarding the role of IL-10,rhodopsin-like receptors,andIER3 in the pathogenesis of olfactory dysfunction.

Eosinophilic chronic rhinosinusitis in East Asians

Chronic rhinosinusitis(CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be divided into eosinophilic CRS(ECRS) and non-ECRS subtypes based on the presence of tissue eosinophilic infiltration or not. There are significant geographic and ethnic differences in the tissue eosinophilic infiltration, which is predominant in Western white patients and less common in East Asians, despite an increasing tendency for its prevalence in East Asia countries. ECRS differs significantly from non-ECRS in clinical characteristics, treatment outcomes and strategies, and underlying pathogenic mechanisms. ECRS commonly demonstrates more severe symptoms, polyp diseases with a higher incidence of bilateral polyps and sinonasal diseases on computed tomography, and the increase in blood eosinophils. ECRS is considered a special and recalcitrant subtype of CRS, commonly with poor treatment outcomes compared to non-ECRS. The differentiation of specific subtypes and clinical features of CRS will be important for developing novel treatment strategies and improving treatment outcomes for individual phenotypes of CRS. This review discusses clinical features, diagnosis, treatment and prognosis of ECRS in East Asians.

Localization of Active Caspase-3 and Caspase-8 in Nasal Polyps and Nasal Hyperplasia in Consideration of Mast Cell Function: A Semiquantitatively Analysis

Introduction: The pathogenesis of nasal polyposis and nasal hyperplasia is still unknown. The localization of caspases in nasal polyps and nasal hyperplasia of patients with and without allergic rhinitis was studied. Methods: Sections of human nasal polyps (n = 5) and hyperplastic nasal turbinates (5 with, 5 without allergy) were stained for active caspase-3 and caspase-8. Double immunofluorescence was used to evaluate colocalization of the caspases with Ki-M1P and tryptase. TUNEL was performed. Results: Active caspase-3 and caspase-8 were seen in nearly all nasal polyps and hyperplastic nasal turbinates. Active caspase-3 was predominantly localized in stromal cells, identified as mast cells. Caspase-8 was localized in mast cells with the pattern similar to active caspase-3 and additionally found in epithelial cells at the nasal and polyp surface and in epithelial cells of glands. Conclusion: Our results suggest that mast cell apoptosis may be involved in the pathological mechanisms which characterize and sustain chronic inflammatory disorders of the nasal mucosa with and without allergy.

CX3CR1 receptor as a potential therapeutic target in chronic rhinosinusitis and allergic rhinitis

Chronic rhinosinusitis and allergic rhinitis are chronic inflammatory diseases that affect the mucous membrane of the nose and paranasal sinuses. These diseases are characterized by recruitment of inflammatory cells to the upper airway. For this to take place a complex interaction between inflammatory cells and the cytokines/chemokines(ligand) liberated at the site of inflammation is involved in a process termed chemotaxis or directed cell migration against concentration gradient of the ligand. This entails signal transduction through the cell surface receptor resulting in cellular functional response and directed migration. In this editorial the novel role of CX3CR1 receptor in the immunopathology of chronic inflammation of the nose and paranasal sinuses will be explored with its potential role as therapeutic target in chronic nasal inflammation.

Clinical and histopathologic features of biofilm-associated chronic rhinosinusitis with nasal polyps in Chinese patients

Background Biofilms have given new insights to the understanding of pathogenesis of chronic rhinosinusitis （CRS）. However, the link between biofilms formation and local inflammatory response remains poorly defined in CRS with nasal polys. The aim of this study was to determine the potential association of the presence of biofilms in the nasal mucosal tissues with clinical features in Chinese patients, which had CRS with nasal polyps （CRSwNP）. Methods A total of 19 patients with CRSwNP and 12 patients with non-CRS were subjected to endoscopic surgery and their nasal mucosal tissue specimens were examined histologically and by scanning electron microscopy （SEM）. Their demographic and clinical features were recorded. Results Thirteen （68.4%） out of the 19 specimens from patients with CRSwNP, but none from control patients, were positive for biofilms that displayed typical characteristics of bacterial and fugal structures. The presence of biofilms in the nasal mucosal tissues was associated with significantly greater values of purulent nasal discharge and preoperative Lund-Kennedy scores, higher levels of serum total IgE and percentages of subjects with endoscopic surgery （ESS） history in patients with CRSwNP, and more severe inflammation in the nasal mucosal tissues of patients with CRSwNP. Conclusion Our study demonstrated the presence of biofilms in the nasal mucosal tissues of many patients, contributing to the understanding of the pathogenic process of CRSwNP in Chinese patients.

Enhanced oxidative stress is associated with tissue neutrophilia and poor steroid response in chronic rhinosinusitis with nasal polyps

Objective:To analyze the oxidative stress status and its association with tissue neutrophilia and oral steroid response in chronic rhinosinusitis with nasal polyps(CRSwNP)patients.Methods:The levels of total oxidant status(TOS)were detected in the sinonasal tissues by using specific assay kits.Tissue neutrophil was examined by immunohistochemical staining,and oxidant status index(OSI)was evaluated in polyps tissues,and the messenger RNA(mRNA)levels of superoxide dismutase 2(SOD2),aldehyde dehydrogenase 1(ALDH1A1),and microsomal glutathione S‐transferase 1(MGST1)were examined using quantitative real‐time polymerase chain reaction in the sinonasal tissues.The receiver operating characteristics(ROCs)curve of ALDH1A1,MGST1,and SOD2 mRNA levels were evaluated to determine the steroid response of CRSwNP patients.Results:The levels of TOS and OSI were significantly higher in CRSwNP and CRSsNP than in normal controls,and OSI in polyps tissues was positively associated with tissue neutrophilia and poor steroid response.The ALDH1A1,MGST1,and SOD2 mRNA levels showed comparable accuracy as predictors of poor steroid response indicated by the area under the curve.Conclusion:These findings provided evidence that the increased level of oxidative stress contributes to enhanced tissue neutrophilia and poor steroid response in CRSwNP patients.

Nasal Schwannoma—A Case Report

According to the literature, half of the schwannoma cases occur in the head and neck areas and only less than 4% occur in the sinonasal tract. In this case, a 50-year-old male patient, Mr. Jeyapal with a-year-long progressive left side nasal obstruction and purulent rhinorrhea, is presented [1]. The CT reveals a mass filling the left nasal cavity. During surgical intervention, the mass is found to originate from the medial side of the septum anteriorly and inferiorly. The pathological examination reveals capsulated tumor with palisading cellular arrangement and high cellular density [2]. The pathological findings and nervous origin of the tumor are discussed after an extensive review of the literature.

慢性鼻窦炎伴鼻息肉鼻黏膜中纤维蛋白交联和降解相关调控基因表达异常

目的研究慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者以及合并哮喘(asthma,AS)患者(CRSwNP+AS)鼻黏膜中纤维蛋白沉积及其相关调控基因的表达情况。方法利用免疫荧光染色评估鼻黏膜中纤维蛋白的沉积情况;利用实时荧光定量聚合酶链式反应检测纤维蛋白交联和降解相关调控基因的表达,以及糖皮质激素治疗后的基因表达变化。结果与对照组相比,CRSwNP鼻黏膜中有显著的纤维蛋白沉积,且呈交联状态,CRSwNP+AS组有更明显的纤维蛋白沉积。基因表达检测显示,促进纤维蛋白交联的基因-凝血因子ⅩⅢA1(factorⅩⅢA chain 1,F13A 1)和抑制纤维蛋白降解的基因-纤溶酶原激活物抑制物1(plasminogen activator inhibitor 1,PAI-1)在CRSwNP和CRSwNP+AS组的表达均升高,并且F13A1在CRSwNP+AS组的表达较CRSwNP显著更高;促进纤维蛋白降解的基因-组织型纤溶酶原激活因子(plasminogen activator tissue type,PLAT)在CRSwNP+AS组的表达显著低于CRSwNP和对照组;尿激酶型纤溶酶原激活因子(plasminogen activator urokinase,PLAU)的表达在两种类型的CRSwNP中均上调。CRSwNP+AS患者经糖皮质激素治疗,可显著下调F13A1、上调PLAT的表达。结论CRSwNP患者鼻黏膜中存在大量纤维蛋白沉积,可能与纤维蛋白交联和降解相关基因的表达失调有关,合并AS患者鼻黏膜中F13A1和PLAT的表达失调更为明显。

Effects of Desloratadine Citrate Disodium combined with Budesonide suspension on serum IgE, EOS and inflammatory factors in patients with CRS after endoscopic sinus surgery

Objective: To observe the clinical application of Desloratadine Citrate Disodium combined with Budesonide suspension in patients with chronic rhinosinusitis CRS after endoscopic sinus surgery, and analyze the change of serum immunoglobulin E (IgE), eosinophils (EOS) and inflammatory factors level in patients. Method: A total of 90 cases of patients with CRS were randomly divided into control group (n=45) and observation group (n=45) according to the lottery method. Both groups were treated with endoscopic sinus surgery. On the basis of this, control group was given Budesonide suspension and observation group was treated with Desloratadine Citrate Disodium combined with Budesonide suspension. The change of serum IgE, EOS and inflammatory factors were measured before and after operation in all subjects. Results: There was no significant difference in IgE and EOS levels between control group and observation group before treatment. After treatment, the levels of serum IgE and EOS in the two groups were significantly lower than those before treatment. Moreover, after treatment, observation group was lower than control group, and the difference was significant. There was no significant difference in inflammatory factors level between control group and observation group before treatment. After treatment, the levels of serum IL-6, IL-8, TNF-α and hs-CRP were significantly lower than those before treatment. After treatment, observation group was lower than the control group in the same period, the difference was significant. Conclusion:Combined Desloratadine Citrate Disodium treatment for CRS patients on the basis of endoscopic sinus surgery and Budesonide Nasal Spray treatment, it can more effectively reduce serum IgE and EOS levels, decrease the inflammatory response. Therefore it was a potential effective treatment for patients with CRS.

鼻黏膜不同炎症的临床表现及客观炎症指标的异同性研究

目的比较慢性鼻炎(CR)、慢性鼻窦炎伴鼻息肉(CRSwNP)和慢性鼻窦炎不伴鼻息肉(CRSsNP)患者在鼻部症状、生活质量评估和临床炎症指标表达方面异同。方法研究共纳入2017年1月~2018年12月在北京同仁医院鼻科就诊的154例连续患者,年龄18~70岁,其中男性106例,女性48例。根据入选标准,纳入患者分为CR组、CRSsNP组和CRSwNP组。患者于就诊当天进行鼻内镜、鼻呼出NO(nasal exhaled nitric oxide,nNO)、皮肤点刺试验、鼻窦CT和血常规检查,并在医师指导下对自身鼻部症状进行视觉模拟量表(VAS)评分,填写鼻腔鼻窦结局测试22条(SNOT-22)问卷。共43例CR患者,58例CRSsNP患者及53例CRSwNP患者入选本研究。结果CRSsNP组SNOT-22总分显著低于CR和CRSwNP组(30.0±19.4 vs.41.1±21.9,30.0±19.4 vs.40.9±18.7,P<0.05),CR组和CRSwNP组的SNOT-22总评分无统计学差异。CRSwNP组鼻部症状及鼻外症状平均得分最高;CRSsNP组得分较低;CR患者对睡眠的损害影响显著高于CRSsNP患者(9.9±6.2 vs.5.1±5.3,P<0.05),与CRSwNP组睡眠评分无显著差异(9.9±6.2 vs.7.1±5.7,P>0.05)。当患者合并过敏原阳性时,CR、CRSsNP和CRSwNP之间症状评分及SNOT-22评分之间无统计学差异;当过敏原阴性时,无论症状评分还是SNOT-22评分,三者之间均表现出明显的统计学差异。结论CR、CRSsNP和CRSwNP三种鼻黏膜炎症类型都对患者生活质量产生明显影响。就症状评分及生活质量评分而言,CR组和CRSwNP组相近且较CRSsNP组损害更明显。客观评价指标与症状和生活质量评分的变化趋势并不一致。

鼻腔局部类固醇药物治疗慢性鼻窦炎息肉和变应性鼻炎患者的临床效果

目的:分析鼻腔局部应用类固醇类药物在治疗鼻窦炎息肉、变应性鼻炎方面的有效性与安全性情况,为临床提供参考。方法:选择2021年3月—2022年3月河南科技大学第二附属医院收治的145例变应性鼻炎和慢性鼻窦炎鼻息肉患者作为研究对象。根据用药差异性划分为参照组与研究组。参照组予以安慰治疗,研究组予以鼻腔局部类固醇药物治疗。比较两组患者的治疗情况与使用安全性情况。结果:参照组采安慰剂治疗无法获得较好效果,仅可对患者的心理状态产生一定安慰作用。研究组各组患者治疗总有效率均明显高于参照组,差异有统计学意义(χ^(2)=50.516、54.133、54.133、50.516,P<0.05)。研究组各组间治疗总有效率比较,差异无统计学意义(χ^(2)=0.352、0.000、0.352、0.352、0.000、0.352,P>0.05)。研究组各组患者的不良反应发生率均较低,但各组间比较,差异无统计学意义(χ^(2)=1.681、1.097、0.420、0.090、0.892、0.132,P>0.05)。结论:将鼻腔局部类固醇药物应用于慢性鼻窦炎息肉和变应性鼻炎患者的治疗工作当中,不仅可以有效提升治疗有效率,同时可以保证患者的用药安全性。

细菌溶解产物治疗慢性鼻窦炎的疗效分析

目的观察手术患者应用细菌溶解产物(bacterial lysates,BLs)联合鼻用激素治疗慢性鼻窦炎(CRS)的疗效。方法收集甘肃省人民医院耳鼻咽喉头颈外科诊断为慢性鼻窦炎伴鼻息肉(CRSwNP)和慢性鼻窦炎不伴鼻息肉(CRSsNP)病例,分为四组,CRSwNP应用BLs组、CRSwNP对照组、CRSsNP应用BLs组和CRSsNP对照组。所有患者均接受手术治疗,对照组术后采用鼻用激素治疗,BLs组术后给予鼻用激素+BLs口服治疗。应用视觉模拟量表(VAS)、鼻腔鼻窦结局测试-20(SNOT-20)、Lund-Kennedy评分、Lund-Mackay评分、嗜酸细胞(Eos)、IL-4、IgG、IgA、IgM和总IgE水平对四组患者术前、术后1个月、术后3个月进行评估。结果CRSwNP应用BLs组和CRSsNP应用BLs组间IgG、IgA、IL-4、Eos水平比较,差异有统计学意义(P<0.05);治疗后1个月、3个月CRSwNP应用BLs组和CRSsNP应用BLs组间VAS及SNOT-20差异均有统计学意义(P<0.05);治疗后1个月、3个月CRSwNP应用BLs组和CRSsNP应用BLs组间Lund-Kennedy评分及Lund-Mackey评分差异均有统计学意义(P<0.05)。四组患者治疗后疾病控制有效率均具有统计学意义(P<0.05)。无与治疗直接相关严重并发症。结论应用BLs对CRS患者术后鼻漏、持续性炎症反应、黏膜恢复情况均有改善,可提高机体IgG、IgA水平,降低Eos及IL-4水平,不良反应少,安全性高,可提高CRS的治疗效果。

下鼻甲射频消融术对慢性鼻-鼻窦炎患者鼻腔结构及气道阻力的影响

目的探究下鼻甲射频消融术对慢性鼻-鼻窦炎患者鼻腔结构及气道阻力的影响。方法选取2019年1个月至2024年6月河南省儿童医院收治的64例慢性鼻-鼻窦炎患者,在组间基线资料匹配的基础上,采用随机信封法将上述患者分为对照组(n=32,实施鼻内镜鼻窦手术)和观察组(n=32,实施鼻内镜鼻窦手术配合下鼻甲射频消融术),比较两组患者手术相关指标、疗效、鼻腔结构、气道阻力、鼻黏液纤毛清除功能、并发症。结果两组患者术中出血量比较差异无统计学意义(P>0.05);观察组患者住院时间相较于对照组更短,总有效率更高,差异有统计学意义(P<0.05)。相较于治疗前,治疗后两组患者宽敞侧及狭窄侧下鼻甲最下缘与鼻底的垂直距离、下鼻甲最内缘与鼻中隔的水平距离均有增长,且观察组相较于对照组更长,差异有统计学意义(P<0.05)。治疗后两组患者宽敞侧及狭窄侧下鼻甲水平方向上的最大厚度均有降低,且观察组相较于对照组更低,差异有统计学意义(P<0.05)。治疗后两组患者呼吸总阻抗、总气道阻力、共振频率均有降低,且观察组相较于对照组更低(P<0.05)。治疗后两组患者黏液纤毛清除率、黏液纤毛清除速率均有升高,且观察组相较于对照组更高;治疗后两组患者糖精清除时间均有降低,且观察组相较于对照组更低,差异有统计学意义(P<0.05)。观察组患者治疗后鼻内镜Lund-Kennedy评分低于对照组,并发症总发生率相低于对照组,差异有统计学意义(P<0.05)。结论相较于单独实施鼻内镜鼻窦手术,实施鼻内镜鼻窦手术配合下鼻甲射频消融术对于慢性鼻-鼻窦炎患者而言,既可降低术中出血量,又可缩短住院时间,提升疗效,改善鼻腔结构与鼻黏液纤毛清除功能,降低气道阻力,减少并发症发生率,具有应用价值。

Cyclin D1、VEGF联合NLR、PLR水平预测慢性鼻窦炎-鼻息肉术后复发的临床研究

目的探究Cyclin D1、血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)表达含量联合中性粒细胞/淋巴细胞比值(Neutrophil-lymphocyte Ratio,NLR)和血小板/淋巴细胞比值(Platelet-lymphocyte Ratio,PLR)水平预测慢性鼻窦炎伴鼻息肉(Chronic Rhinosinusitis with Nasal Polyps,CRSwNP)复发的临床加价值。方法选取广东省韶关市粤北人民医院耳鼻喉科于2021年1月—2022年6月收治的333例CRSwNP患者为研究对象,均行慢性鼻窦炎-鼻息肉术治疗,根据术后复发情况分为复发组(138例)和未复发组(195例),比较两组患者一般资料、Cyclin D1、VEG、NLR、PLR水平,采用受试者工作特征(Receiver Operating Characteristic,ROC)曲线分析Cyclin D1、VEGF联合NLR、PLR水平对CRSwNP者术后1年复发的预测效能。结果两组Cyclin D1、VEGF、NLR、PLR水平对比,差异有统计学意义(P均<0.05)。Logistic回归分析结果显示,CRSwNP患者复发的影响因素包括Cyclin D1、VEGF、NLR、PLR水平(OR=1.521、1.483、1.365、1.403,P均<0.05)。ROC曲线结果显示Cyclin D1、VEGF、NLR、PLR四者联合检测的灵敏度、特异度及曲线下面积均高于单独检测(P均<0.05)。结论Cyclin D1、VEGF、NLR、PLR水平是诱发CRSwNP患者术后复发的相关因素,也是预测CRSwNP患者术后复发的可靠性指标。

分析优质护理对慢性鼻窦炎伴鼻息肉行鼻内镜术后患者睡眠质量的影响

目的:分析优质护理对慢性鼻窦炎伴鼻息肉行鼻内镜术后患者睡眠质量的影响。方法:选取2021年11月至2022年11月中国人民解放军联勤保障部队第九一〇医院收治的慢性鼻窦炎伴鼻息肉患者70例作为研究对象,按照随机数字表法分为对照组和观察组,每组35例。对照组给予常规护理干预,观察组实施优质护理干预。采用我院自制的睡眠质量量表比较干预前后2组患者睡眠质量的差异,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估2组患者干预前后的心理状态,采用SF-36生命质量量表比较2组患者干预前后生命质量的变化,并比较2组患者的护理满意度及并发症发生率。结果:干预后,观察组入睡时间、睡眠障碍、催眠药物评分显著低于对照组,观察组睡眠时间显著高于对照组,观察组SAS评分、SDS评分显著低于对照组,观察组护理满意度显著高于对照组,观察组并发症发生率显著低于对照组,观察组SF-36评分显著高于对照组,差异均有统计学意义(均P<0.05)。结论:优质护理可以减少患者鼻内镜术后并发症的发生率,改善患者睡眠质量,缓解焦虑、抑郁情绪,提高患者的生命质量,具有较好的临床推广应用价值。

慢性鼻窦炎伴鼻息肉患者术后复发影响因素及血清ECP、IL-21对复发的预测价值

目的 探讨慢性鼻窦炎伴鼻息肉患者术后复发的影响因素及血清嗜酸性粒细胞阳离子蛋白(ECP)和白细胞介素-21(IL-21)水平对复发的预测价值,寻找评价慢性鼻窦炎伴鼻息肉术后复发的有效生物学标志物。方法 选取2019年12月至2020年10月衡水市第二人民医院收治的107例接受手术治疗的慢性鼻窦炎伴鼻息肉患者为研究对象,采集患者手术前后静脉血,ImmunoCAP 100~(TM)过敏原检测系统检测血清ECP水平,通过酶联免疫吸附法检测血清IL-21水平,对患者进行随访,随访终点为复发,统计患者术后2年复发情况,分析影响慢性鼻窦炎伴鼻息肉患者术后复发的独立因素,分析ECP、IL-21水平对慢性鼻窦炎伴鼻息肉患者术后复发的预测价值。结果 截止随访结束失访3例,剩余104例患者中术后2年有27例出现复发,其余77例患者未复发,复发组鼻窦CT评分高于未复发组,差异有统计学意义(P<0.05)。治疗前,复发组CD8^(+)T淋巴细胞比例高于未复发组,CD4^(+)/CD8^(+)值低于未复发组,治疗后,复发组CD4^(+)T淋巴细胞比例与CD4^(+)/CD8^(+)值低于未复发组,CD8^(+) T淋巴细胞比例高于未复发组,差异有统计学意义(P<0.05)。治疗前和治疗后,复发组的IgE、CCL4、ECP及IL-21水平均高于未复发组,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示鼻窦CT积分、治疗前ECP、IL-21及治疗后ECP、IL-21是慢性鼻窦炎伴鼻息肉患者术后复发的独立影响因素(P<0.05)。ROC曲线显示鼻窦CT评分、治疗前ECP、IL-21,治疗后ECP、IL-21对术后复发均有预测价值(P<0.05且AUC>0.500),其中治疗前ECP、IL-21联合鼻窦CT评分预测术后复发的最佳敏感度和特异度分别为0.825、0.806,治疗后ECP、IL-21联合鼻窦CT评分预测术后复发的最佳敏感度和特异度分别为0.954、0.633。结论 鼻窦积分、治疗前后的ECP、IL-21水平对慢性鼻窦炎伴鼻息肉患者术后复发均有较高的预测价值,可以作为评价慢性鼻窦炎伴鼻息肉复发的有效生物学标志物。

慢性鼻-鼻窦炎伴鼻息肉患者术后预后不良影响因素分析及模型构建

目的 探讨慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者术后预后不良的影响因素,建立logistic回归模型并进行验证,为临床防治工作提供参考。方法 回顾性选取2021年1月至2023年1月郑州市第七人民医院收治的158例CRSwNP患者为研究对象,依据内窥镜术后1 a预后情况分为预后不良组33例、预后良好组125例。比较两组临床资料,分析预后不良的影响因素。依据多因素logistic回归分析结果构建模型,采用Hosmer-Lemeshow检验模型校准度。结果 变应性鼻炎、支气管哮喘、头/面疼痛评分、鼻窦CT评分、术后感染及白细胞介素-17(IL-17)、趋化因子4(CCL4)水平为预后不良的独立危险因素(P<0.05);模型预测术后预后不良的曲线下面积(AUC)为0.906(95%CI:0.812~0.964),预测敏感度、特异度分别为84.85%、86.40%,且具有良好校准度。结论 变应性鼻炎、支气管哮喘、头/面疼痛评分、鼻窦CT评分、术后感染及IL-17、CCL4水平为CRSwNP患者术后预后不良发生的独立危险因素,基于上述影响因素建立logistic回归模型,该模型对预后不良发生具有一定预测价值,临床需重视上述影响因素并实施个体化干预,以降低预后不良发生风险。