Guilemany J M, Angrill J, Alobid I, Centellas S, Pujols L, Bartra J, Bernal-Sprekelsen M, Valero A, Picado C, Mullol J
Department of Otorhinolaryngology, Rhinology Unit and Smell Clinic, Pneumology and Respiratory Allergy, Hospital Clnic, University of Barcelona, Spain.
Allergy. 2009 May;64(5):790-7. doi: 10.1111/j.1398-9995.2008.01892.x. Epub 2009 Feb 7.
Although various relationships between the lower and upper airways have been found, the association of bronchiectasis with chronic rhinosinusitis and nasal polyps has not been thoroughly evaluated. This study was undertaken to examine the association of idiopathic and postinfective bronchiectasis with chronic rhinosinusitis and nasal polyposis.
In a prospective study, 56 patients with idiopathic and 32 with postinfective bronchiectasis were evaluated for chronic rhinosinusitis and nasal polyposis by using EP(3)OS criteria and assessing: symptoms score, nasal endoscopy, sinonasal and chest CT scan, nasal and lung function and nasal and exhaled NO.
Most bronchiectasis patients (77%) satisfied the EP(3)OS criteria for chronic rhinosinusitis, with anterior (98.5%) and posterior (91%) rhinorrhea and nasal congestion (90%) being the major symptoms. Patients presented maxillary, ethmoidal and ostiomeatal complex occupancy with a total CT score of 8.4 +/- 0.4 (0-24). Using endoscopy, nasal polyps with a moderate score of 1.6 +/- 0.1 (0-3) were found in 25% of patients. Nasal NO was significantly lower in patients with nasal polyposis (347 +/- 62 ppb) than in those without them (683 +/- 76 ppb; P < 0.001), and inversely correlated (R = -0.36; P < 0.01) with the ostiomeatal complex occupancy. In the chest CT scan, patients with chronic rhinosinusitis showed a higher bronchiectasis severity score (7.2 +/- 0.5; P < 0.001) than patients without (3.7 +/- 0.7). The prevalence of chronic rhinosinusitis, nasal polyps and other outcomes were similar in idiopathic and postinfective bronchiectasis.
The frequent association of chronic rhinosinusitis and nasal polyposis with idiopathic and postinfective BQ supports the united airways concept, and it suggests that the two type of bronchiectasis share common etiopathogenic mechanisms.
尽管已发现下呼吸道与上呼吸道之间存在多种关系，但支气管扩张与慢性鼻窦炎和鼻息肉之间的关联尚未得到充分评估。本研究旨在探讨特发性和感染后支气管扩张与慢性鼻窦炎和鼻息肉病之间的关联。
在一项前瞻性研究中，采用EP(3)OS标准并评估症状评分、鼻内镜检查、鼻窦和胸部CT扫描、鼻和肺功能以及鼻和呼出一氧化氮，对56例特发性支气管扩张患者和32例感染后支气管扩张患者进行慢性鼻窦炎和鼻息肉病评估。
大多数支气管扩张患者（77%）符合慢性鼻窦炎的EP(3)OS标准，主要症状为前鼻漏（98.5%）、后鼻漏（91%）和鼻塞（90%）。患者上颌窦、筛窦和窦口鼻道复合体有病变，CT总评分为8.4±0.4（0 - 24）。通过内镜检查，25%的患者发现有中度鼻息肉，评分为1.6±0.1（0 - 3）。鼻息肉患者的鼻一氧化氮水平（347±62 ppb）显著低于无鼻息肉患者（683±76 ppb；P < 0.001），且与窦口鼻道复合体病变呈负相关（R = -0.36；P < 0.01）。在胸部CT扫描中，慢性鼻窦炎患者的支气管扩张严重程度评分（7.2±0.5；P < 0.001）高于无慢性鼻窦炎患者（3.7±0.7）。特发性和感染后支气管扩张患者中慢性鼻窦炎、鼻息肉及其他结果的患病率相似。
慢性鼻窦炎和鼻息肉与特发性和感染后支气管扩张的频繁关联支持了联合气道概念，并表明这两种类型的支气管扩张具有共同的病因发病机制。
