Sakuma Yasunori, Ishitoya Junichi, Komatsu Masanori, Shiono Osamu, Hirama Mariko, Yamashita Yukiko, Kaneko Tetsuji, Morita Satoshi, Tsukuda Mamoru
Department of Otorhinolaryngology, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, Japan.
Auris Nasus Larynx. 2011 Oct;38(5):583-8. doi: 10.1016/j.anl.2011.01.007. Epub 2011 Mar 2.
Chronic rhinosinusitis is a heterogeneous disease. Most cases of chronic rhinosinusitis with nasal polyp(s) (CRSwNP) in Western countries show a strong tendency for recurrence after surgery and pronounced eosinophil infiltration in the nasal polyps. The prevalence of CRSwNP with pronounced eosinophilic inflammation is steadily increasing and is classified as eosinophilic chronic rhinosinusitis (ECRS) in Japan. However, less than 50% of CRSwNP patients in Japan and East Asia show such features. Since the treatment strategy of ECRS differs from that of non-ECRS, clinical diagnostic criteria that distinguish ECRS from non-ECRS are needed.
A total of 124 patients with CRSwNP patients who underwent endonasal sinus surgery were classified as ECRS or non-ECRS according to their clinical characteristics and the clinical features of the two groups were compared. Computed tomography (CT) images of the sinuses were graded according to the Lund-Mackay system. We also graded CT images of the olfactory cleft. Blood examination findings, sinus CT images and asthma complications were analyzed by multivariate logistic regression. Clinical findings that were significantly different between ECRS and non-ECRS were analyzed by receiver operating characteristic curves to determine optimal predictors of ECRS.
Blood eosinophilia, asthma complications and CT image scores were significantly different between ECRS and non-ECRS. In particular, increased blood eosinophil percentage and CT image scores for the posterior ethmoid and the olfactory cleft showed good accuracy as predictors of ECRS. A combination of the cut-off values for three predictors (increased blood eosinophil percentage above the normal range, olfactory cleft score ≥1 and posterior ethmoid score ≥1) indicated high accurate diagnostic ability (sensitivity, 84.6%; specificity, 92.3%).
A set of three clinical findings can differentiate ECRS from non-ECRS with high accuracy, even when these findings are assessed in regular outpatient clinics.
慢性鼻-鼻窦炎是一种异质性疾病。西方国家大多数慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）病例术后复发倾向强烈，且鼻息肉中有明显的嗜酸性粒细胞浸润。在日本，具有明显嗜酸性粒细胞炎症的CRSwNP患病率正在稳步上升，并被归类为嗜酸性粒细胞性慢性鼻-鼻窦炎（ECRS）。然而，在日本和东亚，不到50%的CRSwNP患者有此类特征。由于ECRS的治疗策略与非ECRS不同，因此需要能够区分ECRS和非ECRS的临床诊断标准。
对124例行鼻内镜鼻窦手术的CRSwNP患者，根据其临床特征分为ECRS组和非ECRS组，并比较两组的临床特征。鼻窦计算机断层扫描（CT）图像根据Lund-Mackay系统进行分级。我们还对嗅裂的CT图像进行了分级。通过多因素logistic回归分析血液检查结果、鼻窦CT图像和哮喘并发症。通过绘制受试者工作特征曲线分析ECRS组和非ECRS组之间有显著差异的临床结果，以确定ECRS的最佳预测指标。
ECRS组和非ECRS组之间血液嗜酸性粒细胞增多、哮喘并发症和CT图像评分有显著差异。特别是，血液嗜酸性粒细胞百分比升高以及筛窦后部和嗅裂的CT图像评分作为ECRS的预测指标具有良好的准确性。三个预测指标（血液嗜酸性粒细胞百分比高于正常范围、嗅裂评分≥1和筛窦后部评分≥1）的临界值组合显示出较高的诊断准确性（敏感性84.6%；特异性92.3%）。
即使在普通门诊评估这些结果，一组三项临床结果也能高度准确地区分ECRS和非ECRS。
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