Hirsch A G, Stewart W F, Sundaresan A S, Young A J, Kennedy T L, Scott Greene J, Feng W, Tan B K, Schleimer R P, Kern R C, Lidder A, Schwartz B S
Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA, USA.
Research Development and Dissemination, Sutter Health, San Francisco, CA, USA.
Allergy. 2017 Feb;72(2):274-281. doi: 10.1111/all.13042. Epub 2016 Sep 19.
The objective of this study was to describe the first US-based study to use the European Position Paper on Rhinosinusitis (EPOS) criteria to study the prevalence of chronic rhinosinusitis (CRS) in a general-population sample.
A CRS symptom questionnaire was mailed to 23 700 primary care patients from Geisinger Clinic, a health system serving 45 counties in Pennsylvania. CRS cases were categorized into four unique subgroups based on EPOS symptoms: obstruction and discharge with no smell loss or pain/pressure; smell loss without pain/pressure; facial pain and/or pressure without smell loss; and both smell loss and pain/pressure. All cases were required to have nasal obstruction or discharge. Logistic regression was used to evaluate potential factors associated with CRS subgroups.
We found that 11.9% of patients met criteria for CRS. Prevalence peaked at 15.9% between ages 50 and 59 years and then dropped to 6.8% after age 69. The odds of CRS was higher among patients who were white, younger, smokers, had a history of Medical Assistance, and had other diseases. When CRS subgroups were modeled separately, these associations were no longer significant for some CRS subgroups. Comorbid diseases were most strongly associated with CRS cases who reported smell loss and facial pain and/or pressure and had the weakest associations with CRS cases who did not report these symptoms.
CRS is a highly prevalent and heterogeneous condition. Differences in risk factors and health outcomes across symptom subgroups may be indicative of differences in etiology that have implications for disease management.
本研究的目的是描述美国首个使用欧洲鼻窦炎立场文件（EPOS）标准来研究普通人群样本中慢性鼻窦炎（CRS）患病率的研究。
向来自盖辛格诊所的23700名初级保健患者邮寄了一份CRS症状问卷，该诊所是一个为宾夕法尼亚州45个县提供服务的医疗系统。根据EPOS症状，CRS病例被分为四个独特的亚组：有鼻塞和流涕但无嗅觉丧失或疼痛/压痛；有嗅觉丧失但无疼痛/压痛；有面部疼痛和/或压痛但无嗅觉丧失；既有嗅觉丧失又有疼痛/压痛。所有病例均需有鼻塞或流涕。采用逻辑回归评估与CRS亚组相关的潜在因素。
我们发现11.9%的患者符合CRS标准。患病率在50至59岁之间达到峰值15.9%，然后在69岁以后降至6.8%。CRS的患病几率在白人、年轻人、吸烟者、有医疗救助史以及患有其他疾病的患者中更高。当分别对CRS亚组进行建模时，这些关联对某些CRS亚组不再显著。合并症与报告有嗅觉丧失和面部疼痛和/或压痛的CRS病例关联最为强烈，与未报告这些症状的CRS病例关联最弱。
CRS是一种高度流行且异质性的疾病。症状亚组之间危险因素和健康结局的差异可能表明病因存在差异，这对疾病管理具有重要意义。
