Guo Michael, Alasousi Fahad, Okpaleke Christopher, Habib Al-Rahim, Javer Amin
1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2 Ear, Nose, and Throat Department, Farwaniya Hospital, Al Farwaniyah Governorate, Kuwait.
Am J Rhinol Allergy. 2018 Sep;32(5):440-446. doi: 10.1177/1945892418793523. Epub 2018 Aug 16.
Background Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a high risk of disease recurrence and revision surgery. The ability to predict a polyp recurrence in this patient population is critical in order to provide adequately tailored postoperative management. Objective We aim to explore the role of appropriate postoperative care in the prognosis of CRSwNP patients in relation to preoperative eosinophil and basophils levels. Methods This was a retrospective case series; data were collected for 102 CRSwNP patients over a period of 15 months after surgery. Baseline eosinophil and basophil levels were compared between patients with and without polyp recurrences. The analysis was then stratified based on clinical diagnosis, comorbidities (atopy, asthma, and aspirin allergy), a single versus multiple episodes of sinonasal polyp recurrences, and medication adherence. Results Of the 102 included patients, 65 (63.7%) of the patients experienced no recurrences, 26 (25.5%) experienced a single episode of recurrence, and 11 (10.8%) experienced multiple recurrences. Mean baseline eosinophil count and percentage of total white blood cells were significantly higher in the multiple recurrences group (0.70 × 10/L and 10%) compared with the no recurrences group (0.36 × 10/L and 5%). Adherence to prescribed medical therapy prior to the first episode of recurrence was significantly lower for the single exacerbations group (42.3%) than the multiple recurrences group (88.9%). Conclusions Patients with multiple recurrences of nasal polyps had significantly higher baseline eosinophil counts and significantly higher medication adherence compared to single exacerbations of nasal polyps. Single exacerbations may not reflect true failures of surgery but rather a failure of postoperative medical care. Basophil levels were inadequate to predict polyp recurrence rates.
患有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）患者疾病复发和再次手术的风险较高。为了提供适当的术后个性化管理，预测该患者群体息肉复发的能力至关重要。目的：我们旨在探讨适当的术后护理在CRSwNP患者预后中的作用，以及与术前嗜酸性粒细胞和嗜碱性粒细胞水平的关系。方法：这是一项回顾性病例系列研究；收集了102例CRSwNP患者术后15个月的数据。比较了有息肉复发和无息肉复发患者的基线嗜酸性粒细胞和嗜碱性粒细胞水平。然后根据临床诊断、合并症（特应性、哮喘和阿司匹林过敏）、单发性与多发性鼻息肉复发以及药物依从性进行分层分析。结果：在102例纳入患者中，65例（63.7%）患者未复发，26例（25.5%）患者经历了单次复发，11例（10.8%）患者经历了多次复发。多次复发组的平均基线嗜酸性粒细胞计数和总白细胞百分比（0.70×10/L和10%）显著高于无复发组（0.36×10/L和5%）。单次复发组在首次复发前对规定药物治疗的依从性（42.3%）显著低于多次复发组（88.9%）。结论：与鼻息肉单次复发患者相比，鼻息肉多次复发患者的基线嗜酸性粒细胞计数显著更高，药物依从性也显著更高。单次复发可能并不反映手术的真正失败，而是术后医疗护理的失败。嗜碱性粒细胞水平不足以预测息肉复发率。
