Yang H H, Fang H, You Q J, Han L, Yang Z F, Yu L L, Zhang Y
Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Nov 7;53(11):842-846. doi: 10.3760/cma.j.issn.1673-0860.2018.11.009.
To investigate the correlation between postoperative recurrence and clinical parameters in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and to study predicitve value of total scores of eosinophils (EOS) and sinus CT for postoperative recurrence. A retrospective analysis of 264 patients with CRSwNP who were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2015 was performed. The patient was subjected to a visual analogue scale (VAS) score, a skin prick test, a peripheral blood cell count, a sinus CT score, and a nasal polyp EOS count. All patients underwent endoscopic surgery and were followed up for at least 2 years. The demographic characteristics of the nasal polyps recurrence group and the non-recurrence group were compared with other clinical indicators. Quantitative data were compared by test or Mann-Whitney test, qualitative data were compared by test, and Logistic regression analysis was used for regression analysis. The risk factors for recurrence were assessed. The best cut-off value was determined by using the receiver operating characteristic (ROC) curve. The predictive value of the parameters was determined by area under curve (AUC). The difference was statistically significant at <0.05. The recurrence rate of the study patients was 43.56% (115/264). Sex, olfactory VAS score, total sinus CT score, peripheral blood neutrophil ratio, peripheral blood EOS absolute value and proportion, and tissue EOS absolute value and proportion were associated with postoperative recurrence of nasal polyps (χ(2)=5.241, =-3.146, =-7.441, χ(2)=180.617, =-5.313, χ(2)=100.067, =-7.471, χ(2)=258.916, all <0.05), and the tissue EOS ratio and total sinus CT scores have higher predictive value for recurrence of nasal polyps (AUC values were 0.793, 0.767, respectively, all <0.001). With the EOS ratio of nasal polyps >0.032, the sensitivity of predicting recurrence was 83.48%, the specificity was 56.38%. With the total score of sinus CT>15, the sensitivity of predicting recurrence was 51.30% and the specificity was 87.25%. The combined sensitivity of predictive recurrence was 92.00% and the specificity was 49.20%. The percentage of EOS in nasal polyps and the total score of sinus CT in patients with CRSwNP have better predictive diagnostic value for recurrence of nasal polyps.
探讨慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者术后复发与临床参数之间的相关性，并研究嗜酸性粒细胞（EOS）总分及鼻窦CT对术后复发的预测价值。对2013年6月至2015年12月在温州医科大学附属第一医院住院的264例CRSwNP患者进行回顾性分析。对患者进行视觉模拟量表（VAS）评分、皮肤点刺试验、外周血细胞计数、鼻窦CT评分及鼻息肉EOS计数。所有患者均接受鼻内镜手术并至少随访2年。比较鼻息肉复发组和未复发组的人口统计学特征及其他临床指标。定量资料采用t检验或Mann-Whitney U检验，定性资料采用χ²检验，采用Logistic回归分析进行多因素回归分析，评估复发的危险因素。采用受试者工作特征（ROC）曲线确定最佳截断值，通过曲线下面积（AUC）确定各参数的预测价值。P<0.05为差异有统计学意义。本研究患者的复发率为43.56%（115/264）。性别、嗅觉VAS评分、鼻窦CT总分、外周血中性粒细胞比例、外周血EOS绝对值及比例、组织EOS绝对值及比例与鼻息肉术后复发有关（χ²=5.241，t=-3.146，t=-7.441，χ²=180.617，t=-5.313，χ²=100.067，t=-7.471，χ²=258.916，均P<0.05），组织EOS比例及鼻窦CT总分对鼻息肉复发有较高的预测价值（AUC值分别为0.793、0.767，均P<0.001）。当鼻息肉EOS比例>0.032时，预测复发的敏感度为83.48%，特异度为56.38%。当鼻窦CT总分>15时，预测复发的敏感度为51.30%，特异度为87.25%。联合预测复发的敏感度为92.00%，特异度为49.20%。CRSwNP患者鼻息肉中EOS的百分比及鼻窦CT总分对鼻息肉复发有较好的预测诊断价值。
