Hong H Y, Sun Y Q, Shi J B
Department of Otolaryngology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519020, China.
Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Mar 7;54(3):192-197. doi: 10.3760/cma.j.issn.1673-0860.2019.03.006.
To study the value of olfactory cleft scores through computed tomography (CT) in predicting the oral glucocorticoids (GC) sensitivity in chronic rhinosinusitis with nasal polyps. Fourty-seven consecutive patients with CRSwNP from the Fifth Affiliated Hospital of Sun Yat-sen University between January and March of 2018 were recruited in this prospective, single-blinded study. There were 28 males and 19 females, with age ranging from 17 to 66 years old. After a course of oral prednisone (30 mg/d for 14 d), these patients were subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and -insensitve subgroups: Lund-Mackay scores, olfactory cleft scores, and blood eosinophil counts and ratio. test and χ(2) test were used. Multivariate regression analysis was used for factor prediction and receiver operating characteristic (ROC) curve was used to analyze the predictive ability of those factors. There were 53.2% (25/47) and 61.7% (29/47) of patients objectively and subjectively sensitive to GC therapy, respectively. All data conformed to normal distribution. The olfactory cleft score and the blood eosinophil counts and ratio in objectively GC-sensitive subgroup were significantly higher than those in objectively GC-insensitive subgroup (3.6±1.0 2.2±1.4, (404.4±200.3)/μl (209.5±233.1)/μl, (5.25±2.59)% (3.17±3.46)%, value was 3.98, 3.08, respectively, χ(2)=2.35, all 0.05). The cleft score, the blood eosinophil counts and ratio also showed the same trend in subjectively GC-sensitive and -insensitive subgroup (3.6±1.0 1.9±1.3, (401.4±213.6)/μl (171.1±200.2)/μl, (5.39±2.76)% (2.48±2.99)%, value was 5.05, 3.68, respectively, χ(2)=3.40, all 0.05). Multivariate regression revealed that olfactory cleft score was an independent risk factor for objective or subjective GC-sensitivity (2.882, 95: 1.301-6.384; 2.508, 95: 1.248-5.039). The olfactory cleft score exhibited comparable accuracy with the blood eosinophil ratio as predictor of objective and subjective GC-sensitivity (Area under curve of olfactory cleft score was 0.775, 0.829, respectively). An olfactory cleft score of 3.5 could act as a reliable indicator for predicting the clinical response to GC therapy in CRSwNP. Olfactory cleft score through CT scan has the potential value in predicting GC-sensitivity in CRSwNP patients.
研究通过计算机断层扫描（CT）测量的嗅裂评分在预测慢性鼻-鼻窦炎伴鼻息肉患者口服糖皮质激素（GC）敏感性方面的价值。本前瞻性单盲研究纳入了2018年1月至3月期间中山大学附属第五医院连续收治的47例慢性鼻-鼻窦炎伴鼻息肉患者。其中男性28例，女性19例，年龄17至66岁。在接受一个疗程的口服泼尼松（30mg/d，共14天）治疗后，根据鼻息肉大小评分的变化将这些患者客观地分为GC敏感和GC不敏感亚组，或根据总鼻症状评分的变化将其主观地分为GC敏感和GC不敏感亚组。比较GC敏感和不敏感亚组之间的以下参数：Lund-Mackay评分、嗅裂评分、血液嗜酸性粒细胞计数及比例。采用t检验和χ²检验。使用多因素回归分析进行因素预测，并使用受试者工作特征（ROC）曲线分析这些因素的预测能力。分别有53.2%（25/47）和61.7%（29/47）的患者对GC治疗客观敏感和主观敏感。所有数据均符合正态分布。客观GC敏感亚组的嗅裂评分、血液嗜酸性粒细胞计数及比例显著高于客观GC不敏感亚组（分别为3.6±1.0对2.2±1.4，（404.4±200.3）/μl对（209.5±233.1）/μl，（5.25±2.59）%对（3.17±3.46）%，t值分别为3.98、3.08，χ²=2.35，均P<0.05）。主观GC敏感和不敏感亚组的嗅裂评分、血液嗜酸性粒细胞计数及比例也呈现相同趋势（分别为3.6±1.0对1.9±1.3，（401.4±213.6）/μl对（171.1±200.2）/μl，（5.39±2.76）%对（2.48±2.99）%，t值分别为5.05、3.68，χ²=3.40，均P<0.05）。多因素回归显示，嗅裂评分是客观或主观GC敏感性的独立危险因素（β=2.882，95%CI：1.301-6.384；β=2.508，95%CI：1.248-5.039）。嗅裂评分作为客观和主观GC敏感性预测指标的准确性与血液嗜酸性粒细胞比例相当（嗅裂评分的曲线下面积分别为0.775、0.
