Department of Medicine, Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
Department of Medicine, Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
J Allergy Clin Immunol. 2020 Jun;145(6):1598-1605. doi: 10.1016/j.jaci.2020.01.023. Epub 2020 Jan 29.
Chronic rhinosinusitis (CRS) is complicated by frequent acute exacerbations leading to significant health care burden and impaired quality of life.
The objective of this study was to identify clinical factors associated with frequent acute exacerbation of CRS (AECRS).
This is a retrospective cohort study of patients with CRS from January 1, 2014, to May 31, 2016. Frequent AECRS was defined as at least 4 episodes over a 12-month period in which an antibiotic was prescribed for worsening sinus symptoms, and infrequent AECRS was defined as 0 to 3 episodes. Clinical factors, including asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, and autoimmune disease, were evaluated for associations between the 2 groups.
Of the 3109 patients with CRS who were identified, 600 (19.3%) were classified as having frequent exacerbation. Asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, and autoimmune disease were associated with frequent AECRS with statistically significant adjusted odds ratios (aORs) after controlling for age, race, and sex in multivariate analysis (asthma aOR = 2.61 [95% CI = 2.14-3.18]; allergic rhinitis aOR = 1.96 [95% CI = 1.58-2.42]; eosinophil count of at least 150 cells per microliter aOR = 1.54 [95% CI = 1.21-1.97]; and autoimmune disease aOR = 1.68 [95% CI = 1.36-2.07]). Antibody deficiency, antibiotic allergy, lower FEV, radiographic sinus disease severity, nasal polyposis, and systemic corticosteroid use were also associated with frequent AECRS.
Patients with frequent episodes of AECRS were characterized by a higher prevalence of asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, autoimmune disease, and other allergic and immunologic diseases. These findings identify a high-risk phenotype of patients with CRS for preventive interventions to reduce exacerbation frequency.
慢性鼻-鼻窦炎（CRS）常因频繁急性加重而变得复杂，从而导致重大的医疗保健负担和生活质量受损。
本研究旨在确定与 CRS 频繁急性加重（AECRS）相关的临床因素。
这是一项回顾性队列研究，纳入了 2014 年 1 月 1 日至 2016 年 5 月 31 日期间患有 CRS 的患者。频繁 AECRS 定义为在 12 个月内至少有 4 次因鼻窦症状恶化而开具抗生素的发作，而不频繁 AECRS 定义为 0 至 3 次。评估了哮喘、变应性鼻炎、每微升至少 150 个细胞的嗜酸性粒细胞计数和自身免疫性疾病等临床因素，以确定两组之间的关联。
在确定的 3109 例 CRS 患者中，有 600 例（19.3%）被归类为频繁发作。在控制了年龄、种族和性别等多变量分析后，哮喘、变应性鼻炎、每微升至少 150 个细胞的嗜酸性粒细胞计数和自身免疫性疾病与频繁 AECRS 具有统计学显著的调整后比值比（aOR）（哮喘 aOR=2.61[95%CI=2.14-3.18]；变应性鼻炎 aOR=1.96[95%CI=1.58-2.42]；每微升至少 150 个细胞的嗜酸性粒细胞计数 aOR=1.54[95%CI=1.21-1.97]；自身免疫性疾病 aOR=1.68[95%CI=1.36-2.07]）。抗体缺乏、抗生素过敏、较低的 FEV、放射影像学鼻窦疾病严重程度、鼻息肉和全身皮质类固醇的使用也与频繁 AECRS 相关。
频繁发生 AECRS 的患者具有更高的哮喘、变应性鼻炎、每微升至少 150 个细胞的嗜酸性粒细胞计数、自身免疫性疾病和其他过敏和免疫性疾病的患病率。这些发现确定了 CRS 患者的一种高风险表型，需要进行预防干预以降低发作频率。
