Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Laryngoscope. 2020 Aug;130(8):E460-E468. doi: 10.1002/lary.28639. Epub 2020 Apr 3.
OBJECTIVES/HYPOTHESIS: Severe chronic rhinosinusitis (CRS) in patients with granulomatosis with polyangiitis (GPA) failing medical therapies can be treated with paranasal sinus surgery. Whether this surgery protects from progressive sinonasal damage remains unknown. Here, we aimed to analyze time-dependent relations between sinus surgeries and computed tomography (CT) imaging features in the CRS of GPA.
Longitudinal observational study.
We assessed CRS features including bone thickening by global osteitis scoring scale, bone erosions, and mucosal thickening by Lund-Mackay scores in serial paranasal sinus CT scans (742 CT scans in total) from a cohort of 127 well-characterized GPA patients. Data on sinonasal surgical procedures were from a mandatory national registry and from chart review. We defined the time from baseline CT to last CT as the study observation period in each patient. Datasets were analyzed by linear mixed models.
We found that 23/127 cohort patients had one or more paranasal sinus surgical procedures, and 96% of these (22/23) had osteitis by CT after surgery. In patients with nasal surgery alone or no surgery, we identified osteitis in 7/11 (64%) and 45/93 (48%), respectively. During the observation period of a median of 5 years, 38 patients had progression of their sinus osteitis, with the highest annual osteitis progression rates observed around the time of surgery.
In this cohort, paranasal sinus surgery was associated with prevalence, severity, and progression rate of sinus osteitis, indicating that sinus surgery does not reduce the bone damage development in the CRS of GPA.
4 Laryngoscope, 130: E460-E468, 2020.
目的/假设：患有肉芽肿伴多血管炎（GPA）的严重慢性鼻-鼻窦炎（CRS）患者经药物治疗失败后，可以采用鼻窦手术进行治疗。但鼻窦手术是否能防止鼻窦进行性损害尚不清楚。在此，我们旨在分析 GPA 患者 CRS 中鼻窦手术与计算机断层扫描（CT）影像学特征之间的时间依赖性关系。
纵向观察性研究。
我们评估了 CRS 的特征，包括使用全球骨炎评分量表评估的骨增厚、骨侵蚀以及使用 Lund-Mackay 评分评估的粘膜增厚，评估所依据的是来自 127 例特征明确的 GPA 患者的一系列鼻窦 CT 扫描（共 742 次 CT 扫描）。鼻旁窦手术的数据来自强制性国家登记处和病历回顾。我们将每位患者从基线 CT 到最后一次 CT 的时间定义为研究观察期。通过线性混合模型对数据集进行分析。
我们发现，127 例队列患者中有 23 例接受了一次或多次鼻窦手术，其中 96%（22/23）的患者术后 CT 显示存在骨炎。在仅接受鼻手术或未接受手术的患者中，分别有 7/11（64%）和 45/93（48%）存在骨炎。在中位观察期为 5 年期间，38 例患者的鼻窦骨炎发生进展，手术前后的骨炎进展年发生率最高。
在本队列中，鼻窦手术与鼻窦骨炎的患病率、严重程度和进展率相关，这表明鼻窦手术并不能减少 GPA 患者 CRS 中的骨损伤发展。
4 级喉镜，130：E460-E468，2020 年。
