Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2021 Sep;131(9):1930-1938. doi: 10.1002/lary.29409. Epub 2021 Feb 4.
OBJECTIVE/HYPOTHESIS: To compare pre-and post-operative pulmonary function relative to disease severity in cystic fibrosis (CF) patients following endoscopic sinus surgery (ESS).
Retrospective chart review.
Patients with CF who underwent ESS between January 1996 and July 2018 were identified, with subsequent study exclusions based upon surgical indications or incomplete records. CF disease severity was based upon percentage predicted of forced expiratory volume in 1 second (%FEV1) with <40% considered severe disease, 40% to 70% as moderate disease, and >70% as mild disease. The changes in %FEV1 before and after ESS were examined using multivariable mixed-effects models controlling for age, gender, genotype, medications, nutritional status, diabetes status, microbiology results, extent of surgery, and number of surgeries.
A total of 427 surgeries were performed in 188 patients during the study period. Mean age at first ESS was 12.7 years (SD 6.0 years, range 4-38) and 54.8% were females. The effect of ESS varied by severity of lung disease. After surgery, %FEV1 increased by 8.1% (95% CI: 2.3, 13.9%) among patients with severe lung disease and by 3.0% (95% CI: 0.7, 5.2%) among patients with moderate disease. %FEV1 also increased by 7.3% (95% CI: 4.2, 10.5%) among patients with mild disease whose %FEV1 value was 70% to 80% at baseline. No improvement was observed in patients with a baseline %FEV1 >80%.
When controlling for important confounding factors, lung function improved following ESS among CF patients with severe and moderate disease and in select patients with mild disease. This improvement was sustained at 12 months following surgery.
4 Laryngoscope, 131:1930-1938, 2021.
目的/假设：比较囊性纤维化（CF）患者内镜鼻窦手术（ESS）前后的肺功能与疾病严重程度的关系。
回顾性图表审查。
确定了 1996 年 1 月至 2018 年 7 月期间接受 ESS 的 CF 患者，随后根据手术指征或记录不完整排除了后续研究。CF 疾病严重程度基于 1 秒用力呼气量占预计值的百分比（%FEV1），<40%为严重疾病，40%至 70%为中度疾病，>70%为轻度疾病。使用多变量混合效应模型控制年龄、性别、基因型、药物、营养状况、糖尿病状况、微生物学结果、手术范围和手术次数，检查 ESS 前后 %FEV1 的变化。
在研究期间，共对 188 例患者的 427 次手术进行了分析。首次 ESS 的平均年龄为 12.7 岁（标准差 6.0 岁，范围 4-38），54.8%为女性。ESS 的效果因肺部疾病的严重程度而异。手术后，严重肺部疾病患者的 %FEV1 增加了 8.1%（95%CI：2.3，13.9%），中度肺部疾病患者增加了 3.0%（95%CI：0.7，5.2%）。基线时 %FEV1 值为 70%至 80%的轻度疾病患者的 %FEV1 也增加了 7.3%（95%CI：4.2，10.5%）。在基线 %FEV1>80%的患者中，没有观察到改善。
在控制重要混杂因素后，严重和中度 CF 患者以及部分轻度 CF 患者在 ESS 后肺功能得到改善。手术后 12 个月时仍保持这种改善。
4 Laryngoscope，131：1930-1938，2021。
