Peng Min, Zhang Danmei, Liu Lulu, Tian Xiaoai, Wang Yinxia
Department of Otorhinolaryngology，Fenyang Hospital Affiliated to Shanxi Medical University，Fenyang，032200，China.
Department of Pathology，Fenyang Hospital Affiliated to Shanxi Medical University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr;35(4):345-350. doi: 10.13201/j.issn.2096-7993.2021.04.014.
To explore the predictive factors for asymptomatic airway hyperresponsiveness（AAHR） in patients with chronic rhinosinusitis with nasal polyps（CRSwNP）. A total of 76 CRSwNP patients who were hospitalized in the Department of Otorhinolaryngology of Fenyang Hospital affiliated to Shanxi Medical University from May 2016 to October 2020 were retrospectively analyzed, including 40 patients in AAHR group and 36 patients in non-airway hyperresponsiveness（non-airway hyperresponsiveness, NAHR） group. The clinical symptoms, CT score of paranasal sinuses, eosinophil（EOS） count in peripheral blood and nasal polyp tissue were compared and analyzed. Logistic regression was used to analyze the risk factors of AAHR, and receiver operating characteristics curve was used to judge the predictive value of the parameters. Compared with NAHR group, AAHR group had more symptoms of mouth breathing and postnasal drip, higher total score of CT in ethmoid sinus, sphenoid sinus, olfactory cleft, and more EOS count in peripheral blood and nasal polyp tissue. The differences were statistically significant. There was a positive correlation between EOS count in peripheral blood and in nasal polyp tissue（=0.324, <0.01）. Postnasal drip, high posterior ethmoid sinus（PE） score and nasal polyp tissue EOS count were risk factors for AAHR. The predictive value of nasal polyp tissue EOS count was higher than that of PE score（AUC=0.786 and 0.685, respectively）. When the PE score was ≥1.5, the sensitivity was 80.0% and the specificity was 55.6%. When the nasal polyp tissue EOS count was ≥5.67/HPF, the sensitivity was 82.5% and the specificity was 66.7%. The occurrence of AAHR in patients with CRSwNP was related to clinical symptoms, paranasal sinus CT score, peripheral and nasal polyp tissue EOS count. PE score and nasal polyp tissue EOS count can be used to predict AAHR, however nasal polyp tissue EOS has higher predictive value.
探讨慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者无症状气道高反应性（AAHR）的预测因素。回顾性分析2016年5月至2020年10月在山西医科大学汾阳医院耳鼻咽喉科住院的76例CRSwNP患者，其中AAHR组40例，非气道高反应性（NAHR）组36例。比较分析两组患者的临床症状、鼻窦CT评分、外周血及鼻息肉组织嗜酸性粒细胞（EOS）计数。采用Logistic回归分析AAHR的危险因素，绘制受试者工作特征曲线判断各参数的预测价值。与NAHR组相比，AAHR组口呼吸、鼻后滴漏症状更多，筛窦、蝶窦、嗅裂CT总分更高，外周血及鼻息肉组织EOS计数更多，差异有统计学意义。外周血与鼻息肉组织EOS计数呈正相关（r = 0.324，P < 0.01）。鼻后滴漏、后筛窦（PE）高分及鼻息肉组织EOS计数是AAHR的危险因素。鼻息肉组织EOS计数的预测价值高于PE评分（AUC分别为0.786和0.685）。当PE评分≥1.5时，敏感度为80.0%，特异度为55.6%。当鼻息肉组织EOS计数≥5.67/HPF时，敏感度为82.5%，特异度为66.7%。CRSwNP患者AAHR的发生与临床症状、鼻窦CT评分、外周血及鼻息肉组织EOS计数有关。PE评分和鼻息肉组织EOS计数可用于预测AAHR，但鼻息肉组织EOS计数的预测价值更高。
