Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, United States of America.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States of America.
Am J Otolaryngol. 2021 Sep-Oct;42(5):103025. doi: 10.1016/j.amjoto.2021.103025. Epub 2021 Mar 31.
This study evaluated whether stratified preoperative, pre- aspirin desensitization (AD) sinonasal symptom scores predict postoperative, post-AD outcomes in Aspirin exacerbated respiratory disease (AERD).
Retrospective chart review of patients with aspirin challenge-proven AERD who underwent endoscopic sinus surgery followed by AD was performed. Preoperative, postoperative/pre-AD, and postoperative/post-AD sinonasal symptom scores were collected (22-item Sino-Nasal Outcomes Test, SNOT-22). A longitudinal linear mixed-effects model was used for data analysis.
Forty-seven patients (59.6% female) aged 48.0 ± 13.2 were included. Average time from surgery to AD was 70.0 ± 52.8 days. Preoperative SNOT-22 scores (n = 47) were divided into tertiles (cutoffs of 36 and 54 indicating mild [22.5 ± 13.7], moderate [44.3 ± 12.2], and severe [72.9 ± 19.7] disease). This corresponded to 12 (25.5%), 18 (38.3%), and 17 (36.2%) subjects being categorized into mild, moderate, and severe tertiles, respectively. Postoperative, pre-AD SNOT-22 in all disease groups decreased and were not significantly different (12.3 ± 13.7, 11.1 ± 12.2, 22.7 ± 19.7; p = 0.074). At short-term post-AD, only the severe group worsened (35.0 ± 20.3, p < 0.001), whereas other groups demonstrated negligible change (9.3 ± 14.3 and 14.4 ± 12.2). At long-term post-AD, all groups redemonstrated convergence in symptom scores (23.7 ± 20.9, 19.4 ± 15.4, and 31.0 ± 27.6, p = 0.304).
Preoperative SNOT-22 scores may be used as a predictor of postoperative, post-AD patient-reported outcomes in AERD. Patients with mild and moderate disease may derive benefit from surgery and AD alone, while those with severe disease may require additional interventions (e.g., biologics).
本研究旨在评估分层术前、阿司匹林脱敏（AD）前鼻-鼻窦症状评分是否能预测阿司匹林加重性呼吸道疾病（AERD）患者的术后 AD 后结局。
对接受过内镜鼻窦手术并随后进行 AD 的阿司匹林激发试验阳性的 AERD 患者进行回顾性图表审查。收集了术前、术后/AD 前和术后/AD 后鼻-鼻窦症状评分（22 项鼻-鼻窦结局测试，SNOT-22）。采用纵向线性混合效应模型进行数据分析。
共纳入 47 例（59.6%为女性）患者，年龄 48.0±13.2 岁。手术至 AD 的平均时间为 70.0±52.8 天。术前 SNOT-22 评分（n=47）分为三分位数（36 和 54 分的截点分别表示轻度[22.5±13.7]、中度[44.3±12.2]和重度[72.9±19.7]疾病）。这分别对应 12 例（25.5%）、18 例（38.3%）和 17 例（36.2%）患者分别被归类为轻度、中度和重度三分位数。所有疾病组的术后 AD 前 SNOT-22 评分均下降，且无显著差异（12.3±13.7、11.1±12.2、22.7±19.7；p=0.074）。在短期 AD 后，只有重度组恶化（35.0±20.3，p<0.001），而其他组变化不大（9.3±14.3 和 14.4±12.2）。在长期 AD 后，所有组的症状评分均再次趋同（23.7±20.9、19.4±15.4 和 31.0±27.6，p=0.304）。
术前 SNOT-22 评分可作为 AERD 患者术后 AD 后患者报告结局的预测因子。轻度和中度疾病患者可能仅从手术和 AD 中获益，而重度疾病患者可能需要额外干预（如生物制剂）。
