From the Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
Allergy Asthma Proc. 2021 May 1;42(3):214-221. doi: 10.2500/aap.2021.42.210004.
Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) have poorer outcomes after endoscopic sinus surgery and a higher recurrence rate. This study aimed to investigate the profile of clinical symptoms of eCRSwNP and the related risk factors. We prospectively enrolled 298 inpatients with CRSwNP from February 2019 to December 2019. The patients were divided into eCRSwNP and non-eCRSwNP groups based on the percentage of blood eosinophils; the cutoff value was set at 3.05%. Clinical data on questionnaires, visual analog scale (VAS) scores, and laboratory tests were collected. The differences in clinical symptoms, including nasal congestion, rhinorrhea, olfactory disorders, and head and/or facial pain, between the two groups were analyzed to identify the influential factors. Logistic analysis and receiver operating characteristic curves were used to determine the diagnostic benefit for the specific symptom in the patients in the eCRSwNP group. Nasal congestion and olfactory disorders were significantly different between the eCRSwNP and non-eCRSwNP groups. The patients in the eCRSwNP group more frequently had concerns about olfactory disorders (p = 0.002), whereas patients in the non-eCRSwNP group mostly had nasal congestion (p = 0.001). The logistic analysis showed that the primary risk factors for olfactory disorders of eCRSwNP were disease duration (p = 0.014) and alcohol intake (p = 0.012). Olfactory disorders were not associated with the disease course of the eCRSwNP group but were correlated with the disease duration of non-eCRSwNP (p = 0.008). A VAS score for the olfactory disorders of >5.75 could be used to predict the diagnosis of eCRSwNP (area under the curve, 0.674 [95% confidence intervals, 0.559-0.689]; P < 0.001). Olfactory disorder might be the major nasal symptom that could be used to distinguish a peripheral eosinophilia-based definition of eCRSwNP and non-eCRSwNP. The disease duration was a limiting factor for using olfactory to distinguish two subgroups of nasal polyp. The investigation with regard to the accurate time boundary should be further addressed.
伴有鼻息肉的嗜酸性慢性鼻-鼻窦炎（eCRSwNP）患者行内镜鼻窦手术后结局较差，且复发率较高。本研究旨在探讨 eCRSwNP 患者的临床症状特征及其相关的危险因素。我们前瞻性纳入了 2019 年 2 月至 2019 年 12 月期间的 298 例 CRSwNP 住院患者。根据血嗜酸性粒细胞百分比将患者分为 eCRSwNP 组和非-eCRSwNP 组，以 3.05%作为截断值。收集患者的问卷、视觉模拟评分（VAS）和实验室检查等临床数据。分析两组患者间鼻塞、流涕、嗅觉障碍和头面部疼痛等临床症状的差异，以确定有影响的因素。采用 logistic 分析和受试者工作特征曲线（ROC 曲线）判断 eCRSwNP 患者特定症状的诊断获益。eCRSwNP 组患者的鼻塞和嗅觉障碍与非-eCRSwNP 组患者存在显著差异。eCRSwNP 组患者更关注嗅觉障碍（p=0.002），而非-eCRSwNP 组患者则多存在鼻塞（p=0.001）。logistic 分析显示，eCRSwNP 患者嗅觉障碍的主要危险因素是疾病持续时间（p=0.014）和饮酒（p=0.012）。嗅觉障碍与 eCRSwNP 患者的疾病病程无关，但与非-eCRSwNP 患者的疾病持续时间相关（p=0.008）。VAS 评分>5.75 可用于预测 eCRSwNP 的诊断（曲线下面积，0.674[95%置信区间，0.559-0.689]；P<0.001）。嗅觉障碍可能是鉴别外周嗜酸性粒细胞增多型 eCRSwNP 和非-eCRSwNP 的主要鼻部症状。疾病持续时间是利用嗅觉鉴别两组鼻息肉的限制因素。应进一步研究有关准确时间界限的问题。
