慢性鼻-鼻窦炎伴鼻息肉：如何在临床实践中确定适合使用生物制剂的患者。
Chronic rhinosinusitis with nasal polyps: how to identify eligible patients for biologics in clinical practice.
机构信息
Department of Otolaryngology, University of Foggia, Italy.
UOC of Otolaryngology Hospital Maggiore of Bologna, Italy.
出版信息
Acta Otorhinolaryngol Ital. 2022 Feb;42(1):75-81. doi: 10.14639/0392-100X-N1699.
OBJECTIVE
This study compared three severity measures for chronic rhinosinusitis with nasal polyps (CRSwNP). The outcome was to identify patients who are eligible for biological therapy.
METHODS
330 adult patients with CRSwNP were examined. Nasal polyp score (NPS), sinonasal outcome test (SNOT-22) and clinical-cytological grading (CCG) were compared. Clinical history, past surgery and asthma control test were also considered.
RESULTS
Only 45 (13.6%) patients had a contextual positivity to the three severity measures. The concordance among tests was slight/fair. Patients with severe disease (all tests positive) had more impaired parameters. The mixed cytotype (OR = 4.07), nasal obstruction (OR = 10.06), post-nasal drip (OR = 1.98), embarrassment (OR = 2.53) and difficulty falling asleep (OR = 1.92) were significantly associated with severe CRSwNP.
CONCLUSIONS
To identify candidates for biological therapy, the contextual use of NPS, SNOT-22 and CCG is preferable. In this way, global assessment of CRSwNP, including morphology, inflammation, comorbidity, symptoms and quality of life is possible.
目的
本研究比较了三种慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）严重程度评估方法。旨在确定适合生物治疗的患者。
方法
对 330 例 CRSwNP 成年患者进行检查。比较鼻息肉评分（NPS）、鼻鼻窦结局测试-22 项（SNOT-22）和临床细胞学分级（CCG）。还考虑了临床病史、既往手术和哮喘控制测试。
结果
仅 45 例（13.6%）患者的三种严重程度评估方法均呈阳性。测试之间的一致性为轻度/中度。患有严重疾病（所有测试均为阳性）的患者，其参数受损更严重。混合细胞型（OR=4.07）、鼻塞（OR=10.06）、后鼻滴注（OR=1.98）、尴尬（OR=2.53）和入睡困难（OR=1.92）与严重 CRSwNP 显著相关。
结论
为了确定生物治疗的候选者，最好根据具体情况使用 NPS、SNOT-22 和 CCG。这样，可以对 CRSwNP 进行全面评估，包括形态、炎症、合并症、症状和生活质量。
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