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[复发性嗜酸性粒细胞性慢性鼻-鼻窦炎伴鼻息肉患者自我报告症状的术后变化的预测作用]

[The predicting role of postoperative changes in self-reported symptoms in patients with recurrence eosinophilic chronic sinusitis with nasal polyps].

作者信息

Liu Chengyao, Wang Xiangdong, Sima Yutong, Liu Zhongyan, Zhang Luo

机构信息

Department of Otolaryngology Head and Neck Surgery,Beijing TongRen Hospital,Capital Medical University,Beijing,100730,China.

Beijing Laboratory of Allergic Diseases,Beijing Municipal Education Commission and Beijing Key Laboratory of Nasal Diseases,Beijing Institute of Otolaryngology.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Nov;37(11):864-870. doi: 10.13201/j.issn.2096-7993.2023.11.003.

Abstract

To investigate whether changes in postoperative symptoms and signs in patients can predict the recurrence of ECRS after nasal endoscopic sinus surgery. A total of 70 adult patients with ECRS were enrolled for ESS surgery from June 2020 to March 2022 in a single center. There were 50 males and 20 females, with an average age of (46.9±14.5) years. Follow-up after ESS was at least 52 weeks. Patients undergo peripheral blood tests, CT of the sinuses, olfactory T&T test, visual analogue scale of symptoms(VAS), and endoscopic scoring. VAS scores and endoscopic scores were analyzed at preoperative and 6th week, 12th week, 24th week and 52th week postoperative. After 12th week postoperatively, there was a clear correlation between symptom scores and endoscopic scores. Moreover, olfactory disorder and nasal discharge were the two most obvious symptoms. There were differences in the expression of multiple preoperative clinical inflammatory indicators between the symptom-controled group and the symptom-uncontrolled group(previous surgical history, concomitant asthma, nasal smear eosinophil, serum EOS%, total IgE, CT score, olfactory score, and symptom score, all with <0.05), while there was no difference in baseline endoscopic score(>0.05). At 12th week postoperative, the two groups of patients showed significant differences in both symptom scores and endoscopic scores. The symptoms and endoscopic score at the 12th week point of follow-up were used as predictive indicators for recurrence, with sensitivity and specificity of 62.5% and 83.3%, respectively. The changes in postoperative symptom score and endoscopic score in ECRSwNP patients indicated that the recurred ECRS. In the symptom-uncontrolled group, symptomatic and endoscopic scores showed consistent increased scores; In the symptom-controlled group, conflicting results between increased endoscopic scores and stable symptoms suggest that the presence of asymptomatic recurrence must be considered. The changes in symptoms and signs at the 12th week point of follow-up can serve as clinical indicators for preventing disease recurrence.

摘要

探讨鼻内镜鼻窦手术后患者术后症状和体征的变化是否能预测慢性鼻-鼻窦炎伴鼻息肉(ECRS)的复发。2020年6月至2022年3月,在单一中心共有70例成年ECRS患者接受了鼻内镜鼻窦手术(ESS)。其中男性50例,女性20例,平均年龄(46.9±14.5)岁。ESS术后随访至少52周。患者接受外周血检查、鼻窦CT、嗅觉T&T测试、症状视觉模拟量表(VAS)和内镜评分。在术前、术后第6周、12周、24周和52周分析VAS评分和内镜评分。术后12周后,症状评分与内镜评分之间存在明显相关性。此外,嗅觉障碍和流涕是两个最明显的症状。症状控制组和症状未控制组之间多个术前临床炎症指标的表达存在差异(既往手术史、合并哮喘、鼻涂片嗜酸性粒细胞、血清嗜酸性粒细胞百分比、总IgE、CT评分、嗅觉评分和症状评分,均P<0.05),而基线内镜评分无差异(P>0.05)。术后12周,两组患者的症状评分和内镜评分均有显著差异。将随访第12周时的症状和内镜评分作为复发的预测指标,敏感性和特异性分别为62.5%和83.3%。ECRS伴鼻息肉(ECRSwNP)患者术后症状评分和内镜评分的变化表明ECRS复发。在症状未控制组中,症状和内镜评分均呈一致升高;在症状控制组中,内镜评分升高与症状稳定之间存在矛盾结果,提示必须考虑无症状复发的存在。随访第12周时症状和体征的变化可作为预防疾病复发的临床指标。

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Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis.嗅觉:慢性鼻-鼻窦炎炎症负荷的敏感指标。
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