Sinha Richi, Abhinandan Amit, Mala Mani, Singh Rakesh K
Otolaryngology - Head and Neck Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Cureus. 2025 Feb 12;17(2):e78916. doi: 10.7759/cureus.78916. eCollection 2025 Feb.
This study investigated the role of total body fluid dynamics in developing polyposis in patients with chronic rhinosinusitis. There is a significant gap in our understanding of body fluid dynamics in the pathogenesis of sinonasal polyposis. This preliminary research will be sensitized to explore hidden facts in this field further.
In this cross-sectional study at a tertiary care hospital, 60 participants were enrolled, comprising 30 patients diagnosed with sinonasal polyposis and 30 controls without polyps. The measured parameters included total body water, excess body water, serum osmolality, albumin, creatinine, sodium, eosinophil count, arterial pH, and hematocrit. The t-test/Mann-Whitney U test and chi-square test were used for continuous and categorical variable analysis, respectively. Univariate and multivariate logistic regression was done to identify potential predictors, and model performance was evaluated using the receiver operating characteristic (ROC) curves, with an optimal classification cut-off of 0.5 for the area under the curve (AUC).
The mean age of cases was 34.03 ± 12.76 years, and that of controls was 34.77 ± 12.06 years. Amongst cases, 60% were males and 40% were females, while the control group had an equal distribution of males and females. The mean total body water level in patients with sinonasal polyposis was slightly higher than in those without polyps (34.42 ± 5.26 l vs. 32.38 ± 5.86 l). Moreover, the likelihood of developing sinonasal polyposis was twice as high in patients with excess body water compared to those without, as suggested by an adjusted odds ratio (OR) of 2.08. However, this association was not statistically significant (95% CI: 0.83-5.19, p = 0.116). Patients with polyposis also showed higher serum creatinine levels (0.94 mg/dL) than controls (0.80 mg/dL, p = 0.002). Univariate logistic regression indicated that a 1 mg/dL increase in serum creatinine level was associated with a 2.4-fold increase in the likelihood of polyposis (OR = 2.42, 95% CI: 1.30-4.50, p = 0.005). Multivariate analysis confirmed the significance of serum creatinine level (adjusted OR = 3.36, 95% CI: 1.42-7.97, p = 0.006), with an AUC of 0.803, demonstrating good discriminative ability. The model's accuracy, sensitivity, and specificity were 66.7%, 73.3%, and 60%, respectively.
Significantly elevated serum creatinine levels in patients with sinonasal polyposis may suggest a potential link with renal function or fluid regulation, warranting further research in larger cohorts to clarify this relationship. The regression model indicated a positive correlation between excess body water and the development of polyposis, with a weaker trend observed for other parameters. However, due to insufficient evidence, further research involving larger sample sizes across diverse geographic regions is recommended to validate their roles in the pathogenesis of sinonasal polyps.
本研究调查了全身液体动力学在慢性鼻窦炎患者息肉形成过程中的作用。我们对鼻窦息肉病发病机制中体液动力学的理解存在显著差距。这项初步研究将有助于进一步探索该领域中隐藏的事实。
在一家三级护理医院进行的这项横断面研究中，招募了60名参与者，其中包括30名被诊断为鼻窦息肉病的患者和30名无息肉的对照者。测量参数包括全身水含量、多余体水、血清渗透压、白蛋白、肌酐、钠、嗜酸性粒细胞计数、动脉pH值和血细胞比容。分别使用t检验/曼-惠特尼U检验和卡方检验进行连续变量和分类变量分析。进行单变量和多变量逻辑回归以确定潜在预测因素，并使用受试者工作特征（ROC）曲线评估模型性能，曲线下面积（AUC）的最佳分类临界值为0.5。
病例组的平均年龄为34.03±12.76岁，对照组为34.77±12.06岁。在病例组中，男性占60%，女性占40%，而对照组男女分布均等。鼻窦息肉病患者的平均全身水含量略高于无息肉者（34.42±5.26升对32.38±5.86升）。此外，多余体水患者发生鼻窦息肉病的可能性是无多余体水患者的两倍，校正比值比（OR）为2.08表明了这一点。然而，这种关联无统计学意义（95%置信区间：0.83 - 5.19，p = 0.116）。息肉病患者的血清肌酐水平（0.94毫克/分升）也高于对照组（0.80毫克/分升，p = 0.002）。单变量逻辑回归表明，血清肌酐水平每升高1毫克/分升与息肉病发生可能性增加2.4倍相关（OR = 2.42，95%置信区间：1.30 - 4.50，p = 0.005）。多变量分析证实了血清肌酐水平的显著性（校正OR = 3.36，95%置信区间：1.42 - 7.97，p = 0.006），AUC为0.803，显示出良好的判别能力。该模型的准确性、敏感性和特异性分别为66.7%、73.3%和60%。
鼻窦息肉病患者血清肌酐水平显著升高可能提示与肾功能或液体调节存在潜在联系，需要在更大队列中进行进一步研究以阐明这种关系。回归模型表明多余体水与息肉病的发生呈正相关，其他参数观察到的趋势较弱。然而，由于证据不足，建议在不同地理区域进行涉及更大样本量的进一步研究，以验证它们在鼻窦息肉病发病机制中的作用。
