CAJ | 학술논문

目的通过对慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者肺功能的检测,分析鼻息肉的病变范围及炎症状态与下呼吸道病变发生的相关性及临床意义.方法对2011年3月至6月住院手术的56例CRSwNP患者进行前瞻性研究,详细询问病史,术前均行变应原皮肤点刺试验、肺功能检测、鼻内镜检查、鼻窦CT检查、术后鼻息肉组织嗜酸性粒细胞计数.依据以上检测结果将患者分组,比较各组间气道高反应性、哮喘、肺功能异常的发生率及其与鼻息肉病变范围和炎症状态的相关性.结果 CRSwNP患者发生气道高反应性、哮喘、肺功能异常的比率分别为37.5％、44.6％、53.6％；没有明显下呼吸道症状患者肺功能异常的发生率亦高达50.0％.CRSwNP患者鼻内镜评分、CT评分分值越高,其发生气道高反应性、哮喘、肺功能异常的比率越大,组间差异均有统计学意义(鼻内镜评分x2内镜镜值分别为8.077、3.989、7.445,P值＜0.01或＜0.05；x2CTT值分别为3.863、5.380、4.309；4.293、4.293、4.572;10.572、13.504、13.295;P值＜0.01或＜0.05).皮肤点刺实验阳性患者发生气道高反应性和哮喘的比率比阴性患者大,组间差异有统计学意义(P值＜0.05).鼻息肉组织中嗜酸性粒细胞增多患者气道高反应、哮喘、肺功能异常的发生率均明显高于嗜酸性粒细胞正常的患者,组间差异有统计学意义(P值＜ 0.05或＜0.01).结论 CRSwNP患者可能伴发有症状或无症状的下呼吸道病变,病变范围及炎症程度与下呼吸道病变的发生率呈正相关性.
목적 통과대만성비-비두염반비식육(chronic rhinosinusitis with nasal polyps,CRSwNP)환자폐공능적검측,분석비식육적병변범위급염증상태여하호흡도병변발생적상관성급림상의의.방법 대2011년3월지6월주원수술적56례CRSwNP환자진행전첨성연구,상세순문병사,술전균행변응원피부점자시험、폐공능검측、비내경검사、비두CT검사、술후비식육조직기산성립세포계수.의거이상검측결과장환자분조,비교각조간기도고반응성、효천、폐공능이상적발생솔급기여비식육병변범위화염증상태적상관성.결과 CRSwNP환자발생기도고반응성、효천、폐공능이상적비솔분별위37.5％、44.6％、53.6％；몰유명현하호흡도증상환자폐공능이상적발생솔역고체50.0％.CRSwNP환자비내경평분、CT평분분치월고,기발생기도고반응성、효천、폐공능이상적비솔월대,조간차이균유통계학의의(비내경평분x2내경경치분별위8.077、3.989、7.445,P치＜0.01혹＜0.05；x2CTT치분별위3.863、5.380、4.309；4.293、4.293、4.572;10.572、13.504、13.295;P치＜0.01혹＜0.05).피부점자실험양성환자발생기도고반응성화효천적비솔비음성환자대,조간차이유통계학의의(P치＜0.05).비식육조직중기산성립세포증다환자기도고반응、효천、폐공능이상적발생솔균명현고우기산성립세포정상적환자,조간차이유통계학의의(P치＜ 0.05혹＜0.01).결론 CRSwNP환자가능반발유증상혹무증상적하호흡도병변,병변범위급염증정도여하호흡도병변적발생솔정정상관성.
Objective To investigate the incidence and severity of pulmonary function impairment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods In this prospective study,fifty-six patients with bilateral CRSwNP who were scheduled for functional endoscopic sinus surgery during a period from March to June 2010 in the Department of Otolaryngology of Qilu Hospital,were recruited in this study.Routine medical and rhinological examinations such as nasal endoscopy,sinus CT scan,and skin prick tests (SPT) for common inhalant and food allergens,and cytological examination of the paraffinembedded NP tissues were performed together with a full assessment of the pulmonary functions.Results Based on the pulmonary function tests,the rate of patients showing bronchial hyperresponsiveness (BHR),asthma,and abnormal pulmonery functions were 37.5％,44.6％,and 53.6％.In patients who did not have a history of lower airway symptoms,the rate of abnormal pulmonary functions was 50.0％,the rate of BHR was 43.2％.There was an increased rate of BHR,asthma and abnormal pulmonary functions in patients with a higher polyp grading score or Lund Mackay CT scan score (polyp grading score:x2 were 8.077,3.989 and 7.445,P＜0.01 or ＜0.05.CT scan score:x2 were 3.863,5.380 and 4.309;4.293,4.293 and 4.572;10.572,13.504 and 13.295,P ＜0.01 or ＜0.05).The rate of BHR and asthma in patients with positive SPT were higher (P ＜ 0.05).In patients with eosinophils hyperplasia in nasal polyps,the rate of BHR,asthma and abnormal pulmonary functions were higher (x2 were 4.065,5.217 and 3.376,P ＜0.05 or P ＜0.01).Conclusions There is a high risk of developing lower airway diseases in patients with CRSwNP.