中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2013年
8期
650-653
,共4页
王明婕%周兵%李云川%黄谦
王明婕%週兵%李雲川%黃謙
왕명첩%주병%리운천%황겸
鼻窦炎%鼻息肉%嗜酸细胞
鼻竇炎%鼻息肉%嗜痠細胞
비두염%비식육%기산세포
Sinusitis%Nasal polyps%Eosinophils
目的 探讨伴或不伴嗜酸粒细胞增多的慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者的临床特点以及外周血嗜酸粒细胞比例在分类中的作用.方法 回顾性分析119例确诊为CRSwNP患者的临床资料.根据术后鼻息肉组织病理检测结果,分为嗜酸粒细胞浸润组(ECRSwNP)与非嗜酸粒细胞浸润组(non-ECRSwNP).将两组患者血嗜酸粒细胞比例、血清总IgE水平、嗅觉评分、鼻窦CT Lund-Mackay评分以及皮肤点刺试验结果分别进行统计学分析,比较两组的差异.同时,将各指标与病理结果进行相关性分析,筛选与病理结果相关性较强的临床指标,采用ROC曲线方法计算曲线下面积及ECRSwNP的诊断截断值.以SPSS 17.0软件进行数据统计分析.结果 ECRSwNP患者组63例,non-ECRSwNP患者组56例.两组患者术前外周血嗜酸粒细胞比例(7.31％:3.90％)、血清总IgE水平(60.9 IU/L∶28.9 IU/L)、嗅觉评分分别为(5.8∶0.4),差异均有统计学意义(U值分别为620.01、1020.53、1092.52,P值均＜0.05).两组上颌窦Lund-Mackay 评分分别为2.0、2.5,差异有统计学意义(U=12.01,P＜0.05)；两组额窦、前筛、后筛、蝶窦及窦口鼻道复合体区的Lund-Mackay评分差异均无统计学意义(U值分别为27.5、23.5、22.5、31.5、28.5,P值均＞0.05).两组皮肤点刺试验结果差异无统计学意义(x2=1.96,P=0.19).外周血嗜酸粒细胞比例与血清总IgE均与病理结果中嗜酸粒细胞浸润程度呈正相关趋势(r值分别为0.55、0.24,P值分别为0.001、0.01).ROC曲线下面积为0.818,外周血嗜酸粒细胞比例5.65％为ECRSwNP的诊断截断值.结论 伴或不伴嗜酸粒细胞增多的两组CRSwNP患者在临床特点上有显著差异；可根据患者术前外周血嗜酸粒细胞的比例是否大于5.65％进行初步分类.
目的 探討伴或不伴嗜痠粒細胞增多的慢性鼻-鼻竇炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者的臨床特點以及外週血嗜痠粒細胞比例在分類中的作用.方法 迴顧性分析119例確診為CRSwNP患者的臨床資料.根據術後鼻息肉組織病理檢測結果,分為嗜痠粒細胞浸潤組(ECRSwNP)與非嗜痠粒細胞浸潤組(non-ECRSwNP).將兩組患者血嗜痠粒細胞比例、血清總IgE水平、嗅覺評分、鼻竇CT Lund-Mackay評分以及皮膚點刺試驗結果分彆進行統計學分析,比較兩組的差異.同時,將各指標與病理結果進行相關性分析,篩選與病理結果相關性較彊的臨床指標,採用ROC麯線方法計算麯線下麵積及ECRSwNP的診斷截斷值.以SPSS 17.0軟件進行數據統計分析.結果 ECRSwNP患者組63例,non-ECRSwNP患者組56例.兩組患者術前外週血嗜痠粒細胞比例(7.31％:3.90％)、血清總IgE水平(60.9 IU/L∶28.9 IU/L)、嗅覺評分分彆為(5.8∶0.4),差異均有統計學意義(U值分彆為620.01、1020.53、1092.52,P值均＜0.05).兩組上頜竇Lund-Mackay 評分分彆為2.0、2.5,差異有統計學意義(U=12.01,P＜0.05)；兩組額竇、前篩、後篩、蝶竇及竇口鼻道複閤體區的Lund-Mackay評分差異均無統計學意義(U值分彆為27.5、23.5、22.5、31.5、28.5,P值均＞0.05).兩組皮膚點刺試驗結果差異無統計學意義(x2=1.96,P=0.19).外週血嗜痠粒細胞比例與血清總IgE均與病理結果中嗜痠粒細胞浸潤程度呈正相關趨勢(r值分彆為0.55、0.24,P值分彆為0.001、0.01).ROC麯線下麵積為0.818,外週血嗜痠粒細胞比例5.65％為ECRSwNP的診斷截斷值.結論 伴或不伴嗜痠粒細胞增多的兩組CRSwNP患者在臨床特點上有顯著差異；可根據患者術前外週血嗜痠粒細胞的比例是否大于5.65％進行初步分類.
목적 탐토반혹불반기산립세포증다적만성비-비두염반비식육(chronic rhinosinusitis with nasal polyps,CRSwNP)환자적림상특점이급외주혈기산립세포비례재분류중적작용.방법 회고성분석119례학진위CRSwNP환자적림상자료.근거술후비식육조직병리검측결과,분위기산립세포침윤조(ECRSwNP)여비기산립세포침윤조(non-ECRSwNP).장량조환자혈기산립세포비례、혈청총IgE수평、후각평분、비두CT Lund-Mackay평분이급피부점자시험결과분별진행통계학분석,비교량조적차이.동시,장각지표여병리결과진행상관성분석,사선여병리결과상관성교강적림상지표,채용ROC곡선방법계산곡선하면적급ECRSwNP적진단절단치.이SPSS 17.0연건진행수거통계분석.결과 ECRSwNP환자조63례,non-ECRSwNP환자조56례.량조환자술전외주혈기산립세포비례(7.31％:3.90％)、혈청총IgE수평(60.9 IU/L∶28.9 IU/L)、후각평분분별위(5.8∶0.4),차이균유통계학의의(U치분별위620.01、1020.53、1092.52,P치균＜0.05).량조상합두Lund-Mackay 평분분별위2.0、2.5,차이유통계학의의(U=12.01,P＜0.05)；량조액두、전사、후사、접두급두구비도복합체구적Lund-Mackay평분차이균무통계학의의(U치분별위27.5、23.5、22.5、31.5、28.5,P치균＞0.05).량조피부점자시험결과차이무통계학의의(x2=1.96,P=0.19).외주혈기산립세포비례여혈청총IgE균여병리결과중기산립세포침윤정도정정상관추세(r치분별위0.55、0.24,P치분별위0.001、0.01).ROC곡선하면적위0.818,외주혈기산립세포비례5.65％위ECRSwNP적진단절단치.결론 반혹불반기산립세포증다적량조CRSwNP환자재림상특점상유현저차이；가근거환자술전외주혈기산립세포적비례시부대우5.65％진행초보분류.
Objective Trying to find a useful marker to subclassify chronic rhinosinusitis (CRS),ratio of eosinophil in peripheral blood was investigated.Methods Histologic characteristics of surgical samples were analyzed in 119 CRS with nasal polyps (CRSwNP) patients,who were classified into eosinophil CRSwNP (ECRSwNP) group and non-ECRSwNP group.Peripheral blood eosinophil percentage,olfactory function,skin prick test,serum total IgE and sinus CT scan in two groups were all examined and analyzed.To evaluate the discriminatory power of eosinophil to diagnose ECRSwNP,the Receiver Operating Characteristic (ROC)curve was analysed.Results There were significant differences in Ratio of EOS,serum total IgE,and olfactory function scores,between ECRSwNP group and non-ECRSwNP group (mean value were 7.31％ ∶ 3.90％,60.9 IU/L∶ 28.9 IU/L,5.8∶ 0.4 respectively,U value were 620.01,1020.53 and 1092.52,respectively,all P ＜ 0.05).However,there was no difference in skin prick test between two groups.In CT scan exam,there were no differences in Lund-Mackay scores in frontal sinus,anterior ethmoid sinus,posterior ethmoid sinus,sphenoid sinus and ostiomeatal complex area,but maxillary sinus,between ECRSwNP group and non-ECRSwNP group (U value were 27.5,23.5,22.5,31.5,28.5,respectively,all P ＞0.05,and U value of maxillary sinus was 12.01,P ＜0.05).Peripheral blood eosinophil percentage and serum total IgE were related with pathology of nasal polyps (r value were 0.55,0.24,and P value were 0.001,0.01,respectively),especially blood eosinophilia can be a predictor of ECRSwNP.The area under curve was 0.818 and cutoff value was 5.65％.Conclusions ECRSwNP is different from non-ECRSwNP in many clinical features.Peripheral blood eosinophil percentage is consistent with histologic features of ECRS,which is a useful marker as 5.65％ in classification of CRS.
