慢性鼻-鼻窦炎海口标准有效性的主、客观评估  

Evaluation of Chinese Haikou Chronic Rhinosinusitis Staging System by Using Subjective and Objective Parameters

作　　者：刘争[1] 王恒[1] 陆翔 游学俊[1] 高起学[1] 崔永华[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院耳鼻咽喉-头颈外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2007年第5期681-684,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金(No30500557);教育部留学回国人员科研启动基金(教外司留[2006]331号)资助项目

摘　　要：目的探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)海口标准同鼻窦CT评分、鼻内窥镜检查评分、鼻窦黏膜组织嗜酸性粒细胞(eosinophils,EOS)计数以及患者主观症状间的关系,以评估其科学性和适用性。方法对75例(143侧)CRS患者行海口分型、分期,Lund-Mackay CT评分和Lanza-Kennedy鼻内窥镜检查评分;手术切除标本于显微镜下计数EOS;采用视觉类比法(visual analogs cale,VAS)对患者的症状进行评分;分析上述指标间的相关性。结果①对于术前CT评分和内窥镜检查评分,相同海口分型不同分期患者间以及各型患者间的差异均有显著性意义(均P<0.01);但海口标准3型中不合并鼻息肉的患者与1型3期患者间、3型中合并鼻息肉的患者与2型3期患者间的差异均无显著性意义(均P>0.05);②各型患者间黏膜EOS计数差异有极显著性意义(P<0.01);但3型中不合并鼻息肉的患者与1型3期患者间以及3型中合并鼻息肉的患者与2型3期患者间差异无显著性意义(P>0.05);③各型患者间术前整体VAS评分和5个症状VAS评分之和差异均无显著性意义(P>0.05)。结论海口标准同Lund-MackayCT分级系统,鼻内窥镜检查及黏膜EOS有很好的相关性,具有其科学性和适用性。但在3型鼻窦炎的划分,主观症状的评估和以"侧"计的划分方式方面有待讨论和改进。Objective To evaluate the scientific value of Chinese Haikou chronic rhinosinusitis（CRS） staging system and investigate the correlation between Haikou staging system,CT and endoscopy grades,mucosal eosinophils（EOS） number,and symptom scores in CRS.Methods Prospective data of 75 patients（143 sides） with CRS scheduled for surgery were collected and analyzed retrospectively.Patients were classified according to Chinese Haikou staging system.The preoperative computed tomography（CT） scans were graded according to Lund and Mackay.The preoperative nasal endoscopy was graded by assigning an endoscopy score according to Lanza and Kennedy.Surgical specimen was examined pathologically for the number of EOS per high-powered field.A visual analog scale（VAS） symptom score was completed.Results As to preoperative CT and endoscopy scores,there was significant difference among patients with different types and stages（P〈0.01）.However,there was no significant difference between type 3 patients without nasal polyps and type 1 stage 3 patients or between type 3 patients with nasal polyps and type 2 stage 3 patients（P〉0.05）.The number of mucosal EOS was significantly different among patients with different types（P〈0.01）.However,there was no significant difference between type 3 patients without nasal polyps and type 1 stage 3 patients or between type 3 patients with nasal polyps and type 2 stage 3 patients（P〉0.05）.As to the single VAS symptom score relating to overall symptom severity and the VAS score base on the sum of 5 sinonasal symptoms,there was no difference among patients with different types（P〉0.05）.Conclusion There is a clear correlation between Chinese Haikou staging system and CT,endocopy grades,and mucosal EOS number.However,the necessity of type 3 staging,capacity to evaluate symptoms,and staging approach by side are needed to be discussed further.

关 键 词：鼻窦炎 X线计算机体层摄影 内窥镜检查 嗜酸性粒细胞 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]