伴和不伴鼻息肉的慢性鼻-鼻窦炎患者部分临床和病理学特征的对比研究  

The difference in some clinical and pathological characteristics between chronic sinusitis patients with and without nasal polyps

作　　者：刘争[1] 陆翔 王恒[1] 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：《临床耳鼻咽喉头颈外科杂志》2007年第23期1064-1067,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金资助项目(No:30500557);教育部留学回国人员科研启动基金(No:教外司留[2006]331号)

摘　　要：目的:探讨伴鼻息肉的慢性鼻-鼻窦炎(CRSwNP)和不伴鼻息肉的慢性鼻-鼻窦炎(CRSsNP)患者某些主观症状、客观检查和病理学特征的差异以及临床表现同病理学特征的关系。方法:对42例CRSsNP患者和33例CRSwNP患者的主观症状采用视觉类比法(VAS)进行评分;对鼻窦CT和鼻内镜检查这2项客观检查的结果分别采用Lund-Mackay法和Lanza-Kennedy法进行评分;对外周血嗜酸粒细胞(EOS)采用自动化检测仪计数,黏膜EOS于×400显微镜下计数;对黏膜中IL-5的表达量采用酶联免疫吸附试验定量检测;对比CRSsNP和CRSwNP患者的差异,并进一步分析客观检查结果同病理学特点的相关性。结果:①CRSsNP和CRSwNP患者的总体症状和5个主要症状评分总和均差异无统计学意义(均P>0.05);但相比CRSwNP患者,CRSsNP患者鼻分泌物症状VAS评分显著增高(P<0.05),嗅觉障碍症状VAS评分则显著降低(P<0.01);②相比CRSs-NP患者,CRSwNP患者的CT、鼻内镜检查评分,外周血及黏膜EOS计数和IL-5表达量均显著增高(均P<0.05);③CT和鼻内镜检查评分同外周血、黏膜EOS计数以及IL-5表达量正相关(P<0.01)。结论:CRSsNP和CRSwNP患者在总体症状的严重程度方面差别不大,但CRSwNP患者表现出更为严重和广泛的黏膜病变,这同黏膜局部更为显著的EOS浸润有关。Objective：To explore the difference in some subjective symptoms, objective examination results, and pathological characteristics between chronic sinusitis patients with and without nasal polyps （CRSwNP and CRSsNP）. Method：Prospective data of 42 CRSsNP patients and 33 CRSwNP patients scheduled for surgery were collected and analyzed retrospectively. A visual analog scale （VAS） symptom score was completed. 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. Blood was drawn to determine the number of peripheral eosinophils （EOS） by means of automated analysis. Surgical specimen was examined pathologically for the number of EOS per high-powered field. Interleukin （IL）-5 was determined by means of quantitative enzyme-linked immunosorbent assay. Result： （D As to the single VAS symptom score relating to overall symptom severity and the VAS score based on the sum of five sinonasal symptoms, there was no difference between CRSsNP and CRSwNP patients （ P 〉0.05）. However, compared with CRSwNP patients, CRSsNP patients had higher VAS score of nasal discharge（ P 〈0.05） and lower score of hyposmia（ P 〈0.01） ;② Compared with CRSsNP patients, CRSwNP patients had higher CT and endoscopy scores, peripheral and mucosal EOS counts, and mucosal IL-5 level（ P 〈0.05） ③ The preoperative CT and endoscopy scores were positively correlated with peripheral and mucosal EOS counts and mucosal IL-5 level （ P 〈0.01）. Conclusion：There is no significant difference in overall symptom between CRSsNP and CRSwNP patients. However, CRSwNP patients have more severe inflammation in nasal and sinus cavity, which is related to eosinophilic inflammation in local mucosa.

关 键 词：鼻窦炎 鼻息肉 体层摄影术 X线计算机 内镜术 嗜酸粒细胞 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]