DIP内镜评分系统在慢性鼻-鼻窦炎中的应用  

Application of the discharge, inflammation, polyps/edema （DIP） endoscopic scoring system in patients with chronic rhinosinusitis

作　　者：武鹏[1] 王珍珍[1] 张露[1] 黄振校[2] 骆雅梅 李慧媚 张凌浩[1] 廖志苏[1] 

机构地区：[1]温州医科大学附属第一医院耳鼻咽喉科,325000 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科1

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第2期151-154,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的评估DIP内镜评分系统在慢性鼻一鼻窦炎（CRS）患者功能性内镜鼻窦手术中的应用。方法采用前瞻洼设计，对30例CRS患者进行术前视觉模拟量表评分（visual analogue scale，VAS）、鼻腔鼻窦结局测试20条（sinonasal outcometest-20，SNOT-20）评分、Lund．MackayCT评分，并于术中录制患侧鼻腔检查录像。术后2个月进行随访，再次完成VAS、SNOT-20评分，再次录制术侧鼻腔录像。由2位医生采用双盲法对所有录像应用Lund—Kennedy内镜评分及DIP内镜评分进行评估。分析评分者信度和重测信度，比较主、客观评分的相关性。采用SPSS17．0统计软件进行数据分析。结果CRS患者术前VAS、SNOT-20、Lund-Kennedy内镜评分、DIP评分分别为（29．73±13．05）、（24．43±13．76）、（7．70±3．25）、（32．67±13．48）分，术后2个月的评分为（13．60±8．67）、（10．40±7．45）、（5．03±2．04）、（16．97±8．37）分，差异均有统计学意义（t值分别为7．43、6．49、6．88、10．93，P值均〈0．001）。术前、术后DIP评分系统的信度良好（组内相关系数ICC均〉0．75），高于Lund-Kennedy内镜评分的组内相关系数。Pearson相关性分析显示，术前VAS和SNOT-20评分呈正相关（r=0．5186，P=0．003）；Lund-Kennedy内镜评分与DIP评分呈正相关（r=0．9375，P=0．000）；Lund—Kennedy内镜评分与Lund-MackayCT评分呈正相关（r=0．7480，P=0．000）；DIP评分与Lund—MackayCT评分呈正相关（r=0．7122，P=0．000）。Lund—Kennedy内镜评分、DIP评分、Lund—MackayCT评分与VAS、SNOT-20评分间均无相关性（P值均〉0．05）。术后VAS与SNOT-20呈正相关（r=0．5467，P=0．000）；DIP评分与Lund—Kennedy内镜评分呈正相关（r=0．8696，P=0．000）。结论DIP评分系统与其他客观评估相关性好且有更好的信度，可以作为CRS患者评估的客观方法。Objective To validate the discharge,inflammation,polyps/edema （DIP） scoring system for the assessment of endoscopic sinus surgery （ESS） outcomes in patients with chronic rhinosinusitis （CRS）. Methods Thirty patients with CRS were included in this prospective study. All patients were evaluated before and 2 months after surgery. Baseline measures and postoperative outcomes were evaluated using sino-nasal outcome test-20 （SNOT-20）, visual analogue scale （VAS） symptom score and Lund- Mackay CT score （in baseline only）. All endoscopic videos were recorded before surgery and in the end of follow-up. All videos were scored blindly by two rhinologistis using the DIP and Lund-Kennedy system for investigating the inter-rater and test-retest reliability, as well as the correlations with the existing subjective and objective scoring systems. SPSS17. 0 software was used to analyze the data. Results The average scores of VAS, SNOT-20, Lund-Kennedy, and DIP before and after surgery were listed below. Baseline, 29. 73± 13.05,24. 43 ± 13.76,7. 70 ± 3.25 and 32. 67 ± 13.48. Post-surgical, 13.60 ± 8.67,10. 40 ± 7.45,5.03 ±2. 04 and 16. 97 ±8.37. All scores were declined significantly from baseline （ t value were 7.43,6. 49,6. 88 and 10. 93 ,all P 〈0. 001 ）. The DIP system showed a higher inter-rater and rest-rest reliability than Lund- Kennedy system （ interclass coefficient, ICC 〉 0. 75 ）. The Pearson analysis revealed that VAS scores were significantly correlated with SNOT-20 scores both in baseline and post-surgical assessments （r = 0. 518 6, P = 0. 003, and r = 0. 546 7, P = 0. 000）. Before surgery, Lund-Kennedy scores were significantly correlated with DIP and Lurid-Mackay CT scores （r = 0. 937 5, P = 0. 000 and r = 0. 748 0, P = 0. 000）. DIP scores were significantly correlated with Lund-Mackay CT scores （ r = 0. 712 2, P = 0. 000 ）. After surgery, DIP scores were significantly correlated with Lund-Kennedy scores （r =0. 869 6,P =0. 000 ）. But there were no significan

关 键 词：鼻窦炎 内窥镜检查 体层摄影术 X线计算机 结果可重复性 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]