组织嗜酸粒细胞增多对慢性鼻-鼻窦炎伴鼻息肉复发的预测价值研究  

Predictive significance of tissue eosinophilia for nasal polyp recurrence

作　　者：王成硕[1,3] 娄鸿飞[1,3] 孟一帆[1,3] 朴颖实[2] 张罗[1,3] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730 [2]首都医科大学附属北京同仁医院病理科,100730 [3]北京市耳鼻咽喉科研究所鼻病研究北京市重点实验室,100005

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第4期268-272,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：教育部长江学者和创新团队发展计划（IRT13082）;国家自然科学基金重点国际合作研究项目（81420108009）;科技部“十二五”国家科技支撑计划课题（2014BA107804）;北京市医管局重点医学专业发展计划（ZYLX201310）;国家自然科学基金面上项目（81470678）;国家自然科学基金青年基金项目（81400444）;北京市卫生系统高层次卫生技术人才培养计划（2011-3-043）

摘　　要：目的 观察临床指标与慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者鼻息肉复发的相关性,探讨组织嗜酸性粒细胞增多对鼻息肉复发的预测价值,并初步确定其预测标准.方法 本研究共纳入248例就诊于北京同仁医院的CRSwNP患者.手术治疗后对患者进行随访.对复发组和非复发组的人口学特征和其他临床特征进行比较.鼻息肉标本进行HE染色,计数炎性反应细胞数量.应用多因素Logistic回归和ROC曲线评价CRSwNP患者鼻息肉复发的预测指标,初步确定最佳诊断分界点.以SPSS 19.0软件对数据进行分析.结果 本研究中鼻息肉术后复发率为55.6％（138/248）.鼻息肉组织和外周血嗜酸粒细胞增多、哮喘、嗅觉评分和Lund-Mackay评分与鼻息肉复发密切相关（P值均＜0.01）.其中组织嗜酸粒细胞增多对于复发的预测价值最高.组织嗜酸粒细胞百分比＞27％时,预测鼻息肉复发的敏感度为96.4％,特异度为92.7％ （AUC =0.971,P＜0.001）.结论 鼻息肉组织嗜酸粒细胞增多对于鼻息肉术后复发具有预测价值.组织嗜酸粒细胞百分比＞27％,可作为预测鼻息肉术后复发的标准.Objective To evaluate the association between clinical parameters,especially tissue eosinophilia,and chronic sinusitis with nasal polyps （CRSwNP） recurrence.To identify optimal criteria of tissue eosinophilia as a predictor for recurrence.Methods Two hundred and forty-eight CRSwNP patients were enrolled in this study.The demographic and clinical features were compared between recurrence and no recurrence groups.Mucosal specimens were assessed for the presence of tissue inflammatory cells.Factors associated with polyp recurrence were analyzed by Logistic regression analysis and optimal cutoff point of the predictor for nasal polyp recurrence was determined by receiver operating characteristic curve.SPSS 19.0 software was used to analyze the data.Results The recurrence rate was 55.6% （138/248 patients） in this cohort.Tissue and peripheral eosinophilia,comorbid asthma,olfactory score and Lund-Mackay score were significantly correlated with polyp recurrence（all P 〈 0.01）.As a predictor for recurrence,tissue eosinophil accumulation outweighed other parameters.A cutoff value of 27% for tissue eosinophil percentage was able to predict recurrence with 96.4% sensitivity and 92.7% specificity （AUC =0.971,P 〈 0.001）.Conclusions Tissue eosinophilia provides valuable information regarding to polyp recurrence.Tissue eosinophil proportion equal to or over 27% may be regarded as the prognostic criterion for nasal polyp recurrence.

关 键 词：嗜酸粒细胞 鼻息肉 复发 预后 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]