改良Lund-Mackay内镜评分系统在慢性鼻-鼻窦炎中的临床应用  

Clinical opplication of modified Lund Mackay postoperative endoscopic scoring system in patients with chronic rhinosinusitis

作　　者：李慧媚 张凌浩[1] 骆雅梅 武鹏[1] 王珍珍[1] 徐唱[1] 肖惠雯 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,温州325000

出　　处：《中国眼耳鼻喉科杂志》2016年第3期193-197,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨改良Lund-Mackay内镜评分系统(MLMES)在慢性鼻-鼻窦炎(CRS)中的临床应用。方法收集57例CRS患者的术前视觉模拟量表(VAS)、鼻腔-鼻窦结局测试22条(SNOT-22)以及LundMackay CT评分(LMS)数据,并录制术中鼻腔、鼻窦情况。术后3个月录制鼻内镜下随访情况,并再次行VAS和SNOT-22评估。所有手术均由同一位医师按照Messerklinger径路进行。由2位耳鼻喉科医师采用双盲法对所有录像进行Lund-Kennedy内镜评分(LKES)及MLMES评分。分析评分者的信度和重测信度,比较主、客观评估方法的相关性,同时分析手术疗效。采用SPSS17.0统计软件进行数据分析。结果 CRS患者术前、术后MLMES的信度良好[组内相关系数(ICC)>0.75],且高于LKES。CRS患者术后VAS、SNOT-22、LKES、MLMES均较术前下降,差异均具有统计学意义(t值分别为13.253、15.644、13.609、17.134,P<0.05)。Pearson相关性分析显示:CRS患者术前LMS与MLMES、LKES显著相关(r值分别为0.863、0.742,P<0.05);术前、术后的MLMES与LKES呈正相关(r值分别为0.670、0.441,P<0.05);术前MLMES与VAS、SNOT-22呈正相关(r值分别为0.308、0.400,P<0.05),术后MLMES与VAS、SNOT-22呈正相关(r值分别为0.344、0.518,P<0.05),术前、术后MLMES变化与VAS、SNOT-22评分变化呈正相关(r值分别为0.275、0.334,P<0.05);而LKES与主观评分(VAS、SNOT-22)之间均无相关性(P>0.05)。结论 MLMES与客观评估相关性好,与主观评分系统也有一定的相关性,且有很好的信度,可以作为CRS患者评估的客观方法。Objective To investigate the clinical application of modified Lund Mackay postoperative endoscopic scoring（ MLMES） system in patients with chronic rhinosinusitis（ CRS）. Methods Fifty seven patients with CRS were enrolled prospectively. All patients were evaluated before and 3 months after the surgery. All CRS patients completed the visual analogue scale（VAS） symptom score,the sino-nasal outcome test-22（SNOT-22）,and Lund-Mackay CT score（ LMS）,and then underwent a standardized recorded sinonasal endoscopy. All the operations were performed by the same surgeon through Messerklinger pathway. Videos were scored blindly by two rhinologists using two scoring systems： the Lund-Kennedy endoscopic score（ LKES） and the MLMES. The inter-observer reliability,intra-observer reliability and correlation between the change in MLMES and in subjective measures were also investigated. Results The MLMES showed higher inter-rater and test-retest reliability than the LKES and it was significantly correlated with LMS and LKES（ P 〈 0. 05）. After the surgery,all scores were significantly decreased from baseline（t value were 13. 253,15. 644,13. 609 and 17. 134,all P 〈 0. 05）. The MLMES was significantly correlated with VAS and SNOT-22 in preoperative and post-operative patients（r value were 0. 308,0. 400,0. 344,0. 518,all P 〈 0. 05）. The change in MLMES was correlated with the change in VAS and SNOT-22（r value were 0. 275 and 0. 334,all P 〈 0. 05）. Conclusions The MLMES shows substantial inter-rater and test-retest reliability in pre- and post-endoscopic surgery patients. It is also significantly correlated with the existing LMS and LKES objective scoring parameters. The MLMES represents total sinus inflammatory burden and correlates well with patient-reported outcome measures.

关 键 词：慢性鼻-鼻窦炎 鼻内镜 信度 相关性 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]