改良整体骨炎评分在慢性鼻-鼻窦炎中的临床应用  

Clinical application of modified global osteitis score in chronic rhinosinusitis

作　　者：李云霞[1] 林枫 成雷[3] 黄谦[1] 黄振校[1] 张晓晴[1] 周兵[1] 

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耳鼻咽喉头颈外科教育部重点实验室,北京100730 [2]首都医科大学研究所附属儿童医院耳鼻咽喉科 [3]首都医科大学大兴医院耳鼻咽喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第21期1666-1670,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京市医院管理局"登峰"人才培养计划(No:DFL20150202);北京市教育委员会科技计划重点项目(No:KZ201410025029);院内科研种子基金(No:2016-YJJ-ZZL-017)联合资助

摘　　要：目的:探讨改良整体骨炎评分(GOSS)在慢性鼻-鼻窦炎中的临床应用价值。方法:前瞻性研究,连续纳入药物治疗无效准备行鼻内镜手术的71例慢性鼻-鼻窦炎患者,通过OsiriX软件测量鼻窦CT,根据双侧额窦、筛窦、蝶窦、上颌窦骨炎的范围及厚度行GOSS评分及改良GOSS评分(同法,只测量双侧蝶窦及上颌窦),并于术前行视觉模拟量表(VAS)、鼻腔鼻窦结局测试-22(SNOT-22)、Lund-Kennedy(L-K)、Lund-Mackay(L-M)评分,术后1年进行疗效评判,再次行VAS、SNOT-22、L-K、L-M评分。应用SPSS 23.0软件分析改良GOSS评分的临床价值。结果:(1)改良GOSS评分与GOSS之间存在显著线性正相关(r=0.913,P<0.001);(2)改良GOSS评分及GOSS评分与术前及术后L-K评分、L-M评分间存在相关性,改良GOSS评分与其相关性更高(r=0.316、0.357);与主观VAS评分、SNOT-22评分之间相关性差异无统计学意义(P>0.05);(3)检验不同评分者间GOSS评分与改良GOSS评分的差异,GOSS评分组内相关系数为0.933(95%CI 0.893~0.958),改良GOSS评分组内相关系数为0.947(95%CI0.916~0.967),改良GOSS评分较GOSS评分其信度及一致性更好。结论:改良GOSS评分能够更客观准确地反映慢性鼻-鼻窦炎患者骨炎程度,简化测量,信度及一致性良好,便于临床应用。Objective：To compare GOSS and a newly proposed modified scoring system for assessment of CRS with osteitis.Method：Seventy-one CRS patients were enrolled prospectively.Their preoperative computed tomography（CT）were assessed for severity and extent of osteitis by two otolaryngologists using OsiriX DICOM Viewer software.The method of measurement was similar with GOSS,which retained scoring maxillary and sphenoid,producing a modified global osteitis score（rang：0-20）.Collected the history and completed VAS,SNOT-22,Lund-Kennedy,Lund-Mackay in preoperative.Postoperative follow-up mounted up to 12 months and evaluating CRS patients＇ outcome.Compared for test-retest and inter-rater reliability between the modified system and GOSS.Result：There is a significant linear positive correlation between Modified GOSS score and GOSS（r=0.913,P0.001）.And Modified GOSS had more association with pre and postoperative L-M and L-K scores than GOSS（r=0.316,0.357）.The modified GOSS showed the highest inter-rater and test-retest,interclass correlation coefficient（pre-ICC=0.947;post-ICC=0.943）.Conclusion：Modified GOSS may be a more suitable and convenient scoring system for clinical practice to grading osteitis.

关 键 词：慢性鼻-鼻窦炎 骨炎 改良骨炎评分 预后 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]