鼻窦CT扫描嗅裂评分预测鼻息肉对口服糖皮质激素敏感性的作用  

The value of sinus computed tomography in predicting the response to oral glucocorticoids in chronic rhinosinusitis with nasal polyps

作　　者：洪海裕[1] 孙悦奇[2] 史剑波[2] Hong Haiyu;Sun Yueqi;Shi Jianbo(Department of Otolaryngology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519020, China;Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China)

机构地区：[1]中山大学附属第五医院耳鼻咽喉科,珠海519020 [2]中山大学附属第一医院耳鼻咽喉医院,广州510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2019年第3期192-197,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省科技计划项目(2016A020215049,2016A020215030).

摘　　要：目的探讨鼻窦CT扫描嗅裂评分用于评估鼻息肉患者对口服糖皮质激素(下文简称激素)敏感性的作用。方法将2018年1—3月于中山大学附属第五医院耳鼻咽喉科住院的47例鼻息肉患者纳入进行前瞻性单盲研究,男28例,女19例,年龄17~66岁。所有患者给予泼尼松30 mg/d顿服,连用14 d。根据治疗前后鼻息肉大小和鼻部症状评分的变化分为客观激素敏感/不敏感组,以及主观激素敏感/不敏感组。在客观和主观性分组中,分别比较激素敏感和不敏感患者之间的Lund-Mackay评分、嗅裂评分、血嗜酸粒细胞计数及百分比等参数的差异。采用t检验或χ^2检验进行组间比较,对预测因子采用多因素Logistic回归分析,应用受试者工作特征(receiver operating characteristic,ROC)曲线分析上述参数的预测能力。结果对激素治疗敏感的患者在客观分组中占53.2%(25/47),在主观分组中占61.7%(29/47)。数据均符合正态分布。客观分组激素敏感患者中的嗅裂评分和血嗜酸粒细胞计数及百分比均显著高于不敏感患者[(3.6±1.0)分比(2.2±1.4)分,(404.4±200.3)个/μl比(209.5±233.1)个/μl,(5.25±2.59)%比(3.17±3.46)%,t值分别为3.98、3.08,χ^2=2.35,P值均<0.05]。主观分组中嗅裂评分和血嗜酸粒细胞计数及百分比也存在同样的趋势[(3.6±1.0)分比(1.9±1.3)分,(401.4±213.6)个/μl比(171.1±200.2)个/μl,(5.39±2.76)%比(2.48±2.99)%,t值分别为5.05、3.68,χ^2=3.40,P值均<0.05]。多因素Logistic回归分析提示,客观和主观激素敏感患者中嗅裂评分均为独立危险因素(OR=2.882,95%CI:1.301~6.384;OR=2.508,95%CI:1.248~5.039)。无论客观还是主观分组,用嗅裂评分作为指标预测口服激素的效果和以血嗜酸粒细胞百分比作为指标的预测效果相当(嗅裂评分的曲线下面积客观分组为0.775,主观分组为0.829)。嗅裂评分3.5分可作为临床上预测鼻息肉患者对口服激素治疗敏感性的有效预测指标。结论鼻窦Objective To study the value of olfactory cleft scores through computed tomography (CT) in predicting the oral glucocorticoids (GC) sensitivity in chronic rhinosinusitis with nasal polyps. Methods Fourty-seven consecutive patients with CRSwNP from the Fifth Affiliated Hospital of Sun Yat-sen University between January and March of 2018 were recruited in this prospective, single-blinded study. There were 28 males and 19 females, with age ranging from 17 to 66 years old. After a course of oral prednisone (30 mg/d for 14 d), these patients were subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and -insensitve subgroups: Lund-Mackay scores, olfactory cleft scores, and blood eosinophil counts and ratio. T test and χ^2 test were used. Multivariate Logistic regression analysis was used for factor prediction and receiver operating characteristic (ROC) curve was used to analyze the predictive ability of those factors. Results There were 53.2%(25/47) and 61.7%(29/47) of patients objectively and subjectively sensitive to GC therapy, respectively. All data conformed to normal distribution. The olfactory cleft score and the blood eosinophil counts and ratio in objectively GC-sensitive subgroup were significantly higher than those in objectively GC-insensitive subgroup (3.6±1.0 vs 2.2±1.4,(404.4±200.3)/μl vs (209.5±233.1)/μl,(5.25±2.59)% vs (3.17±3.46)%, t value was 3.98, 3.08, respectively,χ^2=2.35, all P<0.05). The cleft score, the blood eosinophil counts and ratio also showed the same trend in subjectively GC-sensitive and -insensitive subgroup (3.6±1.0 vs 1.9±1.3,(401.4±213.6)/μl vs (171.1±200.2)/μl,(5.39±2.76)% vs (2.48±2.99)%, t value was 5.05, 3.68, respectively,χ^2=3.40, all P<0.05). Multivariate Logistic regression revealed that olfactory cleft score was

关 键 词：鼻窦炎 糖皮质激素类 体层摄影术 螺旋计算机 

分 类 号：R765.25[医药卫生—耳鼻咽喉科]