全身性和局部性嗜酸粒细胞增多对鼻息肉治疗预后的差异影响分析  

Concordant systemic and local eosinophilia relates to poorer disease control in patients with nasal polyps

作　　者：王康华 邓洁[1] 杨梦 陈洋 陈枫虹[1] 高文翔[1] 赖银妍[1] 史剑波[1] 孙悦奇[3] Wang Kanghua;Deng Jie;Yang Meng;Chen Yang;Chen Fenghong;Gao Wenxiang;Lai Yinyan;Shi Jianbo;Sun Yueqi(Otorhinolaryngology Hospital,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Zhongshan School of Medicine,Sun Yat-sen University,Guangzhou 510080,China;Department of Otorhinolaryngology,the Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518107,China)

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院,广州510080 [2]中山大学中山医学院,广州510080 [3]中山大学附属第七医院耳鼻咽喉科,深圳518107

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第10期1042-1050,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81873691,81770975,81800884);广东省科技计划项目(2020A1515010134,2019A1515011029);中山大学青年教师培育项目(19ykpy69)。

摘　　要：目的探讨外周血和鼻息肉组织中嗜酸粒细胞增多是否为鼻息肉治疗预后不佳的独立危险因素。方法回顾性分析2015年1月至2017年12月在中山大学附属第一医院耳鼻咽喉科医院诊断为慢性鼻窦炎伴鼻息肉(CRSwNP)并行内镜鼻窦手术,且术后至少1年以上的183例患者的病例资料,并按照欧洲鼻窦炎和鼻息肉意见书(EPOS)2012对所有病例进行疾病临床控制程度的评估。在校正一般的以及合并症的混杂因素后,采用多重Logistic回归模型分析外周血和组织嗜酸粒细胞数量与病情控制不良风险之间的关联性。结果根据外周血和组织嗜酸粒细胞是否增多将病例分为4组:同时伴有外周血和组织嗜酸粒细胞增多的鼻息肉为BT-high组,仅伴有外周血嗜酸粒细胞增多的鼻息肉为B-high组,仅伴有组织嗜酸粒细胞增多的鼻息肉为T-high组,不伴外周血和组织嗜酸粒细胞增多的鼻息肉为BT-low组。其中BT-low组的患者比例最高,达到了41.5%;BT-high组的病例次之,占31.2%;而T-high组和B-high组的患者比例相对较低,分别为15.3%和12.0%。在校正了混杂因素后,多重Logistic回归模型分析发现外周血嗜酸粒细胞数量和组织嗜酸粒细胞百分比与病情控制不良的风险增加独立相关。此外,相比于B-high和T-high组的患者,BT-high组的患者具有更高的术后病情控制不良风险。结论系统性和局部性嗜酸粒细胞同时增多的鼻息肉患者,术后病情控制不良的风险显著高于仅伴有外周血或组织嗜酸粒细胞增多者。Objective To explore whether blood and polyp tissue eosinophil numbers are independent risk factors for poor disease control in patients with nasal polyp.Methods By using the electronic medical records database and manual evaluation,183 nasal polyp patients who had undergone endoscopic sinus surgery at least one year prior to the study with complete data of tissue specimens,baseline blood routine test,nasal endoscopy and sinus computed tomography,were identified and recruited to assess disease control based on the criteria of a European Position Paper on Rhinosinusitis and Nasal Polyps 2012(EPOS 2012).Multiple logistic regression model was used to determine the association between blood and tissue eosinophil numbers and risk of poor disease control by adjusting for demographics and comorbidities.Results We broke down the cohort into 4 groups according to blood(0.3×109/L)and tissue(10%)eosinophils.The patients without eosinophilic inflammation represented the largest group(41.5%).The group with concordant blood and tissue eosinophilia represented the second largest(31.2%),and the patients with isolated tissue(15.3%)or blood(12.0%)eosinophilia were relatively rare.Multiple logistic regression models found blood eosinophil count and tissue eosinophil percentage were independently associated with increased risk for poor disease control after adjustments for covariates related to poor treatment outcome.Furthermore,subjects with concordant blood and tissue eosinophilia had a higher risk for poor disease control than those with isolated blood or tissue eosinophilia.Conclusion Concordant blood and tissue eosinophilia relates to a higher likelihood of poor disease control than isolated blood or tissue eosinophilia after adjustment of potential confounders in nasal polyp patients.

关 键 词：系统性 局部性 嗜酸粒细胞增多 鼻息肉 预后 

分 类 号：R765.25[医药卫生—耳鼻咽喉科]