变应性真菌性鼻窦炎鼻内镜鼻窦手术后复发的危险因素分析  

Risk factors for postoperative recurrence of allergic fungal sinusitis treated by nasal endoscopic sinus surgery

作　　者：于宁静 周兰柱 孙哲 吴俊 王文忠 Yu Ningjing;Zhou Lanzhu;Sun Zhe;Wu Jun;Wang Wenzhong(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China)

机构地区：[1]蚌埠医科大学第一附属医院耳鼻咽喉头颈外科,蚌埠233004

出　　处：《中华解剖与临床杂志》2024年第10期682-688,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨变应性真菌性鼻窦炎(AFRS)鼻内镜鼻窦手术后复发的危险因素及其对AFRS术后复发的预测价值。方法病例对照研究。纳入2012年1月—2022年12月蚌埠医科大学第一附属医院诊治的AFRS患者103例, 其中男39例、女64例, 年龄9~75(45.4±15.7)岁。103例患者均行鼻内镜鼻窦手术治疗, 根据手术后12个月内有无复发分为复发组32例, 未复发组71例。观察指标:(1)将2组患者性别、年龄、临床表现、内科合并症等临床基线资料, 术前外周血嗜酸性粒细胞(Eos)、嗜碱性粒细胞(Bas), 以及鼻窦CT检查有无骨质吸收或破坏、术前鼻窦CT Lund-Mackay总分纳入单因素分析。(2)选择单因素分析中P<0.05的变量, 进一步多因素logistic回归分析筛选AFRS术后复发的独立危险因素。(3)应用受试者操作特征(ROC)曲线评估独立危险因素单独和联合应用对AFRS术后复发的预测效能。结果 (1)单因素分析结果显示:与未复发组比较, 复发组患者年龄小、单侧鼻息肉患者占比低, 而鼻窦CT评分、外周血Eos和Bas百分比, 以及鼻塞、鼻窦有骨质吸收或破坏的患者占比均高, 差异均有统计学意义(P值均<0.05)。患者性别构成比, 合并高血压、糖尿病, 以及头痛患者占比, 2组间差异均无统计学意义(P值均>0.05)。(2)多因素logistic回归分析显示:鼻窦CT评分[OR(95%CI)=1.462(1.097~1.947)]和外周血Eos百分比[OR(95%CI)=2.087(1.305~3.338)]、外周血Bas百分比[OR(95%CI)=300.656(13.381~6 755.243)]是AFRS患者手术后复发的独立危险因素(P值均<0.05)。(3)鼻窦CT评分、外周血Eos和Bas百分比单独预测AFRS术后复发的ROC曲线的曲线下面积(AUC)分别为0.711(95%CI:0.593~0.829)、0.874(95%CI:0.798~0.950)、0.761(95%CI:0.649~0.873), 均低于三者联合预测AFRS术后复发的AUC[0.956(95%CI:0.922~0.990)], 差异均有统计学意义(Z=4.19、2.64、3.64, P值均<0.05);三者联合的预测效能为优秀, 外周血Eos和Bas百分比、鼻窦Objective This study aimed to investigate the risk factors for the postoperative recurrence of allergic fungal rhinosinusitis(AFRS)treated by nasal endoscopic sinus surgery and their value in predicting postoperative recurrence of AFRS.Methods The case-control study was conducted.A total of 103 patients with AFRS who were treated in the First Affiliated Hospital of Bengbu Medical University from January 2012 to December 2022 were included in this study,including 39 males and 64 females,aged 9-75(45.4±15.7)years.A total of 103 patients were treated with nasal endoscopic sinus surgery,and they were divided into 32 cases of the recurrence group according to the presence of recurrence within 12 months after the surgery and 71 cases of the non-recurrence group.The recurrence group consisted of 32 cases,and the non-recurrence group consisted of 71 cases.The observation indexes were as follows:(1)The baseline clinical data of the two groups,such as gender,age,clinical manifestations,and medical comorbidities,preoperative peripheral blood eosinophils(Eos)and basophils(Bas),as well as the presence of bone resorption or destruction in sinus CT examination,and the preoperative sinus CT Lund-Mackay total score were compared.(2)Variables with P<0.05 in univariate analysis were selected for further multifactorial logistic regression analysis of independent risk factors for the postoperative recurrence of AFRS,and the subject operating characteristic(ROC)curves were plotted to assess the predictive efficacy of independent risk factors alone and in combination for the postoperative recurrence of AFRS.Results Univariate analysis results showed that the patients in the recurrence group were younger in age and had lower proportion of unilateral nasal polyps compared with the non-recurrent group,whereas the sinus CT score,percentage of peripheral blood Eos and Bas,and the proportion of bone absorption or destruction on nasal congestion and sinus CT were all higher,with statistical significance(all P values<0.05).The gender composit

关 键 词：鼻窦炎 变应性真菌性鼻窦炎 鼻内镜鼻窦手术 术后复发 危险因素 嗜酸性粒细胞 嗜碱性粒细胞 鼻窦CT评分 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]