慢性鼻窦炎伴鼻息肉术后嗅觉功能转归的影响因素分析  

Analysis of influencing factors on postoperative olfactory function in patients with chronic rhinosinusitis with nasal polyps

作　　者：徐秀钦 赵琪余 沈暘[1] 杨玉成[1] 洪苏玲[1] 柯霞[1] Xu Xiuqin;Zhao Qiyu;Shen Yang;Yang Yucheng;Hong Suling;Ke Xia(Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院耳鼻咽喉头颈外科,重庆400016

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第2期118-126,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：重庆市中青年医学高端人才项目(2020-219);重庆医科大学未来医学青年创新团队发展支持计划项目(W0157)。

摘　　要：目的分析慢性鼻窦炎伴鼻息肉(CRSwNP)患者鼻内镜术后嗅觉功能的转归情况及其影响因素,为制定有效的干预措施提供理论依据。方法回顾性分析2021年10月至2023年9月就诊于重庆医科大学附属第一医院行鼻内镜手术治疗的伴有嗅觉障碍的CRSwNP患者277例,其中男189例,女88例,年龄46(32,56)岁[M(P 25,P 75),后同](范围:18~84岁)。所有入组患者均于术前完善常规实验室检测、鼻窦CT Lund-Mackay评分、改良鼻窦CT嗅区评分、息肉内镜评分以及鼻内镜Lund-Kennedy评分等客观评分。术中留取鼻息肉组织进行病理学分析。于术前及术后6个月进行宾夕法尼亚大学嗅觉识别测试(University of Pennsylvania smell identification test,UPSIT)评估嗅觉功能。根据患者术后嗅觉测试的结果,将其分为嗅觉功能改善组和嗅觉功能未改善组。采用χ²检验、多因素Logistics回归分析影响CRSwNP患者术后嗅觉功能的相关因素,并构建预测模型,对其一致性进行验证,分析其预测效能。结果277例患者中嗅觉功能改善155例(56%),嗅觉功能未改善122例(44%)。多因素Logistic回归分析显示,合并变应性鼻炎(OR=2.34)、嗅觉障碍持续时间长(OR=1.13)、鼻窦CT嗅区总分高(OR=1.26)、鼻内镜Lund-Kennedy评分高(OR=1.23)、存在嗅裂息肉(OR=4.72)、组织嗜酸粒细胞计数高(OR=1.01)、白细胞介素(IL)-6水平高(OR=1.51)是CRSwNP患者术后嗅觉功能改善的独立危险因素。息肉内镜评分高(OR=0.74)是CRSwNP患者术后嗅觉功能改善的独立保护因素。根据上述独立影响因素构建列线图模型,其受试者工作特征(ROC)曲线下面积(AUC)为0.80(95%CI:0.748~0.852),临床效能良好,校正曲线显示其绝对误差为0.021,一致性良好,预测效果较好。结论变应性鼻炎病史、嗅觉障碍持续时间、鼻窦CT嗅区总分、鼻内镜Lund-Kennedy评分、嗅裂息肉、组织嗜酸粒细胞计数、IL-6以及息肉内镜评分是CRSwNP患者术后嗅�ObjectiveTo analyze the recovery of olfactory function in patients diagnosed with chronic rhinosinusitis with nasal polyps(CRSwNP)after endoscopic sinus surgery and to identify factors influencing recovery to provide a theoretical foundation for taking effective measures.MethodsThis was a retrospective analysis included 277 CRSwNP patients with olfactory dysfunction who underwent endoscopic sinus surgery at the First Affiliated Hospital of Chongqing Medical University from October 2021 to September 2023.This study included 189 males and 88 females,with a median age of 46 years(range:18-84 years).Routine laboratory tests,sinus CT Lund-Mackay score,modified sinus CT score,endoscopic polyp score,and nasal endoscopic Lund-Kennedy score were included for preoperative assessments.Eosinophil counts were obtained from nasal polyp tissues during surgery.The University of Pennsylvania smell identification test(UPSIT)was administered before surgery and 6 months after surgery to evaluate olfactory function.Based on results of postoperative olfactory test,patients were divided into two groups:the group with improved olfactory function and without improvement of olfactory function.Chi-square test and multivariate Logistic regression were used to analyze relevant factors affecting postoperative olfactory function of CRSwNP patients,and the prediction model was constructed to verify its consistency and to analyze its prediction efficiency.ResultsOf the 277 patients,155(56%)showed improved olfactory function and 122(44%)did not improve after surgery.Multivariate Logistic regression analysis identified following independent factors associated with improved postoperative olfactory function:concurrent allergic rhinitis(OR=2.34),long duration of olfactory dysfunction(OR=1.13),higher total score of CT olfactory zone(OR=1.26),higher Lund-Kennedy score(OR=1.23),presence of olfactory cleft polyps(OR=4.72),higher tissue eosinophil count(OR=1.01)and high IL-6 levels(OR=1.51).Conversely,a higher endoscopic polyp score(OR=0.74)was associated

关 键 词：鼻窦炎 鼻息肉 嗅觉障碍 内镜鼻窦手术 危险因素 预测模型 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]