慢性鼻-鼻窦炎患者的肺功能及其相关性分析

目的探讨慢性鼻-鼻窦炎（CRS）患者的肺功能及其相关性。方法对43例慢性鼻、鼻窦炎伴鼻息肉（CRSwNP）（CRSwNP组）、17例慢性鼻-鼻窦炎不伴鼻息肉（CRSsNP）（CRSsNP组）及50例非CRS患者（对照组）进行肺功能检查，比较3组差别。CRSwNP和CRSsNP组患者进行支气管激发或舒张试验，应用视觉模拟评分、鼻腔-鼻窦结局测试20条、Lund-MackayCT评分、Lund-Kennedy内镜评分等评估疾病严重程度；利用直线或秩相关与多元线性回归分析其肺功能与上述指标的相关性。结果CRSwNP组患者第1秒用力呼气量（FEV1）、用力呼气中段流量（FEF25-75）显著高于CRSsNP和对照组患者（P〈0．05），而CRSsNP和对照组问差别无统计学意义。然而峰值呼气流速（PEF）在3组间差异无统计学意义。3组中吸烟和不吸烟患者间3项指标差异无统计学意义。相关分析显示，CRSwNP组患者中FEV，与外周血嗜酸性粒细胞计数（PEC）、病程呈负相关（rl=-0．351，P1：0．021；r2=-0．343，P2=0．024），PEF与病程呈负相关（r=-0．330，P=0．031），而FEF25-75与上述指标无显著相关。CRSsNP组中FEV1、PEF、FEF25-75，与上述指标均无显著相关。CRSwNP组中支气管激发和舒张试验阳性率较低，分别为11．11％和0．00％，CRSsNP组中均为0．00％。此外，多元线性回归分析显示CRSwNP组中支气管激发或舒张试验前后FEV1变异率与PBEC呈线性相关（R2=0．318，P〈0．05），CRSsNP组中FEV1变异率与年龄、PBEC、病程、鼻窦手术次数呈线性相关（R2=0．893，P〈0．05）。结论CRS引起最大通气及小气道功能损害与鼻息肉的存在有关，与吸烟无关，CRSwNP患者中通气功能损害与PBEC、病程正相关，且PBEC是FEV，变异率的独立预测指标。而CRSsNP患者中肺功能与上述指标无显著相关，但年龄、PBEC、病程及鼻窦手术次数是其FEV，变异率的独立预测指标。

Lung function in patients with chronic rhinosinusitis and its correlation analysis

Objective To investigate the lung function in patients with chronic rhinosinusitis （CRS） and the factors that affect lung function. Methods Sixty patients with CRS including 43 patients with CRS with nasal polyps （CRSwNP group） and 17 patients without NP（ CRSsNP group） and 50 non-CRS patients （control group） were tested for lung function. The differences between groups in lung function were compared. CRSwNP and CRSsNP group was required to undergo a bronchial provocation or dilation test. Moreover, the severity of nasal disease was measured by the Visual Analogue Scale （VAS）, 20-item Sino-Nasal Outcome Test （SNOT-20）, Lund-Mackay Score （LMS）, Lund-Kennedy Score （LKS） and so on. The linear or non-parametric correlation and multiple linear regression methods were used to analyze the relationship between their lung function and the above parameters. Results Both the forced expiratory volume in 1 second （ FEV1 ） and forced expiratory flow between 25% and 75% of forced vital capacity （ FEF25.75 ） of CRSwNP group were significantly lower than those of other groups （P 〈 0.05）, but there was no difference within other groups. On peak expiratory flow （PEF）, there was no significant difference among three groups. Lung function parameters were not significantly different between smokers and non-smokers in three groups. In CRSwNP group, FEV1 was negatively correlated with peripheral blood eosinophil count （PBEC） and duration of disease（ rl =-0. 351, P1 =0. 021 ;r2 =-0. 343, P2 = 0.024）, PEF with duration of disease （ r = 43. 330, P = 0. 031 ） and FEF25-75 without all the parameters above. In CRSsNP group, FEV1, PEF and FEF25-75 were not correlated with all the parameters. The incidence of positive bronchial provocation and dilation test was lower in CRSwNP group （11.11%, 0.00% respectively）, with both 0.00% in CRSsNP group. But the multiple linear regression analysis indicated that the change ratioes of FEV1 before and after bronchial provocation or dilation test were correlated with PBEC in CRSwNP group （R2 =0. 318, P 〈0.05）, with age, PBEC,duration of disease and sinus surgery number in CRSsNP group（R 2 = 0. 893, P 〈 0.05）. Conclusions CRS leading to impaired maximun ventilation and small airway is associated with the existence of nasal polyp, not with smoking. In CRSwNP patients, ventilation impairments are positively correlated with PBEC and duration, and PBEC is independent predictors of FEV1 change ratio. In CRSsNP patients, lung function are not correlated with all the parameters above, but age, PBEC, duration and sinus surgery number are independent predictors of FEV1 change ratio. （Chin J Ophthalmol and Otorhinolaryngol,2014,14：83-88 ）