嗜酸性粒细胞型慢性鼻-鼻窦炎的分型及临床特征研究

目的　验证慢性鼻-鼻窦炎（CRS）根据组织嗜酸性粒细胞（eosinophil,Eos）浸润程度进行分型的可行性。分析嗜酸性粒细胞型慢性鼻-鼻窦炎（ECRS）与非嗜酸性粒细胞型慢性鼻-鼻窦炎（NECRS）两组病例临床症状、外周血Eos百分比（Eos%）、影像学变化及预后等临床特点。方法　纳入符合CRS诊断标准的330例研究对象,以组织Eos%≥15%将病例分为ECRS组（n=153）和NECRS组（n=177）,比较和分析两组病例的相关特点,SPSS 22.0进行统计学分析。结果　①ECRS组外周血Eos%显著高于NECRS组,组织Eos%与外周血Eos%呈正相关;②ECRS组鼻窦CT病变程度总分、前后组筛窦评分差异具有显著性（P <0.05）;③ ECRS组全组鼻窦累及率、后组筛窦及上颌窦累及率明显高于NECRS组,差异具有统计学意义（P <0.05）;④FESS术后1年评价远期疗效,ECRS组患者术后鼻塞、流涕、头面部胀痛及嗅觉障碍评分均明显低于术前症状评分（P <0.01）,NECRS组患者术后除头面部胀痛无缓解（P >0.05）外,其余指标评分均低于术前各症状评分（P <0.05）。结论　CRS可按组织Eos浸润程度进行分型,ECRS的鼻窦病变范围及程度较重,更易罹患全组鼻窦炎,其中筛窦病变程度最重,后组筛窦及上颌窦最易受累。外周血Eos%与组织Eos%呈正相关,且在ECRS病例中显著升高,可作为术前CRS分型的参考指标。     

不同年龄段慢性鼻-鼻窦炎患者外周血白细胞和嗜酸细胞与鼻窦CT的相关分析

目的　分析不同年龄段慢性鼻-鼻窦炎（CRS）患者外周血中白细胞（WBC）、中性粒细胞/淋巴细胞比值（NLR）、嗜酸细胞（Eos）与鼻窦CT的相关性。方法　通过分析2016年1月～2019年6月就诊于宁波市医疗中心李惠利医院东部院区的225例CRS患者的临床资料,对所有患者进行年龄分组,并对病例进行Lund-Mackay鼻窦CT评分,同时统计所有患者的外周血中白细胞（WBC）计数、中性粒细胞（NEU）计数、淋巴细胞（LYM）计数、Eos计数和嗜酸细胞占白细胞总数的百分比（Eos%）。对不同年龄段组间的Lund-Mackay鼻窦CT评分结果、WBC计数、NLR、Eos计数和Eos%进行对比分析,从而评判组间是否存在统计学差异。并探讨分析各组内Lund-Mackay鼻窦CT评分结果和WBC计数、NLR、Eos计数、Eos%是否存在相关性。结果　不同年龄段组间的Eos计数和Eos%均存在统计学差异（P 均<0.05）。青年组、成年组、老年组及总体的Lund-Mackay鼻窦CT评分与外周血WBC计数均存在正相关（r 分 别为0.661、0.158、0.332、0.219,P 均<0.05）,而与NLR、Eos计数、Eos%无相关性（P >0.05）。结论　①不同年龄段的 CRS患者外周血Eos计数、Eos%存在差异;②外周血中Eos计数、Eos%、NLR与Lund-Mackay鼻窦CT评分无相关性;③外周血中的WBC计数可作为预测CRS炎症严重的实验室指标,但相关强度不高,临床实用较受限。     

嗜酸性粒细胞与非嗜酸性粒细胞慢性鼻-鼻窦炎患者鼻窦CT特征比较

目的 探讨嗜酸性粒细胞慢性鼻-鼻窦炎(ECRS)患者与非嗜酸性粒细胞慢性鼻-鼻窦炎(NECRS)患者鼻窦CT特征。 方法 纳入2015年10月~2021年6月于武汉大学人民医院进行手术治疗的1 010例慢性鼻-鼻窦炎(CRS)患者作为研究对象,根据组织嗜酸性粒细胞与炎性细胞数量比值(Eos%)≥10%将患者分为ECRS组(n=458)和NECRS组(n=552)。对两组患者Lund Mackay评分、鼻窦累及率和鼻窦病变类型进行差异分析,并探讨不同年龄段ECRS和NECRS组的Lund Mackay评分和鼻窦病变类型是否存在差异及筛窦与上颌窦评分比值(E/M)在预测ECRS中的价值。 结果 ECRS组前组筛窦、后组筛窦、额窦、蝶窦、窦口鼻道复合体(OMC)和总分评分均高于NECRS(P<0.01),而上颌窦评分低于NECRS组(P<0.01);ECRS组前组筛窦、后组筛窦、蝶窦和额窦的累及率也高于NECRS组;ECRS组(P=0.786)和NECRS组(P=0.634)在不同年龄段的评分无明显差异;全组鼻窦炎、筛窦为主和非筛窦为主三种CRS类型在ECRS和NECRS组占比依次为:39.08%、37.24%、23.58%和26.45%、8.88%、64.67%;成年患者随着年龄增长,全组鼻窦炎在ECRS中占比逐渐增高(P=0.04)。以E/M>2为截断值时,其预测所有患者ECRS的AUC为0.67,而预测非全组鼻窦炎的AUC为0.75。 结论 (1) ECRS的筛窦、额窦和蝶窦病变程度较NECRS重,而上颌窦病变较NECRS轻,筛窦、蝶窦和额窦也较NECRS易受累;(2) ECRS以筛窦病变为主和全组鼻窦炎为主,而NECRS则主要表现为非筛窦为主的病变和全组鼻窦炎;(3) 随着年龄增加,成年ECRS患者患全组鼻窦炎比例更高;(4) E/M>2对全组鼻窦炎ECRS预测价值有限。     

慢性鼻-鼻窦炎鼻息肉组织及外周血嗜酸细胞与临床表现的关系

目的 探讨慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者组织及外周血中嗜酸细胞(eosinophils,Eos)计数的相关性,并研究Eos与鼻窦影像学表现及术后复发的关系.方法 回顾性分析102例确诊为CRSwNP患者的临床资料,对鼻息肉组织进行Eos计数,比较其与外周血Eos的相关性.根据术后1年随访结果,比较复发组与非复发组之间的组织及外周血Eos计数、鼻窦CT Lund-Mackay评分的统计学差异.结果 复发组外周血Eos计数、外周血Eos百分数以及鼻息肉组织Eos计数显著高于非复发组(P=0.032、0.033、0.017),两组的鼻窦CT评分无统计学差异(P=0.089).鼻息肉组织Eos计数与外周血Eos绝对值具有显著相关性(r=0.637,P=0.000);鼻息肉组织Eos计数与外周血Eos百分比也具有显著相关性(r=0.542,P=0.000);外周血Eos计数、Eos百分数、鼻息肉组织Eos计数与术前鼻窦CT评分无显著相关性(P=0.072、0.065、0.695).结论 外周血及鼻息肉组织Eos计数具有显著相关性,并且鼻息肉组织及外周血Eos计数与鼻息肉术后复发相关.     

鼻窦CT评分联合特异性免疫球蛋白E和白细胞介素6预测嗜酸粒细胞型慢性鼻窦炎伴鼻息肉患者术后复发风险的价值

目的 探讨鼻窦CT评分联合特异性免疫球蛋白E(sIgE)和白细胞介素6(IL-6)对嗜酸粒细胞型慢性鼻窦炎伴鼻息肉（ECRSwNP）患者术后复发风险的预测价值。方法 选取2019年1月～2022年1月浙江大学医学院附属杭州西溪医院收治的ECRSwNP患者92例,均行功能性鼻内镜手术,根据术后1年复发情况分为复发组（n=29）和未复发组（n=63）。比较两组鼻窦CT评分,并采用Pearson相关性分析法分析外周血嗜酸粒细胞（Eos）及组织Eos百分比（Eos%）与鼻窦CT评分的相关性;利用Logistic回归分析模型分析术后复发的危险因素,用受试者工作特征曲线（ROC）及曲线下面积（AUC）探究鼻窦CT评分、特异性免疫球蛋白E(sIgE)、IL-6对患者术后复发的预测价值。结果 复发组前组筛窦评分、后组筛窦评分、鼻窦CT评分及筛窦与上颌窦评分比值（E/M比）均大于未复发组（P<0.05）;组织Eos%与前组筛窦评分、后组筛窦评分及E/M比均呈正相关（r=0.305、0.381、0.642,P均<0.05）,外周血Eos%与前组筛窦评分、后组筛窦评分及E/M比亦呈正相关（r=0...     

嗜酸粒细胞性慢性鼻窦炎的相关研究

慢性鼻窦炎(CRS)是耳鼻咽喉科的常见病、多发病,根据细胞的浸润方式可分为嗜酸粒细胞性慢性鼻窦炎(eosinophilic chronic rhinosinusitis,ECRS)和非嗜酸粒细胞性慢性鼻窦炎(non-eosinophilic chronic rhinosinusitis,NECRS).ECRS较NECR...     

CD8 +Treg细胞在慢性鼻窦炎中的表达及其与嗜酸粒细胞浸润的研究

目的:明确CD8 +调节性T细胞（Treg细胞）在慢性鼻窦炎（CRS）患者鼻黏膜组织和外周血中的表达情况,及其与鼻黏膜组织中嗜酸粒细胞（Eos）浸润的关系。 方法:对2017年3月至2018年10月于中山大学附属第三医院的33例慢性鼻窦炎伴鼻息肉（CRSwNP）、26例慢性鼻窦炎不伴鼻息肉（CRS...     

Notch通路在鼻息肉中的表达及其与调节性T细胞表达和嗜酸粒细胞浸润的相关性研究

目的:探讨Notch通路在鼻息肉中的表达及其与调节性T细胞（Treg细胞）表达和嗜酸粒细胞（Eos）浸润的相关性。方法:选择2012年11月至2018年8月期间在中山大学附属第三医院接受鼻内镜手术的慢性鼻窦炎（CRS）和鼻中隔偏曲的患者,分别作为CRS组和对照组。收集慢性鼻窦炎不伴鼻息肉（CRSsNP）患者（30例,男...     

鼻窦CT评分在评估慢性鼻-鼻窦炎嗅觉障碍中的应用

目的探讨分析鼻窦CT评分在慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者嗅觉功能评估的价值。方法回顾性分析92 例确诊为CRS患者的临床资料,其中嗜酸性粒细胞性慢性鼻-鼻窦炎（eosinophi chronic rhinosinu sitis,ECRS）组患者28 例,非嗜酸性粒细胞性慢性鼻-鼻窦炎（non eosinophi chronic rhinosinu sitis,nECRS）组患者64 例。排除鼻部手术史和其他可能影响嗅觉功能的因素,进行病史采集、嗅觉功能检测和鼻窦CT评分,采用χ2和t检验比较两组间患者临床资料;采用Mann Whitney U检验比较两组鼻窦CT评分;采用Spearman相关分析对鼻窦CT评分和嗅觉功能进行相关性分析;采用ROC曲线分析鼻窦CT评分在嗅觉障碍中的预测评估价值。 结果ECRS组双侧炎症(26/28),筛窦上额窦总和差,（EM 差）值3.32±2.25;nECRS组双侧炎症(48/64),EM差值1.81±2.33,两组患者比较差异均具有统计学意义(P<0.05)。在CT评分方面,CRS患者的EM 差值与嗅觉功能相关性更强(r=0.634),具有更高的预测评估价值,其曲线下面积为0.827。当EM差截断值取2.5时,诊断嗅觉障碍的敏感度为76.9%,特异度为79.2%。结论与其他鼻窦CT评分相比,筛窦上颌窦总和差值对于CRS患者嗅觉障碍有更好的预测诊断价值。     

变应性气道疾病对嗜酸性鼻息肉炎性亚型界定的影响

目的　探讨不同炎性亚型慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps,CRSwNP）患者临床和组织病理学特点及其发病机制,初步探究外周血嗜酸性粒细胞（eosinophils,Eos）比例在分类中的作用,进而探究合并症（变应性鼻炎、支气管哮喘）对鼻息肉炎性亚型界定的影响。方法　回顾性分析182例确诊为 CRSwNP患者的临床资料。根据术后鼻息肉组织病理检测结果,分为Eos浸润组（ECRSwNP）与非Eos浸润组（non-ECRSwNP）。对两组患者血Eos百分比、血中性粒细胞百分比、血清总IgE、鼻窦CT Lund-Mackay评分及鼻内镜手术翻修率分别进行统计学分析,比较两组的差异;将血清总IgE、血Eos百分比、鼻息肉Eos浸润程度及鼻窦CT评分之间进行相关性分析;采用ROC曲线方法计算曲线下面积及ECRSwNP的诊断截断值;将研究对象按照不同合并症构成进行分组,分析不同合并症时ECRSwNP的诊断截断值变化情况。以SPSS 17.0软件进行数据统计分析。结果  ECRSwNP具有较高的鼻内镜手术翻修率及变应性鼻炎和支气管哮喘合并率,两组差异具有统计学意义（P <0.05）;两种炎性亚型的鼻息肉患者鼻窦CT评分、血Eos百分比及血总IgE之间差异具有统计学意义（U 分别为1028.00、1143.50、800.00,P 均<0.05）,两组之间血中性粒细胞百分比差异不具有统计学意义（U =2155.50,P =0.232）;血Eos百分比和组织Eos浸润程度之间及鼻窦CT评分与二者之间存 在显著相关性（r =0.538、0.568、0.419,P 均<0.05）,其他指标之间相关性无统计学意义。同时合并变应性鼻炎和支气管哮喘可显著增高血Eos百分比,相比无合并症及仅合并变应性鼻炎差异具有统计学意义（U分别为541.50、689.00,P均<0.05）,其他情况差异不具有统计学意义。不同合并症时ECRSwNP血Eos百分比截断值范围是3.05%～4.8%。结论　ECRSwNP及non-ECRSwNP具有不同的临床及组织病理学特点。合并变应性疾病可增高鼻息肉血Eos百分比,并影响以血Eos百分比为诊断指标的鼻息肉炎性亚型的界定。     

Risk factors for olfactory dysfunction in chronic rhinosinusitis

Objective

Although risk factors for olfactory dysfunction in patients with chronic rhinosinusitis (CRS) have been examined, most studies did not distinguish between classified eosinophilic chronic rhinosinusitis (ECRS) and noneosinophilic chronic rhinosinusitis (NECRS). The incidence of eosinophilic disease in Japan differs from that in the West. Thus, when olfaction in CRS is investigated, ECRS and NECRS should be examined separately. In the present study, we examined the clinical characteristics associated with olfactory dysfunction in Japanese patients with ECRS and NECRS enrolled in a large multicenter, prospective cohort study.

Methods

Olfactory examination results, demographic data, clinical factors, and comorbidity data were analyzed for 418 patients with CRS at 3 tertiary care centers. We used T&T olfactometry, intravenous olfactory test (the Alinamin test) and Likert scale to assess subjects’ olfactory function. Data were analyzed with univariate and multivariate analyses.

Results

Olfactory dysfunction was more severe and more prevalent in ECRS than in NECRS. We found that olfactory cleft polyps (odds ratio [OR], 3.24), ethmoid opacification (OR, 2.64), asthma (OR, 2.29), current smoking (OR, 1.74) and age ≥50 years (OR, 1.66) were associated with olfactory dysfunction in CRS. Ethmoid opacification (OR, 3.09) and olfactory cleft polyps (OR, 3.05) were associated with olfactory dysfunction in NECRS. Olfactory cleft polyps (OR, 3.98), current smoking (OR, 2.67), IgE ≥400 IU/ml (OR, 2.65), ethmoid opacification (OR, 2.51), and asthma (OR, 2.34) were associated with olfactory dysfunction in ECRS.

Conclusions

Olfactory dysfunction was more severe and prevalent in ECRS than in NECRS. Physician should pay attention to these clinical findings to diagnose olfactory dysfunction, especially in ECRS, and should provide appropriate explanation, guidance, and care. In addition, smokers should be advised to stop smoking to help prevent olfactory dysfunction.     

Molecular and cellular staging for the severity of chronic rhinosinusitis

OBJECTIVES: To correlate objective and subjective clinical parameters with molecular, cellular, and histologic markers and to acknowledge the importance of these basic science parameters in a severity classification system for chronic rhinosinusitis (CRS). STUDY DESIGN: Retrospective analysis of prospectively collected data of consecutive patients undergoing endoscopic sinus surgery for CRS in an academic institution. METHODS: The preoperative computed tomography (CT) scans of all patients with CRS scheduled for surgery were graded according to Lund and Mackay. The patients completed a Sino-Nasal Outcome Test (SNOT)-20 questionnaire and had a preoperative nasal endoscopy performed, which was graded by assigning an endoscopy score according to Lanza and Kennedy. Subjects had a medical questionnaire regarding presence of aspirin sensitivity, allergic rhinitis, asthma, and medication usage. Subjects also underwent pulmonary function testing and had skin tests for allergies. At the time of surgery, blood was drawn to determine the level of peripheral eosinophilia and the degree of polymorphisms of the leukotriene C4 synthase gene. Sinus mucosal and polyp tissue was examined pathologically for the number of eosinophils per high-powered filed (HPF) and was stained for EG2 to determine the portion of activated eosinophils. Leukotriene C4 levels (pg/g of tissue) were determined using a sensitive competitive enzyme immunoassay. Endoscopy and SNOT-20 scores were reevaluated 1 year after surgery. Data were analyzed for disease-severity correlation to recommend a severity classification system for CRS that incorporates the contribution of clinical, molecular, cellular, and histologic parameters. RESULTS: The presence of polyps resulted in higher preoperative CT scores and higher preoperative and postoperative symptom scores. Average preoperative CT scores were significantly higher in asthmatics and allergy patients and correlated with endoscopy scores. Patients with more than five eosinophils/HPF of sinus tissue had higher frequency of polyps and asthma and higher CT and endoscopy scores than patients without sinus tissue eosinophilia (less than or equal to 5 cells/HPF sinus tissue). The subgroup of patients with eosinophilic nasal polyps (eosinophilic hyperplastic rhinosinusitis) had more severe disease by CT and endoscopy than the subgroup of patients with nasal polyps (hyperplastic rhinosinusitis) but without eosinophilia. Similarly, patients without polyps but with tissue eosinophilia had more severe disease than patients without polyps and without eosinophilia. Leukotriene C4 levels were elevated in all patient groups. Symptom scores did not correlate with any of the parameters. CONCLUSION: We suggest the following severity classification system for CRS: 1) eosinophilic chronic hyperplastic rhinosinusitis (ECHRS): patients with polyps and sinus tissue eosinophilia; 2) noneosinophilic chronic hyperplastic rhinosinusitis (NECHRS): patients with polyps but without sinus tissue eosinophilia; 3) eosinophilic chronic rhinosinusitis (ECRS): patients without polyps but with sinus tissue eosinophilia; 4) noneosinophilic chronic rhinosinusitis (NECRS): patients without polyps and without sinus tissue eosinophilia.     

Comparison of olfactory and taste functions between eosinophilic and non-eosinophilic chronic rhinosinusitis

ObjectiveMost patients with chronic rhinosinusitis (CRS) complain of olfactory and/or taste dysfunctions. However, olfactory and taste dysfunctions depending on the subtype of CRS, classified as eosinophilic CRS (ECRS) and non-eosinophilic CRS (NCRS), have not been clearly reported. Therefore, the purpose of this study was to investigate the clinical features in olfactory and taste functions according to the subtype classified as ECRS and NCRS.MethodsWe retrospectively analyzed the electronic medical records of patients who underwent endoscopic sinus surgery and were diagnosed with CRS. The patients were divided into ECRS and NCRS groups, according to their Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. We analyzed demographic characteristics, Sino-Nasal Outcome Test findings, Lund-Mackay score, and the results of previously-validated tests, including the Korean Version of Sniffin' Stick test and chemical gustatory function test.ResultsPatients with ECRS and NCRS had decreased olfactory and taste functions compared to the control group. In particular, the olfactory score of ECRS patients was lower than that of NCRS patients (18.1 ± 9.5 vs 23.7 ± 8.5, respectively, p <0.001). On the other hand, taste scores of ECRS patients were not statistically different compared to NCRS patients (19.1 ± 4.7 vs. 18.3 ± 4.7, respectively, p = 0.166). Olfactory score decreased with increase in JESREC score (r=-0.203, p = 0.002), but it had no correlation with taste score (r = 0.072, p = 0.276).ConclusionWe found a difference in olfactory function but no difference in taste function between patients in ECRS and NCRS groups. These results may provide valuable clinical features in terms of olfactory and taste functions according to the subtypes of CRS.     

Endotype-related recurrence pattern of chronic rhinosinusitis in revision functional endoscopic sinus surgery

ObjectiveThe recurrence of chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS) is influenced by various factors, potentially including the endotype based on the molecular pathophysiology of CRS. This study investigated differences in the recurrence pattern of CRS by endotype after primary FESS.MethodsThis retrospective study enrolled patients who had undergone revision FESS for recurrent CRS. Based on their clinical diagnosis, the patients were divided into two endotype groups: recurrent eosinophilic CRS (rECRS) and recurrent non-eosinophilic CRS (rNECRS). We compared and analyzed preoperative computed tomography (CT) findings, including typical anatomical findings of recurred CRS such as lateralized middle turbinate and retained uncinate process, the sinus where recurrence took place, and previous surgical completeness of the sinuses, between the rECRS and rNECRS groups.ResultsIn total, 142 patients were enrolled (48 rECRS, 94 rNECRS). No significant difference was found in the typical anatomic findings of recurrent CRS between the rECRS and rNECRS groups. The rates of the completeness of previous surgeries was significantly higher in rECRS than in rNECRS(P=.031). Despite the completeness of previous surgeries, the recurrence rate of frontal and ethmoidal sinuses was higher in the rECRS than rNECRS(P=.012, P<.001, respectively). In subgroup analysis according to the severity of ECRS, the number of involved sinuses and the rates of CRS recurrence and surgical completeness in frontal and anterior ethmoidal sinuses increased with ECRS severity.ConclusionsCT findings of revision FESS cases differed by CRS endotype. The rECRS group showed higher recurrence in the frontal and ethmoidal sinuses despite a higher surgical completeness rate. Incomplete surgery was more often found in the rNECRS group.     

慢性鼻-鼻窦炎CT筛窦分型组织病理学与预后相关性

目的 观察评价慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)CT筛窦分型的组织病理学特点及其与预后的关系.方法 回顾性分析112例CRS患者,按术前轴位鼻窦CT进行筛窦分型;观察筛窦标本骨质病理学改变,并对筛窦骨质重塑活性进行评分;采用Lund和Kennedy鼻内镜评分评价预后;分析不同CT筛窦分型间筛窦骨质组织病理评分和鼻内镜评分的差异以及骨质组织病理评分和鼻内镜评分的相关性.结果 Ⅲ型(骨质增生型)25例,占22.3%;Ⅱ型(空泡型)44例,占39.35;Ⅰ型(蜂窝型)43例,占38.4%.Ⅲ型骨组织病理改变程度和术后随访鼻内镜评分分别与Ⅰ型和Ⅱ型间差异有统计学意义(P值分别为0.01,0.02).CBS患者的筛窦骨组织病理评分和术后鼻内镜评分有明显相关性(X2=9.78,P=0.002).结论 CBS的CT筛窦分型具有相应组织病理学基础;新骨形成或重塑是反映鼻窦疾病严重程度的重要指标,筛窦骨组织病变程度能够反映患者术后预后情况;CT筛窦分型对鼻内镜外科手术疗效的预测具有现实应用意义.     

慢性鼻-鼻窦炎鼻息肉患者细菌生物膜的观察

目的 观察慢性鼻-鼻窦炎鼻息肉患者手术黏膜组织中细菌生物膜的形态特征,并分析其与临床因素、术后疗效的关系.方法 试验组获取72例慢性鼻-鼻窦炎鼻息肉患者手术中筛窦黏膜组织,对照组获取15例鼻中隔偏曲患者、10例鼻骨骨折患者钩突黏膜组织(患者均知情同意),所有组织标本均行扫描电镜检查.对两组患者进行术后随访,分别应用Lund-Kennedy鼻内镜检查、慢性鼻窦炎疗效评定标准(1997年,海口)评估患者病情改善程度.采用t检验分析细菌生物膜对术后Lund-Kennedy评分的影响;采用卡方检验分析细菌生物膜与内镜手术疗效的相关性,以P＜0.05为差异有统计学意义.结果 试验组72例慢性鼻-鼻窦炎鼻息肉患者中有3例患者失访,失访率为4.2%.69例慢性鼻-鼻窦炎鼻息肉患者的细菌生物膜阳性率71.0%(49/69),并且可以观察到黏膜组织纤毛不同程度的损伤.对照组未发现细菌生物膜,可以观察到黏膜纤毛较浓密,排列整齐.卡方检验结果显示,性别、慢性鼻-鼻窦炎鼻息肉类型、病程等因素在试验组细菌生物膜阴性组与阳性组间差异无统计学意义(P值均＞0.05).细菌生物膜阳性组患者术后6个月和12个月的Lund-Kennedy 评分(4.78 ±1.67;4.55 ±1.61)分别高于细菌生物膜阴性组患者(3.65 ±1.39;3.65 ±1.18),差异均有统计学意义(t=-2.654,P＜0.01;t=-2.264,P＜0.05);细菌生物膜阴性组术后6个月和12个月的疗效明显优于细菌生物膜阳性组,差异有统计学意义(x2值分别为18.014、22.063,P值均＜0.001).结论 慢性鼻.鼻窦炎鼻息肉患者手术黏膜组织中存在细菌生物膜的生命周期不同形态,细菌生物膜的存在与否,与慢性鼻-鼻窦炎鼻息肉的类型、性别、病程无明显相关.细菌生物膜可能对患者术后疗效产生不良的影响.

Abstract：

Objective To explore the presence of bacterial biofilms(BF) in patients with CRS and the effect of BF on clinical symptoms and postoperative outcomes.Methods Seventy-two patients with chronic sinusitis were enrolled in this study.The control group included 15 patients with deviation of the nasal septum and 10 patients had a fracture of the nasal bone.Mucosa of the uncinate process or ethmoid near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery.The specimens were subjected to scanning electron microscopy.Patients were followed for 1 year and observed by the LundKennedy endoscopy,and the Haikou standard classification (ESS-1997).Statistical analysis was performed by t-test or chi-square test Results Three patients were lost to follow-up.The scanning electron microscopy analysis showed bacterial biofilms in 49 of the 69 patients with chronic sinusitis.A marked destruction of the epithelium and cilia was observed in samples positive for bacterial biofilms.No bacterial biofilms were detected in the control group,and scanning electron microscopy showed normal epithelium and cilia in those specimens.There was no significant difference in gender,classification or duration of disease between the BF(-) and BF( + ) groups.At six months and one year postoperative,the Lund-Kennedy endoscopy scores for CRS patients with BF(4.78 ± 1.67 ;4.55 ± 1.61) were significantly higher than those without BF(3.65 ±1.39;3.65 ±1.18) (t =-2.654,P＜0.01;l =-2.264,P＜0.05).Based on the Haikou standard classification,there was a significantly difference between patients with BF and those without BF( x2 = 18.014,22.063 ,P ＜ 0.001,respectively).Conclusions Different life stages of bacterial biofilms were demonstrated to be present in CRS.Gender,classification or duration of disease did not affect the presence of bacterial biofilms in patients with CRS.There is a correlation between bacterial biofilms and an unfavorable outcome in patients with CRS after ESS.     

Delayed type of allergic skin reaction to Candida albicans in eosinophilic rhinosinusitis cases

Objective

Eosinophilic chronic rhinosinusitis (ECRS) is frequently complicated by asthma, and recognized as refractory and persistent rhinosinusitis. However, the detailed pathophysiology of ECRS has not been elucidated yet. In this study, we investigated the association between recurrent ECRS and intradermal testing to multi-antigens including Candida albicans.

Comparative outcomes of endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

This study was carried out to compare the outcomes of endoscopic sinus surgery in patients with chronic sinusitis without nasal polyps (CRS) and those with nasal polyps (NP). We also sought to determine the correlation between preoperative computed tomography (CT) findings and postoperative endoscopy and symptom score improvement. Data were collected from two groups of patients diagnosed as CRS with and without nasal polyps that underwent functional endoscopic sinus surgery with a 1-year postoperative follow up. Preoperative symptoms, CT scores, and endoscopic scores were recorded. Postoperative symptom and endoscopic scores were recorded at 1, 6, and 12 months. Assessment of symptoms was performed subjectively using visual analogue scoring (VAS). CT scan findings were scored using the Lund–Mackay system. Endoscopic examination findings were scored according to the staging system proposed by Lanza and Kennedy. The correlations between the CT score, endoscopic scores and VAS scores were calculated. There was a statistically significant correlation between the preoperative CT, symptom, and endoscopic scores. Postoperative symptom and endoscopic scores also showed a significant correlation. Total CT scores of the CRS group were significantly lower than the scores of the NP group. Also preoperative endoscopy and symptom scores were statistically lower in CRS group compared to NP group. Endoscopy total scores and symptom total scores of both groups were significantly decreased at postoperative 12th month. Statistically significant difference was observed between the preoperative and postoperative symptom and endoscopy scores. The patients with polyps had higher symptom scores and worse objective findings compared to the patients with CRS. In all patients groups, objective and subjective scores seemed to correlate well preoperatively and postoperatively. These data suggest that endoscopic sinus surgery provides significant symptomatic relief and endoscopic healing in patients with CRS and NP.