变态反应性因素对慢性鼻-鼻窦炎内镜鼻窦手术疗效的影响

目的：探讨变态反应性因素对慢性鼻-鼻窦炎（CRS）内镜鼻窦手术（ESS）疗效的影响。方法：术前对115例患者进行变态反应性因素血清相关指标测定：血清总IgE浓度、血清特异性变应原IgE半定量检测、血清ECP浓度；进行症状与生活质量调查：VAS、SNOT-20、SF-36问卷调查；并进行LundMackayCT系统评分及海口标准分型分期。实际随访ESS术后1年以上患者74例，进行鼻内镜检查，根据术后疗效评定海口标准、Lund—Kennedy内镜评分系统进行评估；并进行VAS、SNOT-20、SF-36问卷调查。结果：血清总IgE浓度增高者术后VAS评分改善低于不增高者（P〈0．05）。术前海口分型Ⅱ、Ⅲ型患者中血清总IgE浓度增高者手术有效率、术后LundKennedy内镜评分较不增高者差（P〈0．05）。3种及3种以上血清特异性变应原IgE阳性患者的手术有效率、术后Lund—Kennedy内镜评分较3种以下阳性患者差（P〈0．05）。血清特异性变应原IgE强阳性患者的手术有效率、术后Lund—Kennedy内镜评分、术后VAS评分、术后SNOT-20评分较无强阳性患者差（P〈0．05）。ESS术后有效患者的血清ECP浓度显著低于无效患者（P〈0．05）。血清ECP浓度与LundKennedy内镜评分成正相关（r=0．49，P〈0．05）。术前海口分型Ⅱ、Ⅲ型患者中，血清ECP浓度增高的患者手术有效率、术后Lund—Kennedy内镜评分、术后VAS评分、术后VAS评分改善较血清ECP浓度不增高者差（P〈0．05）。结论：变态反应性因素对CRS患者主客观疗效有-定的负面影响作用。血清总IgE浓度增高与血清ECP浓度增高在伴鼻息肉的患者中提示手术疗效不佳。本研究为CRS的免疫治疗提供了-定依据。

Effect of allergy on outcomes after endoscopic sinus surgeryin patients with chronic rhinosinusitis

Objective：To explore correlation of allergy and outcomes after endoscopic sinus surgery （ESS） in patients with chronic rhinosinusitis. Method： Before ESS , 115 cases were arranged to detect allergic serum relative index： the concentration of serum TIgE,specific IgE semi-quatitative test and the concentration of serum ECP; to survey QOL status： VAS,SNOT-20 and SF 36; as well as inquire medical record, Lund-Mackay CT system sco ring, clinical classification of chronic rhinosinusitis. After ESS （〉1 year）, 74 cases were followed up. The subjective and objective assessment were achieved by means of VAS, SNOT 20, SF 36 and Lund Kennedy endoscopic scores. Result：The improvements of VAS scores of the cases with increased serum TIgE were significantly lower than those without increased serum TIgE （P〈0.05）. In cases of Ⅱ , Ⅲ types, the objective outcomes of the cases with increased serum TIgE were significantly worse than those without increased serum TIgE （P〈0. 05）. The objective outcomes of the cases with positive allergen （≥3） were significantly worse than those with positive aller gen （〈3） （P〈0.05）. The objective outcomes of the cases with strong positive allergen were significantly worse than those without strong positive allergen（P〈0.05）. VAS scores and SNOT-20 scores after endoscopic sinus surgery of the cases with strong positive allergen were significantly worse than those without strong positive allergen（P〈0.05）. The concentration of serum ECP of the invalid cases was significantly higher than effective cases （P〈0. 05）. The concentration of serum ECP was positive correlated with Lund-Kennedy endoscopic scores （r=0.49,P〈0.05）. In cases of Ⅱ ,Ⅲ types, the objective outcomes of the cases with increased serum ECP were significantly worse than those without increased serum ECP （P〈0.05）, VAS scores and SNOT-20 scores after endoscopic sinus surgery of the cases with increased serum ECP were significantly worse than those without incr