慢性鼻-鼻窦炎伴鼻息肉患者组织嗜酸性粒细胞与嗅觉功能障碍的相关性研究

目的探讨慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者术后组织嗜酸性粒细胞与嗅觉功能障碍的相关性。方法回顾性选择2016年7月至2018年7月CRSwNP行鼻内镜鼻窦手术(ESS)治疗的120例患者。通过视觉模拟评分(VAS)和Lund-Kennedy评分了解患者病情;术后取筛窦黏膜组织进行嗜酸性粒细胞计数。通过Sniffin’Sticks测试和化学感觉事件相关电位(CSERP)来评估嗅觉功能。Spearman相关分析用以了解嗜酸性粒细胞计数与Sniffin’Sticks测试和CSERP参数之间的关系及VAS评分和CSERP的相关性。结果调整协变量(年龄、性别、饮酒、吸烟、过敏性鼻炎、哮喘、术后时间和Lund-Kennedy评分)后的相关性分析结果与未调整协变量的结果一致。组织嗜酸性粒细胞计数与阈值评分相关(r=-0.460,P=0.012);组织嗜酸性粒细胞计数与苯乙醇(N1:r=0.471,P=0.010;P2:r=-0.487,P=0.007)及乙醇(N1:r=-0.516,P=0.008;P2:r=-0.590,P=0.002)刺激产生的CSERP峰值潜伏期N1和P2相关;但与CSERP振幅均无明显相关(P>0.05)。苯乙醇刺激产生的阈值评分和CSERP峰值潜伏期N1之间存在明显负相关(r=-0.560,P<0.001)。乙醇刺激产生的CSERP潜伏期与症状VAS评分存在明显负相关(r=-0.400,P=0.005)。结论CRSwNP患者鼻术后组织嗜酸性粒细胞增多与术后嗅觉功能障碍明显相关,且三叉神经的敏感性可能与组织嗜酸性粒细胞增多相关,鼻黏膜炎症可同时影响嗅神经及三叉神经的功能。

Correlation between eosinophils and olfactory dysfunction in patients with CRSwNP after nasal operation

Objective To investigate the association between postoperative tissue eosinophils and olfactory dysfunction in patients with chronic rhinosinusitis and nasal polyps(CRSwNP). Methods A retrospective study of 120 patients who underwent CRSFNP endoscopic sinus surgery(ESS)between July 2016 and July 2018 was performed. The conditions of the patients were graded with the VAS and Lund-Kennedy scores; the eosinophil counts of the sinus mucosa were obtained. Olfactory function was assessed using the Sniffin' Sticks test and chemosensory event-related potential(CSERP). Spearman correlation analysis was used to determine the relationship between eosinophil count and the Sniffin' Sticks test results and CSERP parameters as well as the correlation between the VAS score and CSERP. Results The correlation analysis results after adjustment for covariates(age, gender, alcohol consumption, smoking, allergic rhinitis, asthma, postoperative time, and Lund-Kennedy score)were consistent with the results of the unadjusted covariates. The tissue eosinophil counts were associated with the threshold scores(r=-0.460, P=0.012): tissue eosinophil count and phenylethyl alcohol(N1: r=0.471, P=0.010; P2: r=-0.487, P=0.007)and ethanol(N1: r=-0.516, P=0.008; P2: r=-0.590, P=0.002). The peak latency of CSERP induced by stimulation was related to N1 and P2; however, it showed no significant correlation with the CSERP amplitude(P>0.05). There was a significant negative correlation between the threshold score generated by phenylethyl alcohol stimulation and the CSERP peak latency(N1: r=-0.560, P<0.001). There was a significant negative correlation between the CSERP latency generated by ethanol stimulation and the symptomatic VAS score(r=-0.400, P=0.005). Conclusions Postoperative tissue eosinophilia in patients with CRSwNP is significantly associated with postoperative olfactory disturbance, and the sensitivity of the trigeminal nerve may be associated with tissue eosinophilia. Inflammation of the nasal mucosa may affect the function of the olfactory and trigeminal nerves.