嗜酸粒细胞性慢性鼻-鼻窦炎的分型及临床特征研究

发布时间：2018-01-23 09:48

  本文关键词： 嗜酸性粒细胞 鼻窦炎 病理学 组织分型 临床特征　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的验证东北地区慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)依据组织嗜酸粒细胞(eosinophil,EOS)浸润程度进行分型的可行性。而后将CRS分为嗜酸粒细胞性CRS(eosinophilic CRS,ECRS)和非嗜酸粒细胞性CRS(non-eosinophilic CRS,NECRS)两组,观察近12年来ECRS构成比的变化趋势,并对比分析ECRS与NECRS两组间病程、临床症状、鼻部体征、外周血嗜酸粒细胞百分比(EOS%)、影像学变化、预后等临床特点,寻找术前CRS分型的参考指标,为CRS的分类治疗提供临床依据。方法纳入符合CRS诊断标准的病例共330例作为研究对象。根据组织病理类型将病例分为水肿型、腺体增生型、纤维型3组,比较各组中不同EOS浸润程度的CRS的构成差异。以组织EOS%≥15%作为ECRS的判定标准,描绘近12年ECRS构成比的变化曲线,观察其变化趋势;将病例分为ECRS组(n=153)和NECRS组(n=177)。通过记录病程、症状评分、检验外周血EOS%水平、鼻内镜检查评估鼻黏膜病变程度、鼻窦CT评估鼻窦病变程度、对比手术前后症状判断预后等指标描述临床特征,对两组病例的以上特点进行比较和分析,应用SPSS22.0进行数据处理。结果(1)不同病理类型的3组CRS病例之间,性别、年龄的差异无显著性(P0.05),不同EOS浸润程度的CRS病例在3组间的分布有显著差异(P=0.000409)。(2)近12年ECRS构成比及组织EOS%的变化趋势无规律可循。(3)ECRS组和NECRS组间,性别、年龄的差异无显著性(P0.05)。(4)ECRS组病程持续时间为12.00[5.50;30.00]月,NECRS组为9.00[2.50;36.00]月,差异无统计学意义(P0.05)。(5)两组间鼻塞、流涕、头面部胀痛、嗅觉减退的症状评分无明显差异(P0.05)。(6)ECRS组外周血EOS%为5.10[3.00;7.60],显著高于NECRS组的1.90[1.20;3.55],此差异有统计学意义(P=6.14×10-10);分析组织EOS%与血EOS%的相关性,r=0.49,二者呈正相关;当外周血EOS%≥4.15%时,诊断ECRS的敏感度为64%。特异度为81.8%。(7)ECRS组与NECRS组的鼻腔黏膜病变程度、息肉、水肿、鼻漏评分均无显著差异(P0.05)。(8)ECRS组鼻窦CT病变程度总分为10.00[7.00;16.00],NECRS组为8.00[5.50;12.00],结果具有统计学意义(P=0.041);ECRS组前组筛窦评分为2.00[2.00;3.00],NECRS组评分为2.00[1.00;2.00],差异具有显著性(P=0.045);ECRS组后组筛窦评分(2.00[2.00;3.00])高于NECRS组评分(2.00[1.00;2.00]),差异显著(P=0.018);ECRS组和NECRS组的额窦、上颌窦、筛窦/上颌窦比值、蝶窦和OMC评分差异不显著(P0.05)。(9)ECRS组全组鼻窦炎的累及率(22.88%)明显高于NECRS组(11.86%),差异具有统计学意义(P=0.008);ECRS组的后组筛窦累及率(96.08%)明显高于NECRS组(81.92%),差异具有显著性(P=0.00006);ECRS组的上颌窦累及率为98.04%,NECRS组为88.14%,两组间差异显著(P=0.001);额窦、前组筛窦、蝶窦和OMC累及率在两组间的差异无意义(P0.05)。(10)FESS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(P0.01),NECRS组患者术后除头面部胀痛无缓解(P0.05)外,鼻塞、流涕、嗅觉障碍评分均低于术前各症状评分(P0.05);但两组间术后各项症状评分无明显差异(P0.05)。结论东北地区CRS可按组织嗜酸粒细胞浸润程度进行分型。近12年内,ECRS构成比的变化趋势无显著特征。与NECRS相比,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。早期分型有助于CRS的分类治疗,对临床用药及治疗方案的制定具有指导意义。
[Abstract]:Objective to validate the chronic nose - sinusitis in Northeast China (chronic rhinosinusitis, CRS) on the basis of tissue eosinophils (eosinophil, EOS) the feasibility of infiltration type. Then CRS is divided into eosinophilic CRS (eosinophilic, CRS, ECRS) and non eosinophilic CRS (non-eosinophilic CRS NECRS) the two observation group, ECRS in the past 12 years of changes, and the comparative analysis of ECRS and NECRS between the two groups of disease duration, clinical symptoms, nasal symptoms, peripheral blood eosinophil percentage (EOS%), the radiologic changes, clinical characteristics and prognosis, to find the reference index in preoperative CRS classification, provide the clinical basis for the treatment of CRS. Methods included in the classification according to CRS criteria 330 cases as the research object. According to the pathological type of the patients were divided into edematous type, glandular type, fiber type 3 group, which is not the same infiltration degree of EOS CRS were compared in difference ISO. To organize the EOS% more than 15% as the criterion of ECRS, described ECRS in the past 12 years constitute curve ratio, observe its change trend; the cases were divided into ECRS group (n=153) and NECRS group (n=177). By recording the course of disease, symptom score, EOS% level of peripheral blood test, nasal endoscopic evaluation degree the nasal mucosa lesions, sinus CT to assess the degree of sinus lesions, comparing the preoperative and postoperative prognosis symptoms index to describe the clinical features, the above characteristics of the two groups were compared and analyzed, the data were processed by SPSS22.0. Results (1) between the sexes, different pathological types of 3 cases of CRS group, there was no significant difference in age (P0.05), different degrees of infiltration of EOS CRS cases showed significant differences in distribution between the 3 groups (P=0.000409). (2) ECRS in the past 12 years constitute a trend and EOS% no law to follow. (3) ECRS group and NECRS group, gender, age had no significant difference (P0.0 5).(4)ECRS缁勭梾绋嬫寔缁�鏃堕棿涓�12.00[5.50;30.00]鏈，

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