嗜酸性粒细胞对鼻息肉复发的预测价值

发布时间：2018-06-17 22:13

本文选题：鼻息肉复发 + 组织嗜酸性粒细胞计数　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:1.探索鼻息肉复发的危险因素,为预防鼻息肉复发提供理论依据;2.对鼻息肉复发患者行息肉组织中嗜酸性粒细胞计数,并探讨组织嗜酸性粒细胞对鼻息肉复发的预测价值;方法:分析吉大二院耳鼻喉科自2015年10月1日~2016年10月1日收治并行功能性鼻内镜手术患者59例。患者均完整记载病历资料,在术前行血常规检查,记录血液中嗜酸性粒细胞计数、百分比、中性粒细胞计数、血小板计数及淋巴细胞计数;行鼻窦CT,行Lund-Mackay评分;过敏原检测,记录过敏原种类及总Ig E值,术后组织送病理,行组织嗜酸性粒细胞计数,出院后规律用药,术后1月、3月、6月随访,查电子鼻咽镜,行Lund-Kennedy评分。应用spss20.0行统计分析,Graph Pad Prism 6.0绘图。结果:1)鼻息肉复发组和未复发组中过敏原种类无差异(p=0.764),总Ig E在两组之间也无差异(p=0.311);2)鼻息肉复发组与未复发组中,血液嗜酸性粒细胞计数(p=0.538)及百分比(p=0.727)无明显差异,血中性粒细胞计数/淋巴细胞计数(p=0.693)及血小板计数/淋巴细胞计数(p=0.354)差异也无统计学意义;3)两组之间鼻窦CT Lund-Mackay评分筛窦(p=0.53)、窦口鼻道复合体(OMC)阻塞程度(p=0.46)无显著差异,但两组之间上颌窦评分(p=0.01)及筛窦/上颌窦比值(p=0.04)明显不同,上颌窦评分严重程度为鼻息肉复发的独立危险因素;4)复发组和未复发组间哮喘(p=0.021),组织嗜酸性粒细胞计数(p=0.042)有差异,且两者均为鼻息肉复发的独立危险因素;5)诊断性ROC曲线中,上颌窦评分与组织嗜酸性粒细胞相比,曲线下面积较大。但复发组和未复发组中,组织嗜酸性粒细胞较上颌窦评分离散程度大,有较高区分度。结论:1)组织中嗜酸性粒细胞为鼻息肉复发的独立危险因素,并可能对其复发有诊断价值;2)上颌窦评分及筛窦/上颌窦评分对鼻息肉复发有影响,上颌窦评分严重程度为鼻息肉复发的独立危险因素,但复发组与未复发组间不易区分,预测价值可能不强;3)哮喘为鼻息肉复发的独立危险因素,伴有哮喘的鼻息肉患者术后应规律治疗,密切随访;4)过敏原种类及总Ig E在鼻息肉复发组和未复发组间无明显差异;5)鼻息肉为局部炎症反应,外周血液学指标可能对其诊断意义不大
[Abstract]:Purpose 1. To explore the risk factors of nasal polyp recurrence and to provide theoretical basis for prevention of nasal polyp recurrence. The eosinophil count in nasal polyp tissues was studied in patients with recurrent nasal polyps and the predictive value of eosinophilic granulocytes in nasal polyps was discussed. Methods: 59 patients with functional endoscopic sinus surgery from October 1, 2015 to October 1, 2016 in Department of Otorhinolaryngology of the second Jida Hospital were analyzed. All the patients had complete records of their medical records. Before operation, the eosinophilic granulocyte count, percentage, neutrophil count, platelet count and lymphocyte count were recorded, and the nasal sinus CTs, Lund-Mackay score, allergen test were recorded. The types of allergens and the total IgE values were recorded, the pathological changes were observed, the eosinophil count was counted, and the regular medication was used after discharge. The patients were followed up for 1 month, 3 months and 6 months after the operation. The patients were followed up with electronic nasopharyngoscope and Lund-Kennedy score. The graph Pad Prism 6.0 drawing is applied to the statistical analysis of spss20.0 row. Results (1) there was no difference in the types of allergens between recurrent and non-recurrent nasal polyps, and there was no significant difference in total IgE between the two groups. There was no significant difference in eosinophil count and percentage p0.727 between recurrent and non-recurrent nasal polyps. There was no significant difference in neutrophil count / lymphocyte count (p0. 693) and platelet count / lymphocyte count (P < 0. 354) between the two groups. There was no significant difference between the two groups in CT Lund-Mackay score of ethmoid sinus p0. 53 and the degree of obstruction of sinusoidal ostioronasal complex (OMCs) (p0. 46). However, the maxillary sinus score (p0.01) and ethmoid sinus / maxillary sinus ratio (p0.04) were significantly different between the two groups. The severity of maxillary sinus score was the independent risk factor of nasal polyp recurrence (P 0.021) and the count of eosinophilic granulocytes (p0.042) was significantly different between the recurrent group and the non-recurrent group. In the diagnostic ROC curve, the maxillary sinus score was larger than that in the tissue eosinophil. However, the eosinophilic granulocytes in the recurrent group and the non-recurrent group had higher degree of dispersion and higher differentiation than those in the maxillary sinus score. Conclusion eosinophil is an independent risk factor for the recurrence of nasal polyps and may have diagnostic value in the recurrence of nasal polyps. (2) maxillary sinus score and ethmoid / maxillary sinus score have an effect on the recurrence of nasal polyps. The severity of maxillary sinus score was an independent risk factor for the recurrence of nasal polyps, but it was not easy to distinguish between the recurrent group and the non-recurrent group, and the predictive value might not be strong (3) Asthma was the independent risk factor for the recurrence of nasal polyps. The patients with nasal polyps with asthma should be treated regularly after operation and followed up closely. 4) the type of allergen and total IgE had no significant difference between recurrent and non-recurrent nasal polyps. 5) nasal polyps were local inflammatory reaction. Peripheral hematologic markers may be of little significance for its diagnosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.25

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