慢性鼻—鼻窦炎相关病因浅析

发布时间：2019-01-01 14:39

【摘要】：目的:探析慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)发病的相关因素,分析CRS发病原因。方法:选取318例CRS患者为研究对象,术前均作鼻内窥镜、鼻窦CT检查并经手术和病理学检查确诊为CRS,将研究对象分为CRSsNP、CRSwNP两组,结合患者术前外周血嗜酸粒细胞、血清总IgE、特异性IgE、补体C3、C4、鲎株实验、鼻窦CT扫描,术中细菌培养及鼻息肉标本检查结果等临床资料,从变应因素、解剖因素、感染因素三个方面,分析其与CRS的相关性,应用SPSS20.0统计软件对所得数据进行统计学分析。结果:1、318例CRS患者中,伴变应性因素患者157例,占49.37%,其中,慢性鼻-鼻窦炎不伴鼻息肉(CRSsNP)患者22例,占22.68%,慢性鼻-鼻窦炎伴有鼻息肉(CRSwNP)患者135例,占61.09%,两者卡方检验差异有统计学意义(P0.05);2、318例CRS患者,共195例出现鼻腔鼻窦解剖结构异常,发生率为61.35%,以中重度鼻中隔偏曲最常见,其次为钩突异常(偏曲和肥大)、筛泡肥大、中鼻甲异常(气化及反曲)、上颌窦自然孔闭锁等;3、318例CRS患者中,外周血补体C3、C4不正常(升高或降低)者分别有105例(33.02%)、111例(34.91%);外周血鲎株实验阳性者56例(17.61%);132份样本检出细菌,检出率为41.51%,其中,金黄色葡萄球菌最常见。结论:CRS是多种因素相互作用的结果,其中解剖因素最常见,其次为变应性因素和感染因素;变应因素对CRS的发生发展起到促进作用,尤其是CRSwNP发生和病情复发的主要原因之一;CRS的发生常伴有鼻腔鼻窦解剖结构的变异,且随着病变的严重程度增加,鼻部解剖变异发生率增高,其中较为常见的结构异常为鼻中隔偏曲(中重度)、钩突异常(偏曲和肥大)及中鼻甲气化;细菌感染在CRS发病中发挥着重要作用,鼻腔鼻窦解剖异常可以增加病原菌感染的概率。
[Abstract]:Objective: to explore the related factors of chronic rhinosinusitis (chronic rhinosinusitis,CRS) and analyze the causes of CRS. Methods: 318 patients with CRS were enrolled in the study. The patients were divided into two groups: CRSsNP,CRSwNP group and peripheral blood eosinophilic granulocyte before operation by CT examination of paranasal sinuses and confirmed by operation and pathology, combined with eosinophil in peripheral blood of patients before operation. The clinical data of serum total IgE, specific IgE, complement C3C4, Limulus test, paranasal sinus CT scan, intraoperative bacterial culture and nasal polyp examination were analyzed from three aspects: allergic factors, anatomical factors and infection factors. The correlation between SPSS20.0 and CRS was analyzed, and the data was analyzed by SPSS20.0 software. Results: among the 1318 patients with CRS, 157 cases (49.37%) were associated with allergic factors. Among them, 22 cases (22.68%) were chronic rhinosinusitis without nasal polyp (CRSsNP), and 135 cases were chronic rhinosinusitis with nasal polyp (CRSwNP). Accounted for 61.09%, the two chi-square test difference was statistically significant (P0.05); In 2318 patients with CRS, there were 2318 cases with abnormal anatomic structure of nasal cavity and paranasal sinus, the incidence rate was 61.35. The most common of them was moderate and severe deviation of nasal septum, followed by abnormality of uncinate process (deviation and hypertrophy), hypertrophy of ethmoid vesicle, abnormality of middle turbinate (gasification and reversion). Atresia of natural foramen of maxillary sinus; Among the 3318 patients with CRS, 105 cases (33.02%) had abnormal complement C _ 3C _ 4 (increased or decreased), 11.1% (34.91%) had abnormal complement C _ 3C _ 4, 56 cases (17.61%) had positive peripheral blood Limulus test. Bacteria were detected in 132 samples, and the detection rate was 41. 51%, among which Staphylococcus aureus was the most common. Conclusion: CRS is the result of the interaction of many factors, among which the anatomic factor is the most common, followed by the allergic factor and the infection factor. Allergy factors play an important role in the development of CRS, especially in the occurrence and recurrence of CRSwNP. The occurrence of CRS was often accompanied by the variation of nasal anatomic structure, and the incidence of nasal anatomic variation increased with the increase of the severity of the lesion. The most common structural abnormality was nasal septum deviation (moderate and severe). Abnormal uncinate process (deviation and hypertrophy) and middle turbinate gasification; Bacterial infection plays an important role in the pathogenesis of CRS. The anatomic abnormality of nasal cavity and paranasal sinus can increase the probability of pathogen infection.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765

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