患者术前临床特征对嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的预测价值

Predictive value of preoperative clinical features in eosinophilic chronic rhinosinusitis with nasal polyps

摘要:

目的 探讨患者的术前临床特征对嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉(ECRSwNP)的预测价值，并构建用于临床实践的诺模图。方法 选取2019年9月—2020年9月就诊于新乡医学院第一附属医院并行功能性鼻内镜手术治疗的慢性鼻窦炎伴鼻息肉(CRSwNP)患者97例,根据术后病理结果嗜酸性粒细胞(EOS)浸润程度将其分为ECRSwNP组和非嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉(nonECRSwNP)组，收集并比较两组患者的临床特征资料，采用单因素及多因素二元Logistic回归分析筛选对ECRSwNP有预测价值的术前特征资料，并构建用于临床实践的诺模图。采用SPSS 26.0和R语言软件4.1.2对数据进行分析。结果 两组患者在是否合并哮喘史、外周血嗜酸性粒细胞(EOS)计数、外周血嗜碱性粒细胞(Baso)计数、日本难治性嗜酸性慢性鼻窦炎流行病学调查(JESREC)评分、上颌窦评分、前后组筛窦评分、CT总分、E/M(筛窦与上颌窦的Lund-Mackay评分比值)上差异具有统计学意义(P＜0.05)。单因素及多因素二元Logistic回归分析并构建的诺模图显示，基于哮喘史、外周血EOS、外周血Baso、上颌窦评分、及E/M的诺模图对ECRSwNP具有较高的预测价值，协调性指数(C-index)值为0.909，95％可信区间(CI)为0.828~0.989。结论 基于哮喘史、外周血EOS、外周血Baso、上颌窦评分及E/M的诺模图，对ECRSwNP具有较高的预测价值，起到精准医疗和改善预后的作用。

关键词:慢性鼻窦炎伴鼻息肉;嗜酸性粒细胞;预测指标;诺模图

Abstract:

Objective To investigate the predictive value of preoperative clinical features for eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP), and to construct a nomogram for clinical practice.Methods A total of 97 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who underwent functional endoscopic sinus surgery in our hospital from Sept 2019 to Sept 2020 were recruited, and divided into ECRSwNP group and nonesinophilc chronic rhinosinusitis with nasal polyps (nonECRSwNP) group according to the postoperative pathological results of eosinophils (EOS) infiltration. The clinical characteristics of both groups were collected and compared. The univariate and multivariate binary logistic regression analyses were used to screen the preoperative characteristics with predictive value for ECRSwNP, and the nomogram for clinical practice was constructed. SPSS 26.0 and R language software 4.1.2 were used to analyze the data.Results There were significant differences in the history of asthma, peripheral blood EOS percentage (EOS), peripheral blood basophil percentage (Baso), Japanese refractory eosinophilic chronic sinusitis epidemiological survey (JESREC) score, maxillary sinus computed tomography (CT) scores, ethmoid sinus CT scores, total CT scores as well as the ratio of the CT scores for the ethmoid sinus and maxillary sinus (E/M ratio) between the two groups (all P<0.05). The nomogram based on the history of asthma, peripheral blood EOS%, peripheral blood Baso%, maxillary sinus scores, and E/M ratio had a high predictive value for ECRSwNP, and the coordination index value was 0.909 with a 95% confidence interval of 0.828-0.989.Conclusion The nomogram based on asthma history, EOS and Baso in peripheral blood, maxillary sinus CT score and E/M ratio has a high predictive value for ECRSwNP.

Key words:Chronic sinusitis with nasal polyps;Eosinophils;Prediction indicator;Nomogram