鼻窦CT评分在评估慢性鼻-鼻窦炎嗅觉障碍中的应用
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摘要
目的探讨分析鼻窦CT评分在慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者嗅觉功能评估的价值。方法回顾性分析92例确诊为CRS患者的临床资料,其中嗜酸性粒细胞性慢性鼻-鼻窦炎(eosinophi chronic rhinosinu sitis,ECRS)组患者28例,非嗜酸性粒细胞性慢性鼻-鼻窦炎(non eosinophi chronic rhinosinu sitis,nECRS)组患者64例。排除鼻部手术史和其他可能影响嗅觉功能的因素,进行病史采集、嗅觉功能检测和鼻窦CT评分,采用χ~2和t检验比较两组间患者临床资料;采用Mann-Whitney U检验比较两组鼻窦CT评分;采用Spearman相关分析对鼻窦CT评分和嗅觉功能进行相关性分析;采用ROC曲线分析鼻窦CT评分在嗅觉障碍中的预测评估价值。结果 ECRS组双侧炎症(26/28),筛窦上额窦总和差,(EM差)值3.32±2.25;nECRS组双侧炎症(48/64),EM差值1.81±2.33,两组患者比较差异均具有统计学意义(P<0.05)。在CT评分方面,CRS患者的EM差值与嗅觉功能相关性更强(r=0.634),具有更高的预测评估价值,其曲线下面积为0.827。当EM差截断值取2.5时,诊断嗅觉障碍的敏感度为76.9%,特异度为79.2%。结论与其他鼻窦CT评分相比,筛窦上颌窦总和差值对于CRS患者嗅觉障碍有更好的预测诊断价值。
Objective To analyze the value of sinonasal computed tomographic(CT) scores in evaluating the olfactory function in patients with chronic rhinosinusits(CRS). Methods 92 patients with CRS were enrolled in this study. Of them, 28 suffered from eosinophilic CRS(ECRS) and 64 suffered from non-eosinophilic CRS(nECRS). The patients with prior nasal surgery or other diseases affecting the olfaction were excluded. Detailed medical histories were collected, sinonasal CT scan and olfactory detection were performed to all the patients.χ~2and t test were used to compare the medical history. Mann-Whitney U analysis was used to compare the Lund-Mackay scores of the two groups. Spearman rank correlations were used to examine correlations between olfactory acuity and CT score. Receiver operating characteristic(ROC) curve was used to analyze the predictive diagnostic value of CT score in olfactory function.Results The difference of the CT scores between the ethmoid sinus and maxillary sinus(EM difference) and bilateral inflammation of the ECRS group were significantly higher than those of the nECRS group(3.32±2.25 vs 1.81±2.33, 26/28 vs 48/64, both P<0.05). Compared with other CT scores, EM difference showed stronger relationship with olfactory acuity(r=0.634,P<0.01). EM difference had a better predictive value, with an area under the ROC curve(AUC) value of 0.827. The cutoff point of 2.5 for EM difference demonstrated a sensitivity of 76.9% and a specificity of 79.2% for olfactory dysfunction in CRS.Conclusion Compared to other CT scores, EM difference has a better predictive value for the diagnosis of olfactory dysfunction in CRS patients.
Objective To analyze the value of sinonasal computed tomographic(CT) scores in evaluating the olfactory function in patients with chronic rhinosinusits(CRS). Methods 92 patients with CRS were enrolled in this study. Of them, 28 suffered from eosinophilic CRS(ECRS) and 64 suffered from non-eosinophilic CRS(nECRS). The patients with prior nasal surgery or other diseases affecting the olfaction were excluded. Detailed medical histories were collected, sinonasal CT scan and olfactory detection were performed to all the patients.χ~2and t test were used to compare the medical history. Mann-Whitney U analysis was used to compare the Lund-Mackay scores of the two groups. Spearman rank correlations were used to examine correlations between olfactory acuity and CT score. Receiver operating characteristic(ROC) curve was used to analyze the predictive diagnostic value of CT score in olfactory function.Results The difference of the CT scores between the ethmoid sinus and maxillary sinus(EM difference) and bilateral inflammation of the ECRS group were significantly higher than those of the nECRS group(3.32±2.25 vs 1.81±2.33, 26/28 vs 48/64, both P<0.05). Compared with other CT scores, EM difference showed stronger relationship with olfactory acuity(r=0.634,P<0.01). EM difference had a better predictive value, with an area under the ROC curve(AUC) value of 0.827. The cutoff point of 2.5 for EM difference demonstrated a sensitivity of 76.9% and a specificity of 79.2% for olfactory dysfunction in CRS.Conclusion Compared to other CT scores, EM difference has a better predictive value for the diagnosis of olfactory dysfunction in CRS patients.
引文
[1] Enriquez K,Lehrer E,Mullol J.The optimal evaluation and management of patients with a gradual onset of olfactory loss[J].Curr Opin Otolaryngol Head Neck Surg,2014,22(1):34-41.
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[4] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻-鼻窦炎诊断和治疗指南(2012年,昆明)[J].中华耳鼻咽喉头颈外科杂志,2013,48(2):92-94.Subspecialty Group of Rhinology,Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery,Subspecialty Group of Rhinology,Society of Otorhinolaryngology Head and Neck Surgery,Chinese Medical Association.Guidelines for diagnosis and treatment of chronic rhinosinusitis (2012,Kunming)[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2013,48(2):92-94.
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[9] 徐赫.嗅上皮干细胞病理改变与嗅觉障碍发生及严重程度的相关性研究[D].上海:海军军医大学,2018.Xu H.Correlation between pathological changes of olfactory epithelium and the occurrence and severity of olfactory disorder[D].Shanghai:Navy Medical University,2018.
[10] Sánchez-Vallecillo MV,Fraire ME,Baena-Cagnani C,et al.Olfactory dysfunction in patients with chronic rhinosinusitis[J].Int J Otolaryngol,2012:327206.
[11] Lal D,Scianna JM,Stankiewicz JA.Efficacy of targeted medical therapy in chronic rhinosinusitis,and predictors of failure[J].Am J Rhinol Allergy,2009,23(4):396-400.
[12] Baguley C 1,Brownlow A,Yeung K,et al.The fate of chronic rhinosinusitis sufferers after maximal medical therapy[J].Int Forum Allergy Rhinol,2014,4(7):525-532.
[13] Thompson CF,Price CP,Huang JH,et al.A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis[J].Int Forum Allergy Rhinol,2016,6(5):500-507.
[14] Shah SA,Ishinaga H,Takeuchi K.Pathogenesis of eosinophilic chronic rhinosinusitis[J].J Inflamm,2016,13(1):11.
[15] Hauser LJ,Chandra RK,Li P,et al.Role of tissue eosinophils in chronic rhinosinusitis-associated olfactory loss[J].Int Forum Allergy Rhinol,2017,7(10):957-962.
[16] Tokunaga T,Sakashita M,Haruna T,et al.Novel scoring system and algorithm for classifying chronic rhinosinusitis:the JESREC Study[J].Allergy,2015,70(8):995-1003.
[17] Sakuma Y,Ishitoya J,Komatsu M,et al.New clinical diagnostic criteria for eosinophilic chronic rhinosinusitis[J].Auris Nasus Larynx,2011,38(5):583-588.
[2] Croy I,Nordin S,Hummel T.Olfactory disorders and quality of life-an updated review[J].Chem Senses,2014,39(3):185-194.
[3] Thompson CF,Kern RC,Conley DB.Olfaction in endoscopic sinus and skull base surgery[J].Otolaryngol Clin North Am,2015,48(5):795-804.
[4] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻-鼻窦炎诊断和治疗指南(2012年,昆明)[J].中华耳鼻咽喉头颈外科杂志,2013,48(2):92-94.Subspecialty Group of Rhinology,Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery,Subspecialty Group of Rhinology,Society of Otorhinolaryngology Head and Neck Surgery,Chinese Medical Association.Guidelines for diagnosis and treatment of chronic rhinosinusitis (2012,Kunming)[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2013,48(2):92-94.
[5] 王明婕,周兵,李云川,等.外周血嗜酸粒细胞比例在慢性鼻-鼻窦炎伴鼻息肉分类中的作用[J].中华耳鼻咽喉头颈外科杂志,2013,48(8):650-653.Wang MJ,Zhou B,Li YC,et al.The role of peripheral blood eosinophil percentage in classification of chronic rhinosinusitis with nasal polyps[J].Chinese Journal of Otorhinolaryngology Head and Neck Surgery,2013,48(8):650-653.
[6] Chen F,Luo X,Xu R,et al.Evaluation of airway hyperresponsiveness in chronic rhinosinusitis:values of sinus computed tomography[J].Ann Allergy Asthma Immunol,2014,113(6):609-613.
[7] Meng Y,Lou H,Wang C,et al.Predictive significance of computed tomography in eosinophilic chronic rhinosinusitis with nasal polyps[J].Int Forum Allergy Rhinol,2016,6(8):812-819.
[8] Rombaux P,Huart C,Levie P,et al.Olfaction in chronic rhinosinusitis[J].Curr Allergy Asthma Rep,2016,16(5):41.
[9] 徐赫.嗅上皮干细胞病理改变与嗅觉障碍发生及严重程度的相关性研究[D].上海:海军军医大学,2018.Xu H.Correlation between pathological changes of olfactory epithelium and the occurrence and severity of olfactory disorder[D].Shanghai:Navy Medical University,2018.
[10] Sánchez-Vallecillo MV,Fraire ME,Baena-Cagnani C,et al.Olfactory dysfunction in patients with chronic rhinosinusitis[J].Int J Otolaryngol,2012:327206.
[11] Lal D,Scianna JM,Stankiewicz JA.Efficacy of targeted medical therapy in chronic rhinosinusitis,and predictors of failure[J].Am J Rhinol Allergy,2009,23(4):396-400.
[12] Baguley C 1,Brownlow A,Yeung K,et al.The fate of chronic rhinosinusitis sufferers after maximal medical therapy[J].Int Forum Allergy Rhinol,2014,4(7):525-532.
[13] Thompson CF,Price CP,Huang JH,et al.A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis[J].Int Forum Allergy Rhinol,2016,6(5):500-507.
[14] Shah SA,Ishinaga H,Takeuchi K.Pathogenesis of eosinophilic chronic rhinosinusitis[J].J Inflamm,2016,13(1):11.
[15] Hauser LJ,Chandra RK,Li P,et al.Role of tissue eosinophils in chronic rhinosinusitis-associated olfactory loss[J].Int Forum Allergy Rhinol,2017,7(10):957-962.
[16] Tokunaga T,Sakashita M,Haruna T,et al.Novel scoring system and algorithm for classifying chronic rhinosinusitis:the JESREC Study[J].Allergy,2015,70(8):995-1003.
[17] Sakuma Y,Ishitoya J,Komatsu M,et al.New clinical diagnostic criteria for eosinophilic chronic rhinosinusitis[J].Auris Nasus Larynx,2011,38(5):583-588.