医生及患者对慢性鼻—鼻窦炎主、客观评价的相关性分析
摘要
[研究背景和目的]
慢性鼻-鼻窦炎(Chronic fungal rhino-sinusitis, CRS)是耳鼻喉科最常见的慢性疾病之一,患有慢性鼻-鼻窦炎的患者很难被完全治愈,其对社会心理的影响也很难定量,使患者的身体、心理、社会功能受到极大影响,越来越受到耳鼻喉科医师的重视。但是目前关于耳鼻喉科临床医生主观评与CRS病情严重程度相关性分析的研究较少,本文主要从临床医生及患者的角度,分别比较他们的视觉模拟量表(visual analogue scale)VAS评分与计算机CT扫描、鼻内镜检查以及鼻腔鼻窦结局测量20条(sino-nasal outcome test-20, SNOT-20)之间的是否存在相关性,进一步了解哪个因素更能反映CRS病情的严重程度。
[研究方法]
本研究采用汉化SNOT-20、VAS评分、Lund—Kennedy鼻内镜评分系统以及Lund-Mackay CT评分系统前瞻性对110例慢性鼻-鼻窦炎患者进行研究。由三位耳鼻喉临床医生根据患者的临床资料分别对CRS病情严重程度进行VAS主观评分,并与患者的主观评估、客观检查结果进行相关性比较。同时将全部患者分为真菌性鼻窦炎组(fungal rhino-sinusitis, FRS)、CRS伴有鼻息肉(CRS with nasal polyps, CRSwNP)以及CRS不伴有鼻息肉(CRS without nasal polyps, CRSnNP)三个亚组后进行临床医生VAS评分与患者的主观评估、客观检查进行相关性分析。
[结果]
三位临床医生对慢性鼻-鼻窦患者术前生活质量的VAS均呈正相关(r=0.7105P＜0.0001, r=0.5644P＜0.0001, r=0.5204P＜0.0001)；在未分组的情况下,三位临床医生VAS评分平均数和Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6103,P＜0.0001),三位临床医生VAS评分平均数与Lund—Mackay CT评分呈正相关(r=0.7252,P＜0.0001)；真菌性鼻-鼻窦炎亚组中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6056,P=0.01),与Lund—Mackay CT评分呈正相关(r=0.7199,P＜0.0011)；慢性鼻窦炎不伴鼻息肉亚组中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6135,P=0.0003),与Lund—MackayCT评分呈正相关(r=0.4624,P＜0.0101)；慢性鼻窦炎伴有鼻息肉组亚中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.4419,P=0.0003),与Lund—Mackay CT评分呈正相关(r=0.7625,P＜0.0001)；无论是在分组前还是分组后,三位临床医生VAS评分平均数与SNOT-20评分和VAS评分均呈无相关(P＞0.05)；Lund—Kennedy鼻内镜检查评分以及Lund—MackayCT评分在三个亚组之间存在显著差异(P＜0.001),SNOT-20评分和VAS评分均无统计学差异(P＞0.05)。
[结论]
临床医生VAS评分能够反映CRS病情严重程度,没有发现与患者的生活质量之间的相关性。患者VAS评分主要与患者生活质量相关,在一定程度也能反映病变严重程度。真菌性鼻-鼻窦炎、慢性鼻窦炎伴有鼻息肉,慢性鼻窦炎不伴鼻息肉亚组在鼻内镜检查、CT评分以及医生评分之间存在显著差异,慢性鼻窦炎伴有鼻息肉得分较高。
[Objective]
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases that poses a great challenge to specialists in the field of rhino-otolaryngology. CRS is difficult to be completely cured and its impact on patient's physical,psychological, social function is difficult to quantified.However, very few studies have comprehensively examined the relationship between doctors subjective assessment and the severity of CRS. The study was mainly from the point of clinicians and patients to compare the correlation between visual analogue scale (VAS) score and sino-nasal outcome test-20(SNOT-20), Lund—Kennedy endoscopy staging system and the Lund—Mackay CT staging system,respectively. This can help us to find out which factors could most respect the severity of CRS.
[Methods]
In this research, we introduced the SNOT-20,VAS score, Lund—Kennedy endoscopy staging system and the Lund—Mackay CT staging system and to study110patients with CRS. Three experienced physicians were asked to evaluate the severity of patient's condition using the VAS after they analysis the medical records, computed tomography (CT) scans and endoscopic appearances. All of110patients were divided into there groups such as fungal rhino-sinusitis,CRS with nasal polyp,CRS without nasal polyps.We investigate the association between doctors subjective assessment and patient objective and subjective assessment.
[Results]
There were significant correlations between three physicians VAS with each other (r=0.7105P<0.0001, r=0.5644P<0.0001, r=0.5204P<0.0001).In the ungrouped situation, the mean of three physicians VAS correlate with the Lund—Mackay CT score (r=0.7252, P<0.0001) and Lund—Mennedy endoscopy staging (r=0.6103, P<0.0001). In the Fungal rhinosinusitis group, Significant correlations were found between the mean of three physicians VAS and the Lund—Mackay CT staging (r=0.7199, P<0.0011)and Lund—Mennedy endoscopy staging (r=0.6056, P=0.01); In the Chronic rhinosinusitis without nasal poplys group, the mean of three physicians VAS correlate with the Lund—Mackay CT staging (r=0.4624, P<0.0101) and Lund—Kennedy endoscopy staging(r=0.6135, P=0.0003); In the Chronic rhinosinusitis with nasal poplys group, the mean of three physicians VAS correlate with the Lund—Mackay CT staging (r=0.4419, P=0.0003) and Lund—Kennedy endoscopy staging (r=0.7625, P<0.0001); There were no significant correlations between the mean of three physicians VAS and the patient-based VAS and SNOT-20There are significant differences between the three groups in the Lund—Mackay CT staging and Lund—Kennedy endoscopy staging (P<0.05).
[Conclusion]
The physicians subjective testing correlated well with the severity of CRS and did not correlate with patient quality of life.The patients VAS score associated well with patient quality of life and the severity of CRS.The Lund—Mackay CT staging,the doctors VAS score and Lund—Kennedy endoscopy staging were different in three groups and CRS with nasal polyp got most scores.
慢性鼻-鼻窦炎(Chronic fungal rhino-sinusitis, CRS)是耳鼻喉科最常见的慢性疾病之一,患有慢性鼻-鼻窦炎的患者很难被完全治愈,其对社会心理的影响也很难定量,使患者的身体、心理、社会功能受到极大影响,越来越受到耳鼻喉科医师的重视。但是目前关于耳鼻喉科临床医生主观评与CRS病情严重程度相关性分析的研究较少,本文主要从临床医生及患者的角度,分别比较他们的视觉模拟量表(visual analogue scale)VAS评分与计算机CT扫描、鼻内镜检查以及鼻腔鼻窦结局测量20条(sino-nasal outcome test-20, SNOT-20)之间的是否存在相关性,进一步了解哪个因素更能反映CRS病情的严重程度。
[研究方法]
本研究采用汉化SNOT-20、VAS评分、Lund—Kennedy鼻内镜评分系统以及Lund-Mackay CT评分系统前瞻性对110例慢性鼻-鼻窦炎患者进行研究。由三位耳鼻喉临床医生根据患者的临床资料分别对CRS病情严重程度进行VAS主观评分,并与患者的主观评估、客观检查结果进行相关性比较。同时将全部患者分为真菌性鼻窦炎组(fungal rhino-sinusitis, FRS)、CRS伴有鼻息肉(CRS with nasal polyps, CRSwNP)以及CRS不伴有鼻息肉(CRS without nasal polyps, CRSnNP)三个亚组后进行临床医生VAS评分与患者的主观评估、客观检查进行相关性分析。
[结果]
三位临床医生对慢性鼻-鼻窦患者术前生活质量的VAS均呈正相关(r=0.7105P＜0.0001, r=0.5644P＜0.0001, r=0.5204P＜0.0001)；在未分组的情况下,三位临床医生VAS评分平均数和Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6103,P＜0.0001),三位临床医生VAS评分平均数与Lund—Mackay CT评分呈正相关(r=0.7252,P＜0.0001)；真菌性鼻-鼻窦炎亚组中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6056,P=0.01),与Lund—Mackay CT评分呈正相关(r=0.7199,P＜0.0011)；慢性鼻窦炎不伴鼻息肉亚组中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.6135,P=0.0003),与Lund—MackayCT评分呈正相关(r=0.4624,P＜0.0101)；慢性鼻窦炎伴有鼻息肉组亚中,三位临床医生VAS评分平均数与Lund—Kennedy鼻内镜检查评分呈正相关(r=0.4419,P=0.0003),与Lund—Mackay CT评分呈正相关(r=0.7625,P＜0.0001)；无论是在分组前还是分组后,三位临床医生VAS评分平均数与SNOT-20评分和VAS评分均呈无相关(P＞0.05)；Lund—Kennedy鼻内镜检查评分以及Lund—MackayCT评分在三个亚组之间存在显著差异(P＜0.001),SNOT-20评分和VAS评分均无统计学差异(P＞0.05)。
[结论]
临床医生VAS评分能够反映CRS病情严重程度,没有发现与患者的生活质量之间的相关性。患者VAS评分主要与患者生活质量相关,在一定程度也能反映病变严重程度。真菌性鼻-鼻窦炎、慢性鼻窦炎伴有鼻息肉,慢性鼻窦炎不伴鼻息肉亚组在鼻内镜检查、CT评分以及医生评分之间存在显著差异,慢性鼻窦炎伴有鼻息肉得分较高。
[Objective]
Chronic rhinosinusitis (CRS) is one of the most common chronic diseases that poses a great challenge to specialists in the field of rhino-otolaryngology. CRS is difficult to be completely cured and its impact on patient's physical,psychological, social function is difficult to quantified.However, very few studies have comprehensively examined the relationship between doctors subjective assessment and the severity of CRS. The study was mainly from the point of clinicians and patients to compare the correlation between visual analogue scale (VAS) score and sino-nasal outcome test-20(SNOT-20), Lund—Kennedy endoscopy staging system and the Lund—Mackay CT staging system,respectively. This can help us to find out which factors could most respect the severity of CRS.
[Methods]
In this research, we introduced the SNOT-20,VAS score, Lund—Kennedy endoscopy staging system and the Lund—Mackay CT staging system and to study110patients with CRS. Three experienced physicians were asked to evaluate the severity of patient's condition using the VAS after they analysis the medical records, computed tomography (CT) scans and endoscopic appearances. All of110patients were divided into there groups such as fungal rhino-sinusitis,CRS with nasal polyp,CRS without nasal polyps.We investigate the association between doctors subjective assessment and patient objective and subjective assessment.
[Results]
There were significant correlations between three physicians VAS with each other (r=0.7105P<0.0001, r=0.5644P<0.0001, r=0.5204P<0.0001).In the ungrouped situation, the mean of three physicians VAS correlate with the Lund—Mackay CT score (r=0.7252, P<0.0001) and Lund—Mennedy endoscopy staging (r=0.6103, P<0.0001). In the Fungal rhinosinusitis group, Significant correlations were found between the mean of three physicians VAS and the Lund—Mackay CT staging (r=0.7199, P<0.0011)and Lund—Mennedy endoscopy staging (r=0.6056, P=0.01); In the Chronic rhinosinusitis without nasal poplys group, the mean of three physicians VAS correlate with the Lund—Mackay CT staging (r=0.4624, P<0.0101) and Lund—Kennedy endoscopy staging(r=0.6135, P=0.0003); In the Chronic rhinosinusitis with nasal poplys group, the mean of three physicians VAS correlate with the Lund—Mackay CT staging (r=0.4419, P=0.0003) and Lund—Kennedy endoscopy staging (r=0.7625, P<0.0001); There were no significant correlations between the mean of three physicians VAS and the patient-based VAS and SNOT-20There are significant differences between the three groups in the Lund—Mackay CT staging and Lund—Kennedy endoscopy staging (P<0.05).
[Conclusion]
The physicians subjective testing correlated well with the severity of CRS and did not correlate with patient quality of life.The patients VAS score associated well with patient quality of life and the severity of CRS.The Lund—Mackay CT staging,the doctors VAS score and Lund—Kennedy endoscopy staging were different in three groups and CRS with nasal polyp got most scores.
引文
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[1]Kaliner MA, Osguthorpe JD, Fireman P, Anon J, Georgitis J, Davis ML et al. Sinusitis:bench to bedside-current findings, future directions. J Allergy Clin Immunol 1997;99:S829-S848.
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[3]Gliklich R,Metson R,A comparison of sinus computed tomography staging system for outcomes research. Am J Rhinol.1994,8:291-7.
[4]Gliklich R, Metson R. A Techniques for outcomes research in chron ic sinusitis[J].Laryngoscope,1995,105(4 Pt 1):387-390.
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[6]May M, Levine HL, Schaitkin B, et al. Results of surgery. In:Levine H, May M, editors. Rhinology and sinusology. New York:Thieme Medical Publishers, Inc,1993:176-92.
[7]Kenney DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope.1992,102:(Suppl 57):1-18.
[8]Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinology, 1993:107:183-4.
[9]Oluwole M, Russell N, Tan L, et al。A comparison of computerized to mographic staging systems in chronic sinusitis C lin Otolaryngol, 1996,21(1):91-95. M, Russell N, Tan L, et al. A comparison of computerized
[10]Lloyd GAS, Diagnostic imaging of the nose and paranasal sinuses. London:Springer Verlag,1988:10.
[11]. Ware JE, Sherbourne CD. The MOS 36-item short form health survey. I. Conceptual framework and item selection. Med Care 1992:30:473-483.
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[1]Kaliner MA, Osguthorpe JD, Fireman P, Anon J, Georgitis J, Davis ML et al. Sinusitis:bench to bedside-current findings, future directions. J Allergy Clin Immunol 1997;99:S829-S848.
[2]周兵,韩德民,黄谦.鼻窦CT扫描与鼻内窥镜鼻窦手术..中华耳鼻咽喉科杂志,1996,31(3)：185-186.
[3]Gliklich R,Metson R,A comparison of sinus computed tomography staging system for outcomes research. Am J Rhinol.1994,8:291-7.
[4]Gliklich R, Metson R. A Techniques for outcomes research in chron ic sinusitis[J].Laryngoscope,1995,105(4 Pt 1):387-390.
[5]Friedman WH, Katsantonis GP, Sivore M, et al.Computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis. Laryngoscope.1990,100:1116-5.
[6]May M, Levine HL, Schaitkin B, et al. Results of surgery. In:Levine H, May M, editors. Rhinology and sinusology. New York:Thieme Medical Publishers, Inc,1993:176-92.
[7]Kenney DW. Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope.1992,102:(Suppl 57):1-18.
[8]Lund VJ, Mackay IS. Staging in rhinosinusitis. Rhinology, 1993:107:183-4.
[9]Oluwole M, Russell N, Tan L, et al。A comparison of computerized to mographic staging systems in chronic sinusitis C lin Otolaryngol, 1996,21(1):91-95. M, Russell N, Tan L, et al. A comparison of computerized
[10]Lloyd GAS, Diagnostic imaging of the nose and paranasal sinuses. London:Springer Verlag,1988:10.
[11]. Ware JE, Sherbourne CD. The MOS 36-item short form health survey. I. Conceptual framework and item selection. Med Care 1992:30:473-483.
[12]Aaronson NK, Acquadro C, Alonso J, et al. International Quality of Life Assessment (IQOLA) Project. Qual Life Res 1992;1:349-351.
[13]Ware JE Jr, Kosinski M, Keller SD. A 12 Item Short Form Health Survey:Construction of scales and preliminary tests of reliability and validity. Med Care 1996:34:220-233.
[14]. Melzack R. The McGill Pain Questionnaire:major properties and scoring methods. Pain 1975;1:277-299.
[15]Melzack R. The short-form McGill Pain Questionnaire. Pain 1987:30:191-197.
[16]The EuroQol Group. EuroQol:A new facility for the measurement of healthrelated quality of life. Health Policy 1990:16:199-208.
[17]Landgraf JM, Abetz L, Ware JE. The CHQ User s Manual.1st ed. Boston, Mass:The Health Institute, New England Medical Center; 1996.
[18]Cunningham JM, Chiu EJ, Landgraf JM, GliklichRE. The health impact of chronic recurrent rhinosinusitis in children. Arch Otolaryngol Head Neck Surg 2000:126:1363-1368.
[19]Benninger MS, Senior BA. The development of the Rhinosinusitis Disability Index. Arch Otolaryngol Head Neck Surg 1997;123:1175-1179.
[20]Piccirillo JF ED, Haiduk A. Psychometric and clinimetric validity of the 3-item rhinosinusitis outcome measure(RSOM-31). Am J Rhinol 1995:9:297-306.
[21]Piccirillo JF, Merritt MG Jr, Richards ML. Psychometric and clinimetric validity of the 20-item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 2002:126:41-47.
[22]Gliklich RE, Metson R. Techniques for outcomes research in chronic sinusitis. Laryngoscope 1995:105:387-390.
[23]. Atlas SJ, Gallagher PM, Wu YA, Singer DE, Gliklich RE, Metson RB et al. Development and validation of a new health-related quality of life instrument for patients with sinusitis. Qual Life Res 2005:14:1375-1386.
[24]Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy 1991:21:77-83.