慢性鼻-鼻窦炎伴鼻息肉患者肺功能检测分析及临床意义

摘要

Objective To investigate the incidence and severity of pulmonary function impairment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods In this prospective study,fifty-six patients with bilateral CRSwNP who were scheduled for functional endoscopic sinus surgery during a period from March to June 2010 in the Department of Otolaryngology of Qilu Hospital,were recruited in this study.Routine medical and rhinological examinations such as nasal endoscopy,sinus CT scan,and skin prick tests (SPT) for common inhalant and food allergens,and cytological examination of the paraffinembedded NP tissues were performed together with a full assessment of the pulmonary functions.Results Based on the pulmonary function tests,the rate of patients showing bronchial hyperresponsiveness (BHR),asthma,and abnormal pulmonery functions were 37.5％,44.6％,and 53.6％.In patients who did not have a history of lower airway symptoms,the rate of abnormal pulmonary functions was 50.0％,the rate of BHR was 43.2％.There was an increased rate of BHR,asthma and abnormal pulmonary functions in patients with a higher polyp grading score or Lund Mackay CT scan score (polyp grading score:x2 were 8.077,3.989 and 7.445,P＜0.01 or ＜0.05.CT scan score:x2 were 3.863,5.380 and 4.309;4.293,4.293 and 4.572;10.572,13.504 and 13.295,P ＜0.01 or ＜0.05).The rate of BHR and asthma in patients with positive SPT were higher (P ＜ 0.05).In patients with eosinophils hyperplasia in nasal polyps,the rate of BHR,asthma and abnormal pulmonary functions were higher (x2 were 4.065,5.217 and 3.376,P ＜0.05 or P ＜0.01).Conclusions There is a high risk of developing lower airway diseases in patients with CRSwNP.%目的 通过对慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者肺功能的检测,分析鼻息肉的病变范围及炎症状态与下呼吸道病变发生的相关性及临床意义.方法 对2011年3月至6月住院手术的56例CRSwNP患者进行前瞻性研究,详细询问病史,术前均行变应原皮肤点刺试验、肺功能检测、鼻内镜检查、鼻窦CT检查、术后鼻息肉组织嗜酸性粒细胞计数.依据以上检测结果将患者分组,比较各组间气道高反应性、哮喘、肺功能异常的发生率及其与鼻息肉病变范围和炎症状态的相关性.结果 CRSwNP患者发生气道高反应性、哮喘、肺功能异常的比率分别为37.5％、44.6％、53.6％；没有明显下呼吸道症状患者肺功能异常的发生率亦高达50.0％.CRSwNP患者鼻内镜评分、CT评分分值越高,其发生气道高反应性、哮喘、肺功能异常的比率越大,组间差异均有统计学意义(鼻内镜评分x2内镜镜值分别为8.077、3.989、7.445,P值＜0.01或＜0.05；x2CTT值分别为3.863、5.380、4.309；4.293、4.293、4.572;10.572、13.504、13.295;P值＜0.01或＜0.05).皮肤点刺实验阳性患者发生气道高反应性和哮喘的比率比阴性患者大,组间差异有统计学意义(P值＜0.05).鼻息肉组织中嗜酸性粒细胞增多患者气道高反应、哮喘、肺功能异常的发生率均明显高于嗜酸性粒细胞正常的患者,组间差异有统计学意义(P值＜ 0.05或＜0.01).结论 CRSwNP患者可能伴发有症状或无症状的下呼吸道病变,病变范围及炎症程度与下呼吸道病变的发生率呈正相关性.