本文關(guān)鍵詞： 嗜酸性粒細(xì)胞 鼻竇炎 病理學(xué) 組織分型 臨床特征　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的驗(yàn)證東北地區(qū)慢性鼻-鼻竇炎(chronic rhinosinusitis,CRS)依據(jù)組織嗜酸粒細(xì)胞(eosinophil,EOS)浸潤程度進(jìn)行分型的可行性。而后將CRS分為嗜酸粒細(xì)胞性CRS(eosinophilic CRS,ECRS)和非嗜酸粒細(xì)胞性CRS(non-eosinophilic CRS,NECRS)兩組,觀察近12年來ECRS構(gòu)成比的變化趨勢,并對比分析ECRS與NECRS兩組間病程、臨床癥狀、鼻部體征、外周血嗜酸粒細(xì)胞百分比(EOS%)、影像學(xué)變化、預(yù)后等臨床特點(diǎn),尋找術(shù)前CRS分型的參考指標(biāo),為CRS的分類治療提供臨床依據(jù)。方法納入符合CRS診斷標(biāo)準(zhǔn)的病例共330例作為研究對象。根據(jù)組織病理類型將病例分為水腫型、腺體增生型、纖維型3組,比較各組中不同EOS浸潤程度的CRS的構(gòu)成差異。以組織EOS%≥15%作為ECRS的判定標(biāo)準(zhǔn),描繪近12年ECRS構(gòu)成比的變化曲線,觀察其變化趨勢;將病例分為ECRS組(n=153)和NECRS組(n=177)。通過記錄病程、癥狀評分、檢驗(yàn)外周血EOS%水平、鼻內(nèi)鏡檢查評估鼻黏膜病變程度、鼻竇CT評估鼻竇病變程度、對比手術(shù)前后癥狀判斷預(yù)后等指標(biāo)描述臨床特征,對兩組病例的以上特點(diǎn)進(jìn)行比較和分析,應(yīng)用SPSS22.0進(jìn)行數(shù)據(jù)處理。結(jié)果(1)不同病理類型的3組CRS病例之間,性別、年齡的差異無顯著性(P0.05),不同EOS浸潤程度的CRS病例在3組間的分布有顯著差異(P=0.000409)。(2)近12年ECRS構(gòu)成比及組織EOS%的變化趨勢無規(guī)律可循。(3)ECRS組和NECRS組間,性別、年齡的差異無顯著性(P0.05)。(4)ECRS組病程持續(xù)時間為12.00[5.50;30.00]月,NECRS組為9.00[2.50;36.00]月,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(5)兩組間鼻塞、流涕、頭面部脹痛、嗅覺減退的癥狀評分無明顯差異(P0.05)。(6)ECRS組外周血EOS%為5.10[3.00;7.60],顯著高于NECRS組的1.90[1.20;3.55],此差異有統(tǒng)計(jì)學(xué)意義(P=6.14×10-10);分析組織EOS%與血EOS%的相關(guān)性,r=0.49,二者呈正相關(guān);當(dāng)外周血EOS%≥4.15%時,診斷ECRS的敏感度為64%。特異度為81.8%。(7)ECRS組與NECRS組的鼻腔黏膜病變程度、息肉、水腫、鼻漏評分均無顯著差異(P0.05)。(8)ECRS組鼻竇CT病變程度總分為10.00[7.00;16.00],NECRS組為8.00[5.50;12.00],結(jié)果具有統(tǒng)計(jì)學(xué)意義(P=0.041);ECRS組前組篩竇評分為2.00[2.00;3.00],NECRS組評分為2.00[1.00;2.00],差異具有顯著性(P=0.045);ECRS組后組篩竇評分(2.00[2.00;3.00])高于NECRS組評分(2.00[1.00;2.00]),差異顯著(P=0.018);ECRS組和NECRS組的額竇、上頜竇、篩竇/上頜竇比值、蝶竇和OMC評分差異不顯著(P0.05)。(9)ECRS組全組鼻竇炎的累及率(22.88%)明顯高于NECRS組(11.86%),差異具有統(tǒng)計(jì)學(xué)意義(P=0.008);ECRS組的后組篩竇累及率(96.08%)明顯高于NECRS組(81.92%),差異具有顯著性(P=0.00006);ECRS組的上頜竇累及率為98.04%,NECRS組為88.14%,兩組間差異顯著(P=0.001);額竇、前組篩竇、蝶竇和OMC累及率在兩組間的差異無意義(P0.05)。(10)FESS術(shù)后1年評價遠(yuǎn)期療效,ECRS組患者術(shù)后鼻塞、流涕、頭面部脹痛及嗅覺障礙評分均明顯低于術(shù)前癥狀評分(P0.01),NECRS組患者術(shù)后除頭面部脹痛無緩解(P0.05)外,鼻塞、流涕、嗅覺障礙評分均低于術(shù)前各癥狀評分(P0.05);但兩組間術(shù)后各項(xiàng)癥狀評分無明顯差異(P0.05)。結(jié)論東北地區(qū)CRS可按組織嗜酸粒細(xì)胞浸潤程度進(jìn)行分型。近12年內(nèi),ECRS構(gòu)成比的變化趨勢無顯著特征。與NECRS相比,ECRS的鼻竇病變范圍及程度較重,更易罹患全組鼻竇炎,其中篩竇病變程度最重,后組篩竇及上頜竇最易受累。外周血EOS%與組織EOS%呈正相關(guān),且在ECRS病例中顯著升高,可作為術(shù)前CRS分型的參考指標(biāo)。早期分型有助于CRS的分類治療,對臨床用藥及治療方案的制定具有指導(dǎo)意義。
[Abstract]:Objective to validate the chronic nose - sinusitis in Northeast China (chronic rhinosinusitis, CRS) on the basis of tissue eosinophils (eosinophil, EOS) the feasibility of infiltration type. Then CRS is divided into eosinophilic CRS (eosinophilic, CRS, ECRS) and non eosinophilic CRS (non-eosinophilic CRS NECRS) the two observation group, ECRS in the past 12 years of changes, and the comparative analysis of ECRS and NECRS between the two groups of disease duration, clinical symptoms, nasal symptoms, peripheral blood eosinophil percentage (EOS%), the radiologic changes, clinical characteristics and prognosis, to find the reference index in preoperative CRS classification, provide the clinical basis for the treatment of CRS. Methods included in the classification according to CRS criteria 330 cases as the research object. According to the pathological type of the patients were divided into edematous type, glandular type, fiber type 3 group, which is not the same infiltration degree of EOS CRS were compared in difference ISO. To organize the EOS% more than 15% as the criterion of ECRS, described ECRS in the past 12 years constitute curve ratio, observe its change trend; the cases were divided into ECRS group (n=153) and NECRS group (n=177). By recording the course of disease, symptom score, EOS% level of peripheral blood test, nasal endoscopic evaluation degree the nasal mucosa lesions, sinus CT to assess the degree of sinus lesions, comparing the preoperative and postoperative prognosis symptoms index to describe the clinical features, the above characteristics of the two groups were compared and analyzed, the data were processed by SPSS22.0. Results (1) between the sexes, different pathological types of 3 cases of CRS group, there was no significant difference in age (P0.05), different degrees of infiltration of EOS CRS cases showed significant differences in distribution between the 3 groups (P=0.000409). (2) ECRS in the past 12 years constitute a trend and EOS% no law to follow. (3) ECRS group and NECRS group, gender, age had no significant difference (P0.0 5).(4)ECRS緇勭梾紼嬫寔緇椂闂翠負(fù)12.00[5.50;30.00]鏈，

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