【摘要】：目的:探析慢性鼻-鼻竇炎(chronic rhinosinusitis,CRS)發(fā)病的相關(guān)因素,分析CRS發(fā)病原因。方法:選取318例CRS患者為研究對(duì)象,術(shù)前均作鼻內(nèi)窺鏡、鼻竇CT檢查并經(jīng)手術(shù)和病理學(xué)檢查確診為CRS,將研究對(duì)象分為CRSsNP、CRSwNP兩組,結(jié)合患者術(shù)前外周血嗜酸粒細(xì)胞、血清總IgE、特異性IgE、補(bǔ)體C3、C4、鱟株實(shí)驗(yàn)、鼻竇CT掃描,術(shù)中細(xì)菌培養(yǎng)及鼻息肉標(biāo)本檢查結(jié)果等臨床資料,從變應(yīng)因素、解剖因素、感染因素三個(gè)方面,分析其與CRS的相關(guān)性,應(yīng)用SPSS20.0統(tǒng)計(jì)軟件對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1、318例CRS患者中,伴變應(yīng)性因素患者157例,占49.37%,其中,慢性鼻-鼻竇炎不伴鼻息肉(CRSsNP)患者22例,占22.68%,慢性鼻-鼻竇炎伴有鼻息肉(CRSwNP)患者135例,占61.09%,兩者卡方檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05);2、318例CRS患者,共195例出現(xiàn)鼻腔鼻竇解剖結(jié)構(gòu)異常,發(fā)生率為61.35%,以中重度鼻中隔偏曲最常見(jiàn),其次為鉤突異常(偏曲和肥大)、篩泡肥大、中鼻甲異常(氣化及反曲)、上頜竇自然孔閉鎖等;3、318例CRS患者中,外周血補(bǔ)體C3、C4不正常(升高或降低)者分別有105例(33.02%)、111例(34.91%);外周血鱟株實(shí)驗(yàn)陽(yáng)性者56例(17.61%);132份樣本檢出細(xì)菌,檢出率為41.51%,其中,金黃色葡萄球菌最常見(jiàn)。結(jié)論:CRS是多種因素相互作用的結(jié)果,其中解剖因素最常見(jiàn),其次為變應(yīng)性因素和感染因素;變應(yīng)因素對(duì)CRS的發(fā)生發(fā)展起到促進(jìn)作用,尤其是CRSwNP發(fā)生和病情復(fù)發(fā)的主要原因之一;CRS的發(fā)生常伴有鼻腔鼻竇解剖結(jié)構(gòu)的變異,且隨著病變的嚴(yán)重程度增加,鼻部解剖變異發(fā)生率增高,其中較為常見(jiàn)的結(jié)構(gòu)異常為鼻中隔偏曲(中重度)、鉤突異常(偏曲和肥大)及中鼻甲氣化;細(xì)菌感染在CRS發(fā)病中發(fā)揮著重要作用,鼻腔鼻竇解剖異常可以增加病原菌感染的概率。
[Abstract]:Objective: to explore the related factors of chronic rhinosinusitis (chronic rhinosinusitis,CRS) and analyze the causes of CRS. Methods: 318 patients with CRS were enrolled in the study. The patients were divided into two groups: CRSsNP,CRSwNP group and peripheral blood eosinophilic granulocyte before operation by CT examination of paranasal sinuses and confirmed by operation and pathology, combined with eosinophil in peripheral blood of patients before operation. The clinical data of serum total IgE, specific IgE, complement C3C4, Limulus test, paranasal sinus CT scan, intraoperative bacterial culture and nasal polyp examination were analyzed from three aspects: allergic factors, anatomical factors and infection factors. The correlation between SPSS20.0 and CRS was analyzed, and the data was analyzed by SPSS20.0 software. Results: among the 1318 patients with CRS, 157 cases (49.37%) were associated with allergic factors. Among them, 22 cases (22.68%) were chronic rhinosinusitis without nasal polyp (CRSsNP), and 135 cases were chronic rhinosinusitis with nasal polyp (CRSwNP). Accounted for 61.09%, the two chi-square test difference was statistically significant (P0.05); In 2318 patients with CRS, there were 2318 cases with abnormal anatomic structure of nasal cavity and paranasal sinus, the incidence rate was 61.35. The most common of them was moderate and severe deviation of nasal septum, followed by abnormality of uncinate process (deviation and hypertrophy), hypertrophy of ethmoid vesicle, abnormality of middle turbinate (gasification and reversion). Atresia of natural foramen of maxillary sinus; Among the 3318 patients with CRS, 105 cases (33.02%) had abnormal complement C _ 3C _ 4 (increased or decreased), 11.1% (34.91%) had abnormal complement C _ 3C _ 4, 56 cases (17.61%) had positive peripheral blood Limulus test. Bacteria were detected in 132 samples, and the detection rate was 41. 51%, among which Staphylococcus aureus was the most common. Conclusion: CRS is the result of the interaction of many factors, among which the anatomic factor is the most common, followed by the allergic factor and the infection factor. Allergy factors play an important role in the development of CRS, especially in the occurrence and recurrence of CRSwNP. The occurrence of CRS was often accompanied by the variation of nasal anatomic structure, and the incidence of nasal anatomic variation increased with the increase of the severity of the lesion. The most common structural abnormality was nasal septum deviation (moderate and severe). Abnormal uncinate process (deviation and hypertrophy) and middle turbinate gasification; Bacterial infection plays an important role in the pathogenesis of CRS. The anatomic abnormality of nasal cavity and paranasal sinus can increase the probability of pathogen infection.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R765

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