[Predictive study on recurrence of chronic sinusitis with nasal polyps by tissue eosinophils and sinus CT].

Objective: To investigate the correlation between postoperative recurrence and clinical parameters in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and to study predicitve value of total scores of eosinophils (EOS) and sinus CT for postoperative recurrence. Methods: A retrospective analysis of 264 patients with CRSwNP who were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2015 was performed. The patient was subjected to a visual analogue scale (VAS) score, a skin prick test, a peripheral blood cell count, a sinus CT score, and a nasal polyp EOS count. All patients underwent endoscopic surgery and were followed up for at least 2 years. The demographic characteristics of the nasal polyps recurrence group and the non-recurrence group were compared with other clinical indicators. Quantitative data were compared by t test or Mann-Whitney U test, qualitative data were compared by chi-square test, and Logistic regression analysis was used for Logistic regression analysis. The risk factors for recurrence were assessed. The best cut-off value was determined by using the receiver operating characteristic (ROC) curve. The predictive value of the parameters was determined by area under curve (AUC). The difference was statistically significant at P<0.05. Results: The recurrence rate of the study patients was 43.56% (115/264). Sex, olfactory VAS score, total sinus CT score, peripheral blood neutrophil ratio, peripheral blood EOS absolute value and proportion, and tissue EOS absolute value and proportion were associated with postoperative recurrence of nasal polyps (χ(2)=5.241, t=-3.146, t=-7.441, χ(2)=180.617, t=-5.313, χ(2)=100.067, t=-7.471, χ(2)=258.916, all P<0.05), and the tissue EOS ratio and total sinus CT scores have higher predictive value for recurrence of nasal polyps (AUC values were 0.793, 0.767, respectively, all P<0.001). With the EOS ratio of nasal polyps >0.032, the sensitivity of predicting recurrence was 83.48%, the specificity was 56.38%. With the total score of sinus CT>15, the sensitivity of predicting recurrence was 51.30% and the specificity was 87.25%. The combined sensitivity of predictive recurrence was 92.00% and the specificity was 49.20%. Conclusion: The percentage of EOS in nasal polyps and the total score of sinus CT in patients with CRSwNP have better predictive diagnostic value for recurrence of nasal polyps.目的： 探讨慢性鼻－鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps，CRSwNP)患者术后鼻息肉复发与各临床指标的相关性，研究组织嗜酸粒细胞(eosinophils，EOS)及鼻窦CT总分对鼻息肉术后复发的预测价值。 方法： 回顾性分析2013年6月至2015年12月就诊于温州医科大学附属第一医院的264例CRSwNP患者，对患者进行鼻部视觉模拟量表(visualanalogue scale，VAS)评分、皮肤点刺试验、外周血细胞计数、鼻窦CT评分、鼻息肉EOS计数。所有患者均接受鼻内镜手术，术后随访时间至少2年。对鼻息肉复发组和未复发组的人口特征和其他临床指标进行比较，对定量资料用t检验或Mann－Whitney U检验进行比较，对定性资料用卡方检验进行比较；应用Logistic回归分析用于评估复发的危险因素，应用受试者工作特征(ROC)曲线确定最佳截断值，以曲线下面积(area under curve，AUC)判断参数的预测价值；以P<0.05为差异有统计学意义。 结果： 本研究患者复发率为43.56%(115/264)。性别、嗅觉VAS评分、鼻窦CT总分、外周血中性粒细胞占比、外周血EOS绝对值及占比和组织EOS绝对值及占比与鼻息肉术后复发有关(χ(2)＝5.241，t＝－3.146，t＝－7.441，χ(2)＝180.617，t＝－5.313，χ(2)＝100.067，t＝－7.471，χ(2)＝258.916，P值均<0.05)，其中组织EOS占比及鼻窦CT总分对鼻息肉术后复发的预测价值较高(AUC值分别为0.793、0.767，P值均<0.001)。鼻息肉组织EOS占比>0.032预测复发的敏感度为83.48%，特异度为56.38%；鼻窦CT总分>15分预测复发的敏感度为51.30%，特异度为87.25%。两者联合预测复发的敏感度为92.00%，特异度为49.20%。 结论： 许多因素与CRSwNP术后复发有关，其中鼻息肉组织EOS百分比和鼻窦CT总分对其有较好的预测诊断价值。.