嗜酸粒细胞计数与鼻息肉患者鼻内镜手术治疗后复发的相关性分析OACSTPCD

Objective To investigate the correlation between eosinophils(Eos)and the recurrence of nasal polyps(NP)after nasal endoscopic surgery.Methods 189 patients with NP who underwent nasal endoscopic surgery from June 2020 to June 2022 were selected and followed up until June 2023.According to the definition of NP recurrence,they were divided into a recurrence group(n=68)and a non-recurrence group(n=121).The demographic distribution and clinical characteristics of the two groups were compared.Using the multivariate Logistic regression model,analyzed the independent risk factors for recurrence after nasal endoscopic surgery in NP patients,and further stepwise regression filter;Using restricted cubic spline model,analyzed the correlation between the Eos count and NP recurrence after nasal endoscopic surgery;Then establishing a model to predict the recurrence of NP after nasal endoscopic surgery.Result In the recurrent group,the degree of lesion(multiple nasal polyps),history of asthma,history of allergic rhinitis,lesion site(nasal septal deviation),Eos type nasal polyps,postoperative infection,intraoperative cavity adhesions,psychological status(adverse),Lund-Mackay score,pre-olfactory fissure score(≥1),post-olfactory fissure score(≥1),Eos count,and long-term use of nasal decongestants,all of them were higher than those in non-recurrence group(P<0.05).Multivariate Logistic regression analysis showed that multiple nasal polyps(O(＾R)=9.92,95%CI:4.70～20.94),history of asthma(O(＾R)=2.20,95%CI:1.05～4.63),history of allergic rhinitis(O(＾R)=3.16,95%CI:1.50～6.66),Eos type nasal polyp(O(＾R)=4.06,95%CI:2.17～7.61),postoperative infection(O(＾R)=8.35,95%CI:2.94～23.74),intraoperative adhesions(O(＾R)=5.08,95%CI:2.67～9.67),Lund-Mackay score≥15 points(O(＾R)=3.46,95%CI:1.05～6.49),pre-olfactory fissure score≥1 point(O(＾R)=2.29,95%CI:1.25～4.22),post-olfactory fissure score≥1 point(O(＾R)=2.60,95%CI:1.40～4.82),Eos count≥0.47×109/L(O(＾R)=4.19,95%CI:1.56～8.74)and long-term use of nasal decongestants(O(＾R)=3.10,95%CI:1.63～5.87)were all independent risk factors for recurrence in NP patients after nasal endoscopic surgery(P<0.05).And further stepwise regression analysis showed that these 11 clinical factors were most closely associated with postoperative recurrence in NP patients after nasal endoscopic surgery.The formula for calculating the risk of recurrence after nasal endoscopic surgery in NP patients was as follows:Logit(P)=1-1/(1+e1.69-lesion degree×2.29-history of asthma×0.79-history of allergic rhinitis×1.15-Eos type nasal polyp×1.40-postoperative infection×2.12-intraoperative cavity adhesion×1.63-Lund-Mackay score×1.24-pre-olfactory fissure score×0.83-post-olfactory fissure score×0.95-Eos count×1.43-long-term use of nasal decongestants×1.13).According to the formula,the probability of recurrence of NP patients after nasal endoscopic surgery was calculated.When probability was 0.80,Youden index was the highest and the prediction effect was relatively best.Conclusion Multiple nasal polyps,history of asthma,history of allergic rhinitis,Eos type nasal polyps,postoperative infection,surgical adhesions,high Lund Mackay score,high score in the pre-and post olfactory fissure area,as well as increased Eos count and long-term use of nasal decongestants are associated with recurrence after nasal endoscopic surgery in NP patients.The established risk prediction model has certain predictive value for the risk of recurrence in NP patients undergoing nasal endoscopic surgery.