实用医学杂志2025，Vol.41Issue(18)：2928-2936,9.DOI:10.3969/j.issn.1006-5725.2025.18.021
内窥镜鼻窦手术治疗慢性鼻窦炎伴鼻息肉患者术后复发的预测模型
Risk factors for postoperative recurrence in patients with chronic sinusitis and nasal polyps treated by en-doscopic sinus surgery
摘要
Abstract
Objective To analyze the risk factors for postoperative recurrence in patients with chronic sinusitis and nasal polyps(CRSwNP)treated by endoscopic sinus surgery(ESS),and to construct a predictive model.Methods A retrospective study was conducted on 203 patients with CRSwNP who underwent ESS in the hospital from March 2022 to February 2023.These patients were divided into a recurrence group(n=43)and an non-recurrence group(n=160)based on whether they experienced recurrence after surgery.Clinical data were collected and analyzed using univariate analysis to identify significant differences.Lasso regression was used to screen potential influencing factors.Multivariate logistic regression was employed to analyze the risk factors.A nomogram was constructed for postoperative recurrence model,and the receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the model.Results Single-factor analysis showed that disease duration,Lund-Mackay CT score,SNOT-22 score,EOS,ECP,total IgE,CRP,IL-5,and IL-1β in the recurrence group after ESS were higher than those in the non-recurrence group(P<0.05),while the UPSIT score,CD3+,CD4+,CD8+,and CD4+/CD8+were lower(P<0.05);the proportion of patients with allergic rhinitis,asthma,no preoperative glucocorticoid treatment,and surgery time≥2 hours in the recurrence group after ESS was higher than that in the non-recurrence group(P<0.05).Multivariate logistic regression analysis model showed that disease duration(OR=1.389,95%CI:1.094～1.763,P=0.007),combined asthma(OR=2.997,95%CI:1.065～8.432,P=0.038),Lund-Mackay CT score(OR=1.156,95%CI:1.027～1.301,P=0.016),EOS(OR=1.540,95%CI:1.249～1.898,P<0.001),total IgE(OR=1.005,95%CI:1.000～1.009,P=0.041),and IL-5(OR=1.165,95%CI:1.078～1.260,P<0.001)were risk factors for ESS recurrence.Based on multivariate logistic regression analysis nomogram,the area under the ROC curve(AUC)was 0.9057;the sensitivity 76.74%;the specificity 87.5%;the average absolute error(MAE)of the calibration curve 0.03;the mean square error(MSE)0.00157,and the absolute error at the 0.9 percentile 0.065.Conclusions Disease course,the presence of asthma,Lund-Mackay CT score,EOS,total IgE,and IL-5 are all risk factors for postoperative recurrence in patients with CRSwNP.Moreover,the relevant nomogram model can be used as a reliable tool for assessing the risk of postoperative recurrence in CRSwNP.关键词
慢性鼻窦炎伴鼻息肉/内窥镜鼻窦手术/复发/危险因素Key words
chronic sinusitis with nasal polyps/endoscopic sinus surgery/recurrence/risk factors分类
医药卫生引用本文复制引用
李德宏,倪茂美,蔡婷,任娟娟..内窥镜鼻窦手术治疗慢性鼻窦炎伴鼻息肉患者术后复发的预测模型[J].实用医学杂志,2025,41(18):2928-2936,9.基金项目
贵州省卫生健康委科学技术基金项目(编号:gzwkj2022-160) （编号:gzwkj2022-160）
