接受内窥镜鼻窦手术的嗜酸性粒细胞 CRS 患者的嗅觉和生活质量

IF 1 Q3 OTORHINOLARYNGOLOGY International Archives of Otorhinolaryngology Pub Date : 2024-02-16 eCollection Date: 2024-04-01 DOI:10.1055/s-0043-1772494
Miguel Soares Tepedino, Richard Louis Voegels, Rogério Pezato, Andrew Thamboo, Eduardo Macoto Kosug, Ana Clara Miotello Ferrão, Raíssa de Figueiredo Neves, Valéria Maria Barcia Castilla, Luis Carlos Gregório
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引用次数: 0

摘要

导言:慢性鼻炎(CRS)是一种常见的炎症性疾病。这种高发病率导致了高昂的直接和间接公共卫生成本,其中包括就诊、实验室检查和影像学检查、药物治疗、住院治疗和手术治疗。此外,CRS 还严重影响患者的生活质量,影响工作效率,是缺勤的常见原因之一。CRS 相关的嗅觉功能障碍非常普遍,但手术干预的实际效果仍不一致。虽然有研究评估了嗜酸性粒细胞慢性鼻炎(eCRS)患者接受大量布地奈德冲洗治疗的术后疗程,但关于这种干预措施对嗅觉状态和生活质量的影响的客观信息却很少。目的 对接受手术治疗后进行大容量布地奈德鼻腔冲洗的 eCRS 患者的嗅觉和生活质量进行术前和术后分析。方法 对 eCRS 患者进行前瞻性、描述性、非对照研究。所有患者均接受了术前和术后鼻内窥镜检查、SNOT-22 问卷调查和宾夕法尼亚大学气味识别文本(UPSIT)测试,所有测试均由之前接受过培训的同一检查人员进行。所有患者在术后 3 个月、6 个月和 1 年时重新接受 SNOT-22 问卷和 UPSIT 测试,并将得分与术前进行比较。结果 研究共纳入 20 名患者,其中男性 13 名,女性 7 名,年龄在 23 岁至 65 岁之间;8 名患者合并有哮喘。使用 UPSIT 测试进行的定量评估显示,术后 3 个月嗅觉有明显改善,术后 6 个月和 1 年仍有改善(p = 0.0063)。息肉组织中的嗜酸性粒细胞浓度与术后 SNOT-22 和 UPSIT 结果之间没有明显关联。组织中嗜酸性粒细胞大于 50 的患者术前 UPSIT 评分较低。早在术后 3 个月,患者的生活质量就有了明显改善,这体现在 SNOT-22 值的降低上,这种改善一直持续到术后 1 年的随访评估(p = 0.0005)。使用 UPSIT 测试进行的定量评估显示,术后 3 个月嗅觉明显改善,术后 6 个月和术后 1 年仍然如此(p = 0.0063)。结论 对于术后坚持使用大量布地奈德鼻腔冲洗的患者,手术能有效控制 eCRS。患者的生活质量和嗅觉得到了明显改善,这种改善至少持续到术后一年。
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Olfaction and Quality of Life in Patients with Eosinophilic CRS Undergoing Endoscopic Sinus Surgery.

Introduction  Chronic rhinosinusitis (CRS) is a common inflammatory disease. This high prevalence leads to high direct and indirect public health costs, which include medical visits, laboratory tests and imaging, pharmacotherapy, hospitalizations, and surgical treatment. Furthermore, CRS has a substantial impact on patient quality of life, affecting productivity and being a common cause of absence from work CRS-associated olfactory dysfunction is highly prevalent, the actual effectiveness of surgical intervention remains inconsistent. Although there are studies evaluating the postoperative course of patients with eosinophilic Chronic rhinosinusitis (eCRS) treated with high-volume budesonide irrigation, there is little objective information regarding the impact of this intervention on olfactory status and quality of life. Objective  To conduct a pre- and postoperative analysis of olfaction and quality of life in patients with eCRS treated with surgical intervention followed by high-volume budesonide nasal irrigation. Methods  Prospective, descriptive, uncontrolled study of patients with eCRS. All patients underwent pre- and postoperative nasal endoscopy, SNOT-22 questionnaire, and the University of Pennsylvania Smell Identification Text (UPSIT), always by the same previously trained examiner. The SNOT-22 questionnaire and the UPSIT were readministered to all patients at 3 months, 6 months, and 1 year postoperatively, and scores compared with those obtained preoperatively. Results  Twenty patients were included in the study, 13 males and 7 females, between the ages of 23 and 65; 8 patients had comorbid asthma. Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). There was no significant association between eosinophil concentrations in polypoid tissue and postoperative SNOT-22 and UPSIT results. Patients with tissue eosinophils >50 had a lower preoperative UPSIT score. As early as 3 months postoperatively, a significant improvement in quality of life was already noticeable, as represented by a decrease in SNOT-22 values, which persisted through the 1-year postoperative follow-up evaluation (p = 0.0005). Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). Conclusion  Surgery effectively controlled eCRS in patients who adhered to high-volume budesonide nasal irrigation postoperatively. There were significant improvements in quality of life and olfaction, which persisted at least up to one year postoperatively.

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