目的: 探讨不同年龄段的慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with polyps, CRSwNP)患者的嗜酸性粒细胞(eosinophil,EOS)计数与鼻内镜术后的症状评分、鼻内镜评分相关性,预判患者年龄、手术疗效与随访干预密度。方法: 选择慢性鼻窦炎伴鼻息肉患者204例,并分为青少年组、成年组、老年组。采用Messerklinger术式,息肉切除、鼻窦开放,鼻中隔偏曲影响引流者同期进行鼻中隔矫正,下鼻甲予射频消融。标本进行病理检查,HE染色后镜下作EOS计数,术后(0.5、1、3、6、12个月)进行鼻塞、鼻漏、头面部胀痛感或者头昏,嗅觉主观症状VAS评分,CT,鼻内镜Lund-Kennedy评分。分析各个评分对比及变量之间关联性。结果: 鼻塞、鼻漏、头昏(术后0.5、1、3、6、12个月)、嗅觉、胀痛(术后0.5、3、6、12个月)在不同时间窗症状评分与EOS计数有相关性(P＜0.01),而胀痛、嗅觉(术后1个月)时间窗无相关性(P＞0.05)。EOS计数与CT、内镜评分有相关性(P＜0.01),而青少年的鼻塞(术后3、6、12个月)、鼻漏(术后0.5、1、3、6、12个月),胀痛(术后3、6、12个月),头昏(0.5、6、12个月)症状评分高于其他2组(P＜0.05)。青少年嗅觉症状评分与其他二组比较差异无统计学意义(P＞0.05)。结论: EOS计数与不同时间窗疗效有相关性,术后青少年的症状评分高于其他两组,提示术后需要加强对青少年组的随访干预密度,减少复发。

Objective: To investigate the correlation between eosinophil (EOS) count in nasal polyp and recovering process of CRSwNP (Chronic rhinosinusitis with polyps, CRSwNP) patients at different ages after nasal endoscopic surgery. Methods: 204 CRSwNP patients were selected and divided into the adolescent group, adult group and elderly group. Messerklinger was used to remove nasal polyps and open sinuses. Patients with deviated septum affecting nasal drainage were given septal correction simultaneously. Radiofrequency ablation was performed on patients with the inferior turbinate hypertrophy. Surgical specimens were given pathological examination, and EOS was counted under the microscope after HE staining. VAS score for nasal congestion, nasal leakage, head and face swelling pain, olfaction, and dizziness, CT and Lund-Kennedy score were performed 0.5 month, 1 month, 3 months, 6months and 12 months after surgery. SPSS18.0 was used to compare and analyze correlation among variables. Results: EOS counts were significantly correlated with scores of nasal congestion, rhinorrhea, dizziness (0.5 month, 1 month, 3 months, 6 months and 12 months after surgery), olfaction, head and face swelling pian (0.5 month, 3 months, 6 months and 12 months after surgery) (P＜0.01). However, head and face swelling pain, olfaction (1 month after surgery) and EOS counts had no correlation (P＞0.05). There was a correlation between EOS counts and CT results and endoscopic scores (P＜0.01). The scores of nasal congestion (3 months, 6 months and 12 months after surgery) , rhinorrhea(0.5 month, 1 month, 3 months, 6 months and 12 months after surgery), head and face swelling pain(3 months, 6 months and 12 months after surgery) , dizziness (0.5 month, 6 months and 12 months after surgery) in the adolescents had higher symptom scores than the other two groups(P＜0.05). Meanwhile, there was no significant correlation between the adolescents with the other groups on nasal congestion(P＞0.05). Conclusion: EOS counts is correlated with efficacy at different time windows. postoperative symptom scores of adolescents are higher than those of the other two groups, suggesting that follow-up intervention should be enhanced after surgery to reduce recurrence.