Risk factors investigation for different outcomes between unilateral and bilateral chronic rhinosinusitis with nasal polyps patients

IF 4.6 2区医学 Q2 ALLERGY

Clinical and Translational Allergy Pub Date : 2024-09-25 DOI:10.1002/clt2.12395

Jianwei Wang, Yu Zhang, Ying Chen, Xinjun Xu, Yujuan Yang, Jiali Yin, Jing Guo, Pengyi Yu, Zhen Liu, Huifang Liu, Ting Zuo, Hongfei Zhao, Yan Hao, Bei Zhang, Xicheng Song

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Abstract

Background

Studies involving chronic rhinosinusitis with nasal polyps (CRSwNP) have mostly focused on bilateral cases, making unilateral CRSwNP inadequately recognized. This study examined the differences in clinical characteristics, outcomes, and risk factors for poor outcomes between unilateral and bilateral CRSwNP to facilitate a better assessment in the two groups.

Methods

Demographic information, tissue and blood cells, endoscopic scores, Lund-Mackay scores, recurrence rates, and disease control conditions were compared between 310 unilateral and 596 bilateral CRSwNP patients. Furthermore, the stepwise regression multivariate Cox proportional hazard models were performed to generate risk factors for poor outcomes in the two groups.

Results

Bilateral cases exhibited higher rates of smoking, AR, and asthma comorbidities, along with higher numbers of tissue eosinophils and blood inflammatory cells when compared to unilateral patients. Endoscopic nasal polyp score, total computed tomography (CT) score (with scores for each sinus cavity), and adjusted CT scores were significantly higher in the bilateral group, except for a markedly higher adjusted maxillary score in the unilateral group. Furthermore, significantly higher proportions of bilateral patients experienced nasal polyp recurrence, uncontrolled status, and most disease control-related symptoms at follow-up. The primary risk factors for poor outcomes were asthma, tissue eosinophils, and total CT score in the bilateral group and blood basophils in the unilateral group.

Conclusions

Bilateral CRSwNP patients experience worse disease severity and outcomes than their unilateral counterparts. Primarily, asthma, tissue eosinophils, and total CT score were risk factors for poor outcomes in bilateral CRSwNP patients, with blood basophils in unilateral cases.

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单侧和双侧慢性鼻炎伴鼻息肉患者不同结局的风险因素调查

背景有关慢性鼻炎伴鼻息肉（CRSwNP）的研究大多集中在双侧病例上，因此对单侧 CRSwNP 的认识不足。本研究探讨了单侧和双侧 CRSwNP 在临床特征、预后和不良预后风险因素方面的差异，以便更好地评估这两组病例。方法比较 310 名单侧和 596 名双侧 CRSwNP 患者的人口统计学信息、组织和血细胞、内镜评分、Lund-Mackay 评分、复发率和疾病控制情况。此外，还采用逐步回归多变量考克斯比例危险模型，以得出两组患者不良预后的风险因素。结果与单侧患者相比，双侧患者的吸烟率、AR 和哮喘合并症发生率更高，组织嗜酸性粒细胞和血液炎症细胞的数量也更高。双侧患者的内窥镜鼻息肉评分、计算机断层扫描（CT）总评分（包括每个鼻窦腔的评分）和调整后的 CT 评分均显著高于单侧患者，但单侧患者的调整后上颌评分明显高于双侧患者。此外，双侧患者在随访时出现鼻息肉复发、病情失控和大多数与疾病控制相关症状的比例明显更高。导致不良后果的主要风险因素是双侧组的哮喘、组织嗜酸性粒细胞和 CT 总分，以及单侧组的血液嗜碱性粒细胞。结论双侧 CRSwNP 患者的疾病严重程度和预后均比单侧患者差。在双侧 CRSwNP 患者中，哮喘、组织嗜酸性粒细胞和 CT 总分是导致不良预后的主要风险因素，而在单侧病例中，血液嗜碱性粒细胞是导致不良预后的主要风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.