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一项关于马鼻窦疾病的大型多中心研究中治疗与治疗反应之间的关联

Associations between treatments and response to treatments from a large multicentre study of equine sinonasal disease.

临床研究鼻科IF 2.5Q1

文献信息

PMID42713759
原文在 PubMed 查看原文 ↗
发表日期2026
作者Padraic Dixon
查看其他 22 位作者

Tim Barnett；Eric Parente；Rhiannon Morgan；John Mark O'Leary；Lieven Vlaminck；Alison Talbot；Alexandra Gillen；Tom McGinley；Moses Brennan；Henry Tremaine；Elke Pollaris；Erica Dobbs；Ben Anghileri；Linda Wright；Elin Olsson；Jonathan Olijnyk；Charles Alexandre；Neil Townsend；Adam Northwood；Tim Mair；Darren Shaw；Richard J M Reardon

作者单位Independent Veterinary Consultant, Edinburgh, UK.
查看其他 21 条单位信息

Rossdales Equine Hospital, Newmarket, UK.；New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA.；IVC/Evidensia, Bristol, UK.；School of Veterinary Medicine, University College Dublin, Dublin, Ireland.；Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium.；School of Veterinary Science, University of Liverpool, Liverpool, UK.；Liphook Equine Hospital, Hampshire, UK.；Rainbow Equine Hospital, Yorkshire, UK.；B&W Equine Hospital, Gloucestershire, UK.；Morette Equine Clinic, Asse, Belgium.；Rood and Riddle Equine Hospital, Lexington, Kentucky, USA.；Oakham Veterinary Hospital, Leicestershire, UK.；IVC Evidensia, Helsingborg, Sweden.；IVC Evidensia, Strömsholm, Sweden.；Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.；Faculty of Veterinary Medicine, University of Liege, Liege, Belgium.；Three Counties Equine Hospital, Worcestershire, UK.；Royal Veterinary College, London, UK.；Bell Equine Veterinary Clinic, Mereworth, Kent, UK.；The Roslin Institute, University of Edinburgh, Midlothian, UK.；The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK.

期刊Equine veterinary journal
SCI 分区Q1
IF2.5
研究类型临床研究 · 临床
所属专科鼻科

中文摘要

背景： 尚无大型研究探讨经计算机断层扫描（CT）确诊的鼻窦疾病马匹的治疗及治疗反应。
目的： 报告转诊的马鼻窦疾病病例的治疗及治疗反应。在多变量模型中探讨病例结局与临床和内镜特征、CT表现、疾病亚型及治疗之间的关联。
研究设计： 回顾性病例系列。
方法： 从19家马医院收集鼻窦疾病病例的医疗记录，所有病例均接受了CT成像。病例结局通过临床记录和/或联系畜主及转诊兽医获得。采用逻辑回归分析检验治疗与结局之间的关联，并识别临床和影像学变量与病例结局之间的关联。
结果： 在可获得该参数信息的马匹中，615/1299（47.3%，95% CI 44.6-50.1）接受了鼻窦镜下清创术并上颌隔窦泡开窗术。鼻额窦切开术和上颌窦切开术分别实施于324/1302（24.9%，95% CI 22.6-27.3）和93/1299（7.2%，95% CI 5.8-8.7）匹马。鼻窦镜下灌洗在711/1299（54.7%，95% CI 52.0-57.4）例中进行，通常在其他操作之后。鼻窦镜治疗与较高的治愈可能性相关，而鼻额窦切开术与较低的治愈可能性相关，但困难病例可能接受了更多的窦骨切开术。原发性、牙源性和真菌性鼻窦炎的完全治愈率最高（均超过79%），而鼻窦肿瘤（7.3%）和PEH（40.4%）的治愈率最低。口腔拔牙OR 2.43（95% CI 1.67-3.54，p < 0.001）和鼻窦镜治疗OR 1.68（95% CI 1.19-2.36，p = 0.003）与治愈可能性增加相关，而接受鼻额骨切开术治疗的病例治愈可能性较低OR 0.62（95% CI 0.42-0.89，p = 0.011）。在纳入750例病例的临床和内镜特征、CT表现、疾病亚型及治疗的最终多变量模型中，与治愈显著相关的变量包括：最终诊断为进行性筛窦血肿（OR 0.17，95% CI 0.08-0.37，p < 0.001）、鼻窦肿瘤（OR 0.02，95% CI 0.00-0.06，p < 0.001）或牙源性鼻窦炎（OR 0.38，95% CI 0.19-0.76，p = 0.006）的病例，其治愈可能性均低于原发性鼻窦炎。接受口腔拔牙的病例比未接受者治愈可能性显著更高（OR 3.1，95% CI 1.66-5.81，p < 0.001）。接受鼻额骨切开术治疗的病例比其他方法治疗的病例治愈可能性更低（OR 0.38，95% CI 0.24-0.61，p = 0.001）。骨肥厚分级为“中度或重度”的病例比“无或轻度”者治愈可能性更低（OR 0.54，95% CI 0.35-0.82，p = 0.004）。
主要局限性： 回顾性研究，部分病例数据不完整。
结论： 口腔拔牙和鼻窦镜治疗与完全治愈的最高可能性相关。

英文摘要

BACKGROUND: No large study has examined the treatment and response to treatment of horses with sinonasal disease confirmed by computed tomography (CT).
OBJECTIVES: To report the treatment and response to treatment of referred cases of equine sinonasal disease. To explore associations between case outcome and clinical and endoscopic features, CT findings, disease subtypes, and treatments in a multivariable model.
STUDY DESIGN: Retrospective case series.
METHODS: Data were collected from medical records from 19 equine hospitals on cases of sinonasal disease, all of which underwent CT imaging. Case outcome was obtained from clinical records, and/or by contacting clients and referring veterinarians. Logistic regression analysis was used to examine associations between treatments and outcome and to identify associations between clinical and imaging variables and case outcome.
RESULTS: Sinoscopic debridement with maxillary septal bulla fenestration was performed in 615/1299 (47.3%, 95% CI 44.6-50.1) horses where information on this parameter was available. Nasofrontal and maxillary sinusotomies were performed in 324/1302 (24.9%, 95% CI 22.6-27.3) and 93/1299 (7.2%, 95% CI 5.8-8.7) horses, respectively. Sinoscopic lavage was performed in 711/1299 (54.7%, 95% CI 52.0-57.4) cases, usually following other procedures. Sinoscopic treatment was associated with a higher likelihood of cure, and nasofrontal sinusotomy with a lower likelihood of cure, but difficult cases may have had more sinus osteotomies. Primary, dental and mycotic sinusitis had the highest complete cure rate (all over 79%), while sinonasal neoplasia (7.3%) and PEH (40.4%) had the lowest cure rates. Oral extraction OR 2.43 (95% CI 1.67-3.54, p < 0.001) and sinoscopic treatment OR 1.68 (95% CI 1.19-2.36, p = 0.003), were associated with increased likelihood of cure while cases treated by nasofrontal osteotomy were less likely to achieve cure OR 0.62 (95% CI 0.42-0.89, p = 0.011). Variables retained in the final multivariable model of clinical and endoscopic features, CT findings, disease sub-types and treatments, as significantly associated with cure that included 750 cases were: Final diagnoses of: Progressive ethmoid haematomas (OR 0.17, 95% CI 0.08-0.37, p < 0.001), sinonasal tumours (OR 0.02, 95% CI 0.00-0.06, p < 0.001) or Dental sinusitis (OR 0.38, 95% CI 0.19-0.76, p = 0.006) all having lower likelihood of cure than primary sinusitis. Cases that had undergone oral extractions were significantly more likely to be cured than those that did not (OR 3.1, 95% CI 1.66-5.81, p < 0.001). Cases treated by nasofrontal osteotomy were less likely to achieve cure (OR 0.38, 95% CI 0.24-0.61, p = 0.001) than those treated by other methods. Cases with bone hyperostosis graded as 'moderate or severe' were less likely to be cured than those with 'none or mild' (OR 0.54, 95% CI 0.35-0.82, p = 0.004).
MAIN LIMITATIONS: Retrospective study with incomplete data for some cases.
CONCLUSIONS: Oral extraction and sinoscopic treatments were associated with the highest likelihood of complete cure.