内镜下鼻窦手术后难治性原发性慢性鼻窦炎的预测因素
Predictors of Refractory Primary Chronic Rhinosinusitis Following Endoscopic Sinus Surgery.
文献信息
| PMID | 42716515 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ismail M Khaderi |
| 作者单位 | University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. |
| 期刊 | International forum of allergy & rhinology |
| SCI 分区 | Q1 |
| IF | 4.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 功能性内镜鼻窦手术（FESS）后难治性慢性鼻窦炎（CRS）传统上仅以再次手术来定义。随着生物疗法的出现，治疗升级现在包括再次手术和/或开始生物治疗。我们试图使用包含手术和/或开始生物治疗的复合结局来确定难治性原发性CRS的独立预测因素。
方法： 在TriNetX研究网络中识别2015年后接受FESS的成人原发性CRS患者。排除继发性CRS、既往生物治疗或鼻窦肿瘤患者。主要结局为难治性CRS，定义为术后3个月至5年内再次FESS或开始生物治疗。使用Cox比例风险模型并结合逐步选择法评估术前协变量。
结果： 在24,759例患者中，2866例（11.6%）在FESS后出现难治性CRS。其中，66.6%接受了再次FESS，42.0%开始了生物治疗，8.7%既接受了再次手术又开始了生物治疗。在多变量分析中，哮喘是最强的预测因素（HR 2.06，p < 0.001），其次是镇痛药（如NSAIDs）过敏（HR 1.87，p < 0.001）、鼻息肉（HR 1.67，p < 0.001）、食物过敏（HR 1.37，p = 0.096）、COPD（HR 1.27，p = 0.006）、嗜酸性粒细胞增多（HR 1.27，p < 0.001）以及黑人或非裔美国人种族（HR 1.16，p = 0.044）。
结论： FESS后难治性CRS与2型炎症共病及特定人口学因素密切相关。将生物治疗纳入结局定义，为风险分层和术后咨询提供了当代框架。
英文摘要
BACKGROUND: Refractory chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS) has traditionally been defined by revision surgery alone. With the emergence of biologic therapies, treatment escalation now includes revision surgery and/or biologic initiation. We sought to identify independent predictors of refractory primary CRS using a composite outcome incorporating surgery and/or biologic initiation.
METHODS: Adult patients with primary CRS undergoing FESS after 2015 were identified in the TriNetX Research Network. Patients with secondary CRS, prior biologic therapy, or sinonasal neoplasms were excluded. The primary outcome was refractory CRS, defined as revision FESS or biologic initiation from 3 months to 5 years postoperatively. Preoperative covariates were evaluated using Cox proportional hazards modeling with stepwise selection.
RESULTS: Among 24,759 patients, 2866 (11.6%) had refractory CRS after FESS. Of these, 66.6% underwent revision FESS, 42.0% initiated biologic therapy, and 8.7% had revision surgery and initiated a biologic therapy. In multivariable analysis, asthma was the strongest predictor (HR 2.06, p < 0.001), followed by allergy to analgesic agents (e.g., NSAIDs) (HR 1.87, p < 0.001), nasal polyps (HR 1.67, p < 0.001), food allergy (HR 1.37, p = 0.096), COPD (HR 1.27, p = 0.006), eosinophilia (HR 1.27, p < 0.001), and Black or African American race (HR 1.16, p = 0.044).
CONCLUSION: Refractory CRS following FESS is strongly associated with type 2 inflammatory comorbidities and select demographic factors. Incorporating biologic therapy into outcome definitions provides a contemporary framework for risk stratification and postoperative counseling.