鼻内物质使用慢性鼻窦炎患者的结构化组织病理学发现

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中文摘要

目的： 描述接受内镜鼻窦手术的慢性鼻窦炎（CRS）患者中，有记录鼻内物质使用者的结构化鼻窦组织病理学发现。
方法： 回顾性分析2021年1月至2024年10月期间接受内镜鼻窦手术的药物治疗难治性CRS成年患者。将有记录鼻内物质使用的患者与无记录物质使用的CRS患者进行比较。根据情况使用卡方检验、Fisher精确检验和Student t检验分析人口学、临床和结构化组织病理学变量。
结果： 共识别出21例有记录鼻内物质使用的CRS患者。报告的物质包括10例（47.6%）大麻、6例（28.6%）可卡因、2例（9.5%）海洛因，以及3例（14.3%）涉及超过3种物质的多物质使用。与非使用者相比，物质使用者中男性更常见（76.2% vs. 46.4%，p = 0.008），且CRS亚型分布不同（p < 0.001）。年龄或种族方面未观察到显著差异。物质使用者中性粒细胞浸润（33.4% vs. 10.7%，p = 0.001）、基底膜增厚（100% vs. 31.0%，p < 0.001）、上皮下水肿（90.4% vs. 25.8%，p < 0.001）、鳞状化生（42.9% vs. 20.8%，p = 0.016）和纤维化（38.0% vs. 20.8%，p = 0.013）的发生率更高。
结论： 与不使用物质者相比，有记录鼻内物质使用的CRS患者表现出更明显的中性粒细胞性炎症以及上皮损伤和重塑的组织学特征。这些发现支持对该人群进行仔细的物质使用评估、戒断咨询和术后监测。需要更大规模的研究来确定这些组织病理学差异是否影响治疗反应和手术结局。

英文摘要

OBJECTIVES: To characterize structured sinonasal histopathology findings among patients with chronic rhinosinusitis (CRS) and documented intranasal substance use undergoing endoscopic sinus surgery.
METHODS: Adult patients with medically recalcitrant CRS who underwent endoscopic sinus surgery between January 2021 and October 2024 were reviewed. Patients with documented intranasal substance use were compared with CRS patients without documented substance use. Demographic, clinical, and structured histopathology variables were analyzed using chi-square, Fisher exact, and Student's t-tests, as appropriate.
RESULTS: Twenty-one CRS patients with documented intranasal substance use were identified. Reported substances included cannabis in 10 patients (47.6%), cocaine in 6 patients (28.6%), heroin in 2 patients (9.5%), and polysubstance use involving more than 3 substances in 3 patients (14.3%). Compared with non-users, substance users were more frequently male (76.2% vs. 46.4%, p = 0.008) and differed by CRS subtype distribution (p < 0.001). No significant differences were observed by age or race. Substance users had higher rates of neutrophil infiltrate (33.4% vs. 10.7%, p = 0.001), basement membrane thickening (100% vs. 31.0%, p < 0.001), subepithelial edema (90.4% vs. 25.8%, p < 0.001), squamous metaplasia (42.9% vs. 20.8%, p = 0.016), and fibrosis (38.0% vs. 20.8%, p = 0.013).
CONCLUSION: CRS patients with documented intranasal substance use demonstrated greater neutrophilic inflammation and histologic features of epithelial injury and remodeling compared with non-users. These findings support careful substance-use assessment, cessation counseling, and postoperative surveillance in this population. Larger studies are needed to determine whether these histopathologic differences influence treatment response and surgical outcomes.