空鼻综合征的气流特征：基于患者特异性计算模型对气流分布模式与鼻腔空气调节的洞察

文献信息

中文摘要

背景： 计算流体力学（CFD）越来越多地用于研究空鼻综合征（ENS）复杂的病理生理学。尽管既往CFD研究报告了ENS中以中鼻道为主的气流以及空气-黏膜相互作用减少，但仅凭气流分布能否解释症状或鼻腔生理功能受损仍不清楚。
方法： 使用由计算机断层扫描重建的鼻腔模型，对14例ENS患者进行了患者特异性CFD模拟。分析了气流分布、鼻阻力、空气温度、相对湿度和表面积-体积比（SAVR）。为进行比较，分析了10例无既往鼻部手术的鼻中隔偏曲（NSD）非ENS受试者和5例正常受试者。
结果： ENS中的气流分布具有异质性，包括以中鼻道为主（9/14）、以下鼻道为主（4/14）和混合型（1/14）模式。ENS6Q评分在以下鼻道为主组中趋于更高，而其他变量在各模式之间无差异。NSD受试者显示出同样多样的分布（分别为3/10、3/10和4/10），表明偏斜的气流分布并非ENS所特有，尽管以中鼻道为主的气流在ENS中更为常见。所有正常受试者均表现为混合型分布。ENS受试者的鼻后孔相对湿度低于正常受试者且变异性更大，并且相对湿度在ENS和NSD中均与SAVR呈正相关，提示鼻腔空气调节可能与残余黏膜表面几何形态有关。ENS与NSD之间没有任何参数存在显著差异，也没有任何参数与ENS6Q评分相关。
结论： ENS并非以单一气流模式为特征，而是代表异质性的气流特征谱，类似表型也出现在非ENS受试者中。仅气流分布模式不足以解释ENS症状，并且所评估的全局CFD参数均未与ENS6Q评分显著相关，尽管样本量小，无法可靠排除具有临床相关性的关联。尽管如此，保留黏膜表面积可能在鼻腔空气调节中发挥重要作用。这些发现支持对ENS采取基于生理学和患者特异性的理解。

英文摘要

BACKGROUND: Computational fluid dynamics (CFD) is increasingly used to investigate the complex pathophysiology of empty nose syndrome (ENS). Although previous CFD studies reported middle-meatus-dominant airflow and reduced air-mucosal interaction in ENS, whether airflow distribution alone explains symptoms or impaired nasal physiology remains unclear.
METHODS: Patient-specific CFD simulations were performed in 14 ENS patients using nasal cavity models reconstructed from computed tomography. Airflow distribution, nasal resistance, air temperature, relative humidity, and surface area-to-volume ratio (SAVR) were analyzed. Ten non-ENS subjects with nasal septal deviation (NSD) without prior nasal surgery and five normal subjects were analyzed for comparison.
RESULTS: Airflow distributions in ENS were heterogeneous, consisting of middle-meatus-dominant (9/14), inferior-meatus-dominant (4/14), and mixed (1/14) patterns. ENS6Q scores tended to be higher in the inferior-meatus-dominant group, whereas other variables did not differ between patterns. NSD subjects showed similarly diverse distributions (3/10, 3/10, and 4/10, respectively), indicating that skewed airflow distribution is not unique to ENS, although middle-meatus-dominant airflow was more frequent in ENS. All normal subjects exhibited mixed distributions. ENS subjects showed lower and more variable choanal relative humidity than normal subjects, and relative humidity correlated positively with SAVR in ENS and NSD, suggesting that nasal air-conditioning may be related to residual mucosal surface geometry. No parameter differed significantly between ENS and NSD or correlated with ENS6Q scores.
CONCLUSION: ENS is not characterized by a single airflow pattern but represents a heterogeneous spectrum of airflow characteristics, with similar phenotypes also occurring in non-ENS subjects. Airflow distribution pattern alone was insufficient to explain ENS symptoms, and none of the evaluated global CFD parameters correlated significantly with ENS6Q scores, although the small sample precludes firm exclusion of clinically relevant associations. Preservation of mucosal surface area may nevertheless play an important role in nasal air-conditioning. These findings support a physiology-based and patient-specific understanding of ENS.