血嗜酸性粒细胞计数与Lund-Mackay筛窦评分作为CRSwNP内镜鼻窦手术后复发的预测因素
Blood Eosinophil Count and Lund-Mackay Ethmoid Score as Predictors of Recurrence After Endoscopic Sinus Surgery in CRSwNP.
文献信息
| PMID | 42866524 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Zikang Xiao |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery Third Xiangya Hospital, Central South University Changsha Hunan China. |
| 期刊 | Laryngoscope investigative otolaryngology |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 评估血嗜酸性粒细胞计数（BEC）和Lund-Mackay（LM）筛窦评分在年龄和哮喘之外对成人慢性鼻窦炎伴鼻息肉（CRSwNP）患者内镜鼻窦手术（ESS）后复发的增量预后价值。
方法： 本回顾性队列纳入2022年1月至2024年11月接受ESS的成人CRSwNP患者。结局为内镜确诊的复发。Cox模型首先纳入年龄和哮喘，随后加入BEC和LM筛窦评分。在36个月时评估模型性能，并使用1000次bootstrap重抽样进行内部验证。
结果： 在157例患者中，51例（32.5%）发生复发；36个月无复发生存率为72.5%（95%置信区间[CI]，64.7%-78.9%）。较早复发与年龄（每10年调整风险比[HR]，1.26；95% CI，1.03-1.53）、哮喘（HR，2.00；95% CI，1.03-3.90）、BEC（每0.1×10^9/L的HR，1.23；95% CI，1.12-1.36）以及LM筛窦评分（每分HR，1.29；95% CI，1.13-1.47）相关。加入BEC和LM筛窦评分使Akaike信息准则从476.3降至458.6和446.1。表观和乐观校正后的36个月曲线下面积分别为0.818（bootstrap 95%区间，0.747-0.896）和0.804；校正后C指数和Brier评分分别为0.756和0.154。
结论： BEC和LM筛窦评分在年龄和哮喘之外提供了补充信息。在临床使用前需要外部验证和重新校准。
英文摘要
OBJECTIVES: To evaluate the incremental prognostic value of blood eosinophil count (BEC) and Lund-Mackay (LM) ethmoid score beyond age and asthma for recurrence after endoscopic sinus surgery (ESS) in adults with chronic rhinosinusitis with nasal polyps (CRSwNP).
METHODS: This retrospective cohort included adults with CRSwNP undergoing ESS from January 2022 to November 2024. The outcome was endoscopically confirmed recurrence. Cox models included age and asthma, then added BEC and LM ethmoid score. Performance was evaluated at 36 months and internally validated using 1000 bootstrap resamples.
RESULTS: Among 157 patients, 51 (32.5%) experienced recurrence; 36-month recurrence-free survival was 72.5% (95% confidence interval [CI], 64.7%-78.9%). Earlier recurrence was associated with age (adjusted hazard ratio [HR] per 10 years, 1.26; 95% CI, 1.03-1.53), asthma (HR, 2.00; 95% CI, 1.03-3.90), BEC (HR per 0.1 × 109/L, 1.23; 95% CI, 1.12-1.36), and LM ethmoid score (HR per point, 1.29; 95% CI, 1.13-1.47). Adding BEC and LM ethmoid score reduced the Akaike information criterion from 476.3 to 458.6 and 446.1. Apparent and optimism-corrected 36-month area under the curve values were 0.818 (bootstrap 95% interval, 0.747-0.896) and 0.804; corrected C-index and Brier score were 0.756 and 0.154.
CONCLUSION: BEC and LM ethmoid score provided complementary information beyond age and asthma. External validation and recalibration are required before clinical use.