鼻腔气流分布对嗅觉功能及鼻旁窦通气的重要性：度普利尤单抗治疗的CRSwNP患者计算流体力学评估的启示。
The Importance of Nasal Airflow Distribution for Olfactory Function and Paranasal Sinus Ventilation: Insights From a Computational Fluid Dynamics Evaluation in Dupilumab-Treated CRSwNP Patients.
文献信息
| PMID | 42924370 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Carlotta Pipolo |
| 作者单位 | Otorhinolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy. |
| 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： 度普利尤单抗是重度慢性鼻窦炎伴鼻息肉（CRSwNP）的成熟治疗方法，可显著改善症状和嗅觉功能。然而，关于度普利尤单抗如何改变鼻腔气流分布和鼻旁窦通气的客观数据有限。计算流体力学（CFD）可对体内无法评估的鼻腔气流变化进行详细、定量的评价。本研究旨在量化度普利尤单抗治疗后鼻腔气流、嗅裂通气和鼻旁窦通畅度的变化，并探讨其与嗅觉结局的关系。
方法： 这项回顾性、单中心CFD研究纳入26例接受度普利尤单抗治疗6个月的2型CRSwNP成年患者。使用配准的CFD模拟分析配对的治疗前后CT扫描（52次扫描）。在吸气和呼气期间量化总鼻腔气流及三个鼻部横截面的气流分布。使用Sniffin' Sticks识别测试（SSIT-16）评估嗅觉功能。对鼻旁窦通畅度进行评分（0-16），并与手术完成指数（CoSI）进行相关性分析。治疗前后差异采用Wilcoxon符号秩检验分析，相关性采用Spearman rho分析。
结果： 6个月后，总吸气气流从17.35 ± 6.70 L/min增加至22.30 ± 4.71 L/min（p = 0.003），总呼气气流从18.15 ± 6.51 L/min增加至21.86 ± 5.69 L/min（p = 0.025）。相对气流增加最大的是嗅裂（吸气时+567%）。SSIT-16评分从4.7 ± 3.2增加至10.3 ± 2.7，且嗅部吸气气流的变化与SSIT-16评分的变化显著相关（ρ = 0.431，p = 0.028）。鼻旁窦通畅度增加7.5分（p < 0.01），与CoSI无显著相关性。
结论： 度普利尤单抗可显著改善CRSwNP患者的鼻腔气流和鼻旁窦通气。嗅裂气流增加与嗅觉功能改善相关，支持这些患者嗅觉丧失存在传导性成分。
英文摘要
BACKGROUND: Dupilumab is an established treatment for severe chronic rhinosinusitis with nasal polyps (CRSwNP), leading to significant improvements in symptoms and olfactory function. However, objective data on how dupilumab modifies nasal airflow distribution and paranasal sinus ventilation are limited. Computational fluid dynamics (CFD) allows detailed, quantitative evaluation of nasal airflow changes that cannot be assessed in vivo. This study aims to quantify changes in nasal airflow, olfactory cleft ventilation, and paranasal sinus patency after dupilumab treatment, and to explore their relationship with olfactory outcomes.
METHODS: This retrospective, single-center CFD study included 26 adult patients with type 2 CRSwNP treated with dupilumab for 6 months. Paired pre- and post-treatment CT scans (52 scans) were analyzed using registered CFD simulations. Total nasal airflow and airflow distribution across three nasal sections were quantified during inspiration and expiration. Olfactory function was assessed using the Sniffin' Sticks Identification Test (SSIT-16). Paranasal sinus patency was scored (0-16) and correlated with the Completion of Surgery Index (CoSI). Pre- and post-treatment differences were analyzed using Wilcoxon signed-rank tests and correlations with Spearman's rho.
RESULTS: After 6 months, total inspiratory airflow increased from 17.35 ± 6.70 to 22.30 ± 4.71 L/min (p = 0.003), while total expiratory airflow increased from 18.15 ± 6.51 to 21.86 ± 5.69 L/min (p = 0.025). The greatest relative airflow increase occurred in the olfactory cleft (+567% inspiratory). SSIT-16 scores increased from 4.7 ± 3.2 to 10.3 ± 2.7, and the change in inspiratory airflow within the olfactory section significantly correlated with the change in SSIT-16 score (ρ = 0.431, p = 0.028). Paranasal sinus patency increased by 7.5 points (p < 0.01), without a significant correlation with CoSI.
CONCLUSIONS: Dupilumab significantly improves nasal airflow and paranasal sinus ventilation in CRSwNP. Increased airflow in the olfactory cleft is associated with improved olfactory function, supporting a conductive component of smell loss in these patients.