需手术治疗的慢性鼻窦炎伴鼻息肉患者的眼表表现：一项回顾性研究

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中文摘要

背景/目的： 炎症在慢性鼻窦炎（CRS）和干眼病（DED）的病理生理中均发挥核心作用，提示这两种疾病之间可能存在联系。本研究旨在探讨需手术治疗的慢性鼻窦炎伴鼻息肉（CRSwNP）与干眼病相关眼表参数之间的关系，并评估其与影像学疾病严重程度的关联。方法：本回顾性研究纳入32例接受功能性内镜鼻窦手术的需手术治疗的CRSwNP患者（2021年1月至2025年1月）和31例对照者，所有受试者均完成完整的眼科检查。比较两组间的眼表参数，包括眼表疾病指数（OSDI）评分、泪膜破裂时间（BUT）、Schirmer试验值和Oxford染色评分。采用鼻窦结局测试-22（SNOT-22）和Lund-Mackay评分（LMS）评估疾病严重程度。采用广义估计方程（GEE）进行眼水平分析。还评估了同侧LMS与眼表参数之间的关联，以及鼻窦受累程度和部位的影响。结果：CRSwNP组的OSDI评分较高（p = 0.001），BUT和Schirmer试验值较低，Oxford染色评分较高（均p < 0.05）。同侧LMS与同侧BUT、Schirmer试验值或Oxford染色评分无显著关联。OSDI评分与LMS或SNOT-22评分之间均未观察到关联。经多重比较校正后，包括窦口鼻道复合体在内的任何鼻窦区域均未显示显著关联。结论：需手术治疗的CRSwNP与客观眼表功能障碍相关，包括泪膜稳定性受损和房水样泪液分泌减少。然而，眼表表现和干眼症状与影像学疾病负担无关。这些发现提示，对需手术治疗的CRSwNP患者可考虑进行眼表评估，但仍需前瞻性研究加以证实。

英文摘要

Background/Objectives: Inflammation plays a central role in the pathophysiology of both chronic rhinosinusitis (CRS) and dry eye disease (DED), suggesting a possible link between these two conditions. This study aimed to investigate the relationship between surgery-indicated chronic rhinosinusitis with nasal polyps (CRSwNP) and ocular surface parameters related to dry eye disease and to evaluate their association with radiological disease severity. Methods: This retrospective study included 32 patients with surgery-indicated CRSwNP who underwent functional endoscopic sinus surgery (January 2021-January 2025) and 31 controls, all of whom had complete ophthalmological examinations. Ocular surface parameters, including Ocular Surface Disease Index (OSDI) scores, tear break-up time (BUT), Schirmer test values, and Oxford staining scores, were compared between the groups. Disease severity was assessed using the Sino-Nasal Outcome Test-22 (SNOT-22) and the Lund-Mackay score (LMS). Generalized estimating equations (GEE) were used for eye-level analyses. Associations between ipsilateral LMS and ocular surface parameters, as well as the effects of the degree and location of sinus involvement, were also assessed. Results: Higher OSDI scores (p = 0.001), lower BUT and Schirmer test values, and higher Oxford staining scores were observed in the CRSwNP group (all p < 0.05). Ipsilateral LMS was not significantly associated with ipsilateral BUT, Schirmer test values, or Oxford staining scores. No association was observed between OSDI scores and either LMS or SNOT-22 scores. No sinus region, including the osteomeatal complex, showed a significant association after correction for multiple comparisons. Conclusions: Surgery-indicated CRSwNP is associated with objective ocular surface dysfunction, including impaired tear film stability and reduced aqueous tear secretion. However, ocular surface findings and dry eye symptoms were not related to radiological disease burden. These findings suggest that ocular surface evaluation may be considered in patients with surgery-indicated CRSwNP, but prospective studies are needed to confirm this.