血清ACE-2联合鼻窦CT评分对慢性鼻窦炎术后复发风险的预测价值

Predictive value of serum ACE-2 combined with sinus CT score for postoperative recurrence risk in chronic rhinosinusitis

摘要

目的：探讨血清血管紧张素转换酶2（ACE-2）联合鼻窦CT评分对慢性鼻窦炎术后复发的预测价值。方法：选取2020年1月至2024年1月山西医科大学附属运城医院耳鼻咽喉头颈外科收治的198例需行鼻内镜手术的慢性鼻窦炎患者，所有患者术前均检测血清ACE-2水平，并行鼻窦高分辨率CT扫描，采用Lund-Mackay评分进行鼻窦CT评分。术后通过门诊复诊及电话追踪完成12个月随访，统计术后复发情况。基于多因素Logistic回归模型筛选慢性鼻窦炎患者术后复发的危险因素，绘制受试者工作特征曲线分析血清ACE-2联合鼻窦CT评分预测慢性鼻窦炎患者术后复发的价值。结果：62例慢性鼻窦炎患者在术后随访1年内发生复发，复发组哮喘、鼻塞评分、外周血嗜酸粒细胞百分比、血清特异性免疫球蛋白（sIgE）水平，鼻窦CT评分高于未复发组（P<0.05），血清ACE-2水平低于未复发组（P<0.05）。多因素Logistic回归显示高鼻窦CT评分、高血清sIgE是影响慢性鼻窦炎患者术后复发的危险因素（P<0.05），高血清ACE-2是保护因素（P<0.05）。联合血清ACE-2、鼻窦CT评分预测慢性鼻窦炎患者术后复发的曲线下面积为0.902，高于单独ACE-2、鼻窦CT评分预测（P<0.05）。结论：慢性鼻窦炎患者低水平ACE-2和高鼻窦CT评分与术后复发密切相关，联合鼻窦CT评分和血清ACE-2能提高对术后复发的预测价值。

Abstract

Objective: To investigate the predictive value of serum angiotensin-converting enzyme 2 (ACE-2) combined with sinus CT score for postoperative recurrence of chronic rhinosinusitis. Methods: A total of 198 chronic rhinosinusitis patients requiring endoscopic sinus surgery (ESS) were prospectively enrolled from the Department of Otorhinolaryngology-Head and Neck Surgery, Yuncheng Central Hospital, Shanxi Medical University, between January 2020 and January 2024. Preoperative serum ACE-2 levels were measured, and sinus high-resolution CT scans were performed to calculate Lund-Mackay scores. Patients were followed for 12 months postoperatively via outpatient visits and telephone interviews to assess recurrence. Multivariate logistic regression analysis was performed to identify risk factors for recurrence, and ROC curves were constructed to evaluate the predictive efficacy of serum ACE-2 combined with sinus CT score. Results: Sixty-two patients experienced recurrence within 12 months. The recurrence group exhibited higher rates of comorbid asthma, higher nasal obstruction scores, elevated peripheral blood eosinophil percentages, increased serum-specific immunoglobulin E (sIgE) levels, and higher sinus CT scores compared to the non-recurrence group (allP<0.05), whereas serum ACE-2 levels were significantly lower (P<0.05). Multivariate analysis identified high sinus CT score and elevated serum sIgE as independent risk factors for recurrence (P<0.05), whereas high serum ACE-2 was a protective factor (P<0.05). The combination of serum ACE-2 and sinus CT score achieved an area under the ROC curve of 0.902, significantly outperforming each parameter alone (P<0.05). Conclusion: Low serum ACE-2 levels and high sinus CT scores are closely associated with postoperative recurrence for chronic rhinosinusitis. The combination of these parameters enhanced predictive accuracy and offers a valuable tool for risk stratification and personalized postoperative management.

关键词

慢性鼻窦炎 / 手术 / 术后复发 / 血管紧张素转换酶2 / 鼻窦CT评分

Key words

Chronic Rhinosinusitis / Surgery / Postoperative Recurrence / Angiotensin-Converting Enzyme 2 / Sinus CT Score

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基金资助

山西省卫生健康科研课题(2020038)