基于囊泡组织Ki67、GM-CSF表达评估Messerkliger中鼻甲成形术对慢性鼻-鼻窦炎合并鼻息肉的效果

Evaluation of the effect of Messerkliger middle turbinate plasty on chronic rhinosinusitis with nasal polyps based on the expression of Ki67 and GM-CSF in vesicular tissue

摘要

目的 探讨Messerkliger中鼻甲成形术治疗慢性鼻-鼻窦炎合并鼻息肉(chronic rhinosinusitis with nasal polyps, CRSwNP)的疗效与对囊泡组织Ki67、粒细胞-巨噬细胞集落刺激因子(granulocyte-macrophage colony-stimulating factor, GM-CSF)表达的影响。方法 选取CRSwNP患者86例，按照随机数表法进行分组，分为对照组(予以鼻内镜中鼻甲部分切除术，43例)与观察组(予以Messerkliger中鼻甲成形术，43例)。对比两组的临床疗效、鼻腔功能[鼻腔最小横截面积(nasal minimum cross-sectional area, NMCA)、鼻腔容积(nasal cavity volume, NCV)、鼻腔最小横截面到前鼻孔距离(distance from the anterior nasal cavity to the anterior nares, DCAN)及气道阻力(airway resistance, Raw)]、嗅觉功能、囊泡组织Ki67、GM-CSF表达情况、并发症及复发情况。结果 观察组临床疗效高于对照组(P=0.034)；术后3个月，两组NCV、NMCA均有升高，且观察组高于对照组(P=0.008, 0.006)；术后3个月，两组DCAN、Raw均有降低，且观察组低(P=0.006, <0.001)；术后3个月，两组嗅觉功能均有改善，且观察组改善程度高于对照组(P=0.014)；观察组的Ki67、GM-CSF阳性表达水平低于对照组(P=0.016, 0.023)；术毕至随访期间，观察组复发率低于对照组(P=0.034)。结论 Messerkliger中鼻甲成形术可显著提高CRSwNP患者的临床疗效，有效改善鼻腔功能及嗅觉功能，降低囊泡组织Ki67、GM-CSF的阳性表达水平和复发情况，值得临床推广使用。

Abstract

Objective To investigate the efficacy of Messerkliger turbinate reduction in treating chronic rhinosinusitis with nasal polyps (CRSwNP) and its effects on Ki67 expression and granulocyte-macrophage colony-stimulating factor (GM-CSF) expression in endoscopic tissue samples. Methods Eighty-six patients with chronic rhinosinusitis with nasal polyps (CRSwNP) were selected and randomly assigned using a random number table to either the control group (43 patients undergoing partial turbinectomy via endoscopic sinus surgery) or the observation group (43 patients undergoing Messerkliger turbinate reshaping). Comparison of clinical efficacy, nasal function [nasal minimum cross-sectional area (NMCA), nasal cavity volume (NCV), distance from the nostril cavity to the anterior inferior (DCAN), and airway resistance (Raw)], olfactory function, Ki67 expression in cystic tissue, GM-CSF expression in cystic tissue, complications, and recurrence rates. Results The clinical efficacy in the observation group was higher than that in the control group (P=0.034). At 3 months postoperatively, both groups showed increased NCV and NMCA, with the observation group exhibiting higher values than the control group (P=0.008, 0.006). At 3 months postoperatively, both groups demonstrated decreased DCAN and Raw, with the observation group exhibiting lower levels (P=0.006, <0.001). At 3 months postoperatively, the olfactory function of both groups was improved, and the improvement degree in the observation group was higher than that in the control group (P=0.014). At 3 months postoperatively, Ki67 and GM-CSF positive expression levels were lower in the observation group than in the control group (P=0.016, 0.023). From the time of surgery to follow-up, the recurrence rate was lower in the observation group than in the control group (P=0.034). Conclusion Messerkliger turbinate reduction significantly improves clinical outcomes in CRSwNP patients, effectively enhancing nasal function and olfactory function while reducing Ki67 and GM-CSF positive expression levels in cystic tissue and recurrence rates. This technique warrants clinical implementation.

关键词

Messerkliger中鼻甲成形术 / 慢性鼻-鼻窦炎合并鼻息肉 / Ki67 / 粒细胞-巨噬细胞集落刺激因子 / 鼻腔功能 / 嗅觉功能

Key words

Messerkliger middle turbinate reduction / Chronic rhinosinusitis with nasal polyps / Ki67 / Granulocyte macrophage colony-stimulating factor / Nasal function / Olfactory function

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基金资助

河北省医学科学研究课题计划资助(20240266)