“互联网+”医疗模式下慢性鼻窦炎患者FESS术后疗效评估及预后影响因素分析

Evaluation of postoperative efficacy and analysis of prognostic factors in chronic sinusitis patients undergoing functional endoscopic sinus surgery in the "internet+" medical model

摘要

目的 分析慢性鼻窦炎患者术前及术后的临床指标，评价鼻窦炎术后疗效，探讨可能影响慢性鼻窦炎预后的相关因素，为临床精准治疗、改善患者预后提供相应参考。方法 回顾性分析100例慢性鼻窦炎手术患者的临床资料，采用统一的慢性鼻窦炎综合治疗方案，并采用“远程+线下+医学交互”的“互联网+”医疗模式，治疗12周后进行随访来评价短期疗效，并对所有患者随访至18个月，分析可能影响慢性鼻窦炎预后的因素。结果 各量表治疗后的效应量>0.50，且差异均有统计学意义(P<0.05)。性别(P=0.674)、年龄(P=0.527)、患病侧别(P=0.369)、病程(P=0.430)、合并高血压(P=0.094)、合并冠心病或心梗(P=0.144)、外周血中性粒细胞/淋巴细胞值(neutrophil-to-lymphocyte ratio，NLR。P=0.514)及血小板/淋巴细胞值(platelet-to-lymphocyte ratio，PLR。P=0.635)各组之间与慢性鼻窦炎预后无明显相关性，差异无统计学意义；罹患糖尿病(HR=2.879，P=0.037)、合并过敏性鼻炎(OR=4.240，P=0.013)、伴有鼻息肉(HR=0.203，P=0.042)、外周血EOS百分比(OR=0.243，P=0.046)为预后不良的独立危险因素，且术前Lund-Mackay得分(OR=1.166，P=0.016)、术前鼻腔-鼻窦结局测试-22(sino-nasal outcome test-22，SNOT-22)得分(OR=1.340，P<0.001)、术前视觉模拟评分(visual analogue scale，VAS)(OR=2.046，P<0.001)及术前Lund-Kennedy得分(OR=1.441，P=0.008)，各组之间慢性鼻窦炎的预后差异均有统计学意义。线性混合效应模型显示，SNOT-22得分、VAS得分及Lund-Kennedy得分在治疗后各时间点均显著下降(P均<0.05)。结论 慢性鼻窦炎的预后与性别、年龄、患病侧别、病程、合并高血压、合并冠心病及心梗、外周血中性粒细胞/淋巴细胞值(neutrophil-to-lymphocyte ratio，NLR)及血小板/淋巴细胞值(platelet to lymphocyte ratio，PLR)无关；与罹患糖尿病、合并过敏性鼻炎、伴有鼻息肉、外周血EOS百分比有关，且术前Lund-Mackay得分、术前SNOT-22得分、术前VAS得分及术前Lund-Kennedy得分是慢性鼻窦炎预后良好的正性因素。罹患糖尿病、合并过敏性鼻炎及鼻息肉的患者，预后更差，故临床上要重视调控患者血糖、及时联用抗过敏抗炎药物，改善患者预后。

Abstract

Objective To investigate preoperative and postoperative clinical parameters in patients with chronic sinusitis, evaluate surgical outcomes, analyze potential prognostic factors, and provide a reference for precise clinical management to improve patient prognosis. Methods We conducted a retrospective analysis of clinical data from 100 patients who underwent surgery for chronic sinusitis. A standardized comprehensive treatment protocol for chronic sinusitis was implemented, utilizing an ‘Internet Plus’ health-care model that integrated remote, in person, and interactive medical services. Short-term efficacy was evaluated through follow-up assessments 12 weeks after treatment, and all patients were followed for 18 months to analyze factors that may influence the prognosis of chronic sinusitis. Results The effect sizes for all scales after treatment were >0.50, and the differences were all statistically significant (P<0.05). Gender (P=0.674), age (P=0.527), affected side (P=0.369), duration of illness (P=0.430), concomitant hypertension (P=0.094), concomitant coronary heart disease or myocardial infarction (P=0.144), peripheral blood neutrophil-to-lymphocyte ratio (NLR) (P=0.514), and platelet-to-lymphocyte ratio (PLR) (P=0.635) did not show a significant association with the prognosis of chronic sinusitis between groups, and the differences were not statistically significant; however, diabetes (HR=2.879, P=0.037), concomitant allergic rhinitis (OR=4.240, P=0.013), the presence of nasal polyps (HR=0.203, P=0.042), and the percentage of eosinophils in peripheral blood (OR=0.243, P=0.046) were independent risk factors for poor prognosis. Additionally, the preoperative Lund-Mackay score (OR=1.166, P=0.016), the preoperative SNOT-22 score (OR=1.340, P<0.001), preoperative VAS score (OR=2.046, P<0.001), and the preoperative Lund-Kennedy score (OR=1.441, P=0.008). The differences in the prognosis of chronic sinusitis among the groups were all statistically significant. The linear mixed-effects model showed that SNOT-22 scores, VAS scores, and Lund-Kennedy scores all decreased significantly at all post-treatment time points (all P<0.05). Conclusion The prognosis of chronic sinusitis is not associated with gender, age, affected side, duration of the disease, concomitant hypertension, coronary heart disease, or hematological indices such as NLR and PLR. It is significantly influenced by diabetes mellitus, concomitant allergic rhinitis, the presence of nasal polyps, and the percentage of eosinophils in peripheral blood. Preoperative Lund-Mackay, SNOT-22, VAS, and Lund-Kennedy scores serve as positive prognostic factors. Patients with diabetes, allergic rhinitis, or nasal polyps tend to have a less favorable prognosis. Therefore, clinical management should emphasize stringent glycemic control and timely administration of combined anti-allergic and anti-inflammatory therapy to mitigate the risk of a poor outcome.

关键词

慢性鼻窦炎 / 实验室指标 / 量表 / 预后 / 疗效

Key words

Chronic rhinosinusitis / Laboratory indicators / Scales / Prognosis / Therapeutic efficacy

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基金资助

成都市医学科研课题立项项目(2023440)