内窥镜鼻窦手术治疗慢性鼻窦炎伴鼻息肉患者术后复发的预测模型

doi:10.3969/j.issn.1006-5725.2025.18.021

Abstract

Abstract:

Objective To analyze the risk factors for postoperative recurrence in patients with chronic sinusitis and nasal polyps （CRSwNP） treated by endoscopic sinus surgery （ESS）， and to construct a predictive model. Methods A retrospective study was conducted on 203 patients with CRSwNP who underwent ESS in the hospital from March 2022 to February 2023. These patients were divided into a recurrence group （n = 43） and an non-recurrence group （n = 160） based on whether they experienced recurrence after surgery. Clinical data were collected and analyzed using univariate analysis to identify significant differences. Lasso regression was used to screen potential influencing factors. Multivariate logistic regression was employed to analyze the risk factors. A nomogram was constructed for postoperative recurrence model， and the receiver operating characteristic （ROC） curve and calibration curve were used to evaluate the model. Results Single-factor analysis showed that disease duration， Lund-Mackay CT score， SNOT-22 score， EOS， ECP， total IgE， CRP， IL-5， and IL-1β in the recurrence group after ESS were higher than those in the non-recurrence group （P < 0.05）， while the UPSIT score， CD3⁺， CD4⁺， CD8⁺， and CD4⁺/CD8⁺ were lower （P < 0.05）； the proportion of patients with allergic rhinitis， asthma， no preoperative glucocorticoid treatment， and surgery time ≥ 2 hours in the recurrence group after ESS was higher than that in the non-recurrence group （P < 0.05）. Multivariate logistic regression analysis model showed that disease duration （OR = 1.389， 95% CI： 1.094 ~ 1.763， P = 0.007）， combined asthma （OR = 2.997， 95% CI： 1.065 ~ 8.432， P = 0.038）， Lund-Mackay CT score （OR = 1.156， 95% CI： 1.027 ~ 1.301， P = 0.016）， EOS （OR = 1.540， 95% CI： 1.249 ~ 1.898， P < 0.001）， total IgE （OR = 1.005， 95% CI： 1.000 ~ 1.009， P = 0.041）， and IL-5 （OR = 1.165， 95% CI： 1.078 ~ 1.260， P < 0.001） were risk factors for ESS recurrence. Based on multivariate logistic regression analysis nomogram， the area under the ROC curve （AUC） was 0.9057； the sensitivity 76.74%； the specificity 87.5%； the average absolute error （MAE） of the calibration curve 0.03； the mean square error （MSE） 0.00157， and the absolute error at the 0.9 percentile 0.065. Conclusions Disease course， the presence of asthma， Lund-Mackay CT score， EOS， total IgE， and IL-5 are all risk factors for postoperative recurrence in patients with CRSwNP. Moreover， the relevant nomogram model can be used as a reliable tool for assessing the risk of postoperative recurrence in CRSwNP.

Key words: chronic sinusitis with nasal polyps, endoscopic sinus surgery, recurrence, risk factors

CLC Number:

R765.4

Dehong LI,Maomei NI,Ting CAI,Juanjuan REN. Risk factors for postoperative recurrence in patients with chronic sinusitis and nasal polyps treated by endoscopic sinus surgery[J]. The Journal of Practical Medicine, 2025, 41(18): 2928-2936.

Figures/Tables 5

Tab.1

Comparison of clinical data between patients with recurrence and those without recurrence"

条目	复发组（n = 43）	未复发组（n = 160）	t/χ²值	P值
年龄/岁	45.86 ± 12.51	42.67 ± 11.87	1.548	0.123
性别/［例（%）］			0.034	0.854
男	27（62.80）	98（61.30）
女	16（37.20）	62（38.70）
BMI/（kg/m²）	24.21 ± 3.19	23.75 ± 2.90	0.906	0.366
病程/年	4.82 ± 2.23	3.18 ± 1.85	4.919	< 0.001
合并变应性鼻炎/［例（%）］			5.360	0.021
是	21（48.84）	48（30.00）
否	22（51.16）	112（70.00）
哮喘/［例（%）］			8.725	0.003
是	18（41.86）	32（20.00）
否	25（58.14）	128（80.00）
吸烟史/［例（%）］			1.251	0.263
是	15（34.88）	42（26.25）
否	28（65.12）	118（73.75）
饮酒史/［例（%）］			0.315	0.574
是	13（30.23）	38（23.75）
否	30（69.77）	122（76.25）
术前糖皮质激素治疗/［例（%）］			5.098	0.024
是	26（60.47）	124（77.50）
否	17（39.53）	36（22.50）
Lund-Mackay CT评分/分	18.58 ± 4.27	15.61 ± 4.09	4.200	< 0.001
SNOT-22评分/分	42.88 ± 11.45	38.15 ± 10.32	2.609	0.010
UPSIT评分/分	18.51 ± 6.38	22.13 ± 7.81	2.796	0.006
病变部位/［例（%）］			0.907	0.341
鼻中隔偏曲	19（44.19）	58（36.25）
嗅裂息肉	24（55.81）	102（63.75）
手术时间/［例（%）］			5.203	0.023
< 2 h	18（41.86）	98（61.25）
≥ 2 h	25（58.14）	62（38.75）
术后感染/［例（%）］			2.754	0.097
是	9（20.93）	18（11.25）
否	34（79.07）	142（88.75）
EOS/%	6.82 ± 3.18	4.24 ± 2.14	6.285	< 0.001
PLT/（×10?·L^-1）	298.49 ± 68.27	285.28 ± 59.73	1.248	0.216
ECP/（μg/L）	24.65 ± 8.95	18.32 ± 6.83	5.031	< 0.001
总IgE/（IU/mL）	286.47 ± 142.27	191.74 ± 100.26	4.997	< 0.001
WBC/（×10?·L^-1）	7.83 ± 2.11	7.2 ± 1.88	1.898	0.059
CRP/（mg/L）	8.59 ± 4.13	6.79 ± 3.01	3.193	0.002
IL-5/（pg/mL）	18.92 ± 7.34	12.34 ± 5.73	6.276	< 0.001
IL-1β/（pg/mL）	15.56 ± 6.78	11.18 ± 4.9	4.765	< 0.001
NLR	3.22 ± 1.42	2.69 ± 1.10	2.668	0.008
CD3⁺/%	68.43 ± 8.87	71.22 ± 7.62	2.055	0.041
CD4⁺/%	42.19 ± 6.77	44.77 ± 7.21	2.106	0.036
CD8⁺/%	28.67 ± 5.39	26.83 ± 4.82	2.171	0.031
CD4⁺/CD8⁺	1.44 ± 0.37	1.75 ± 0.43	4.272	< 0.001

Tab.1

Fig.1

Tab.2

Fig.2

Fig.3

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条目	单因素分析		多因素分析
条目	OR（95%CI）	P值	OR（95%CI）	P值
病程	1.426（1.207 ~ 1.684）	0.000	1.389（1.094 ~ 1.763）	0.007
合并变应性鼻炎	2.214（1.129 ~ 4.342）	0.021	-	-
哮喘	2.907（1.424 ~ 5.933）	0.003	2.997（1.065 ~ 8.432）	0.038
术前糖皮质激素治疗	0.445（0.220 ~ 0.896）	0.024	-	-
Lund-Mackay CT评分	1.179（1.087 ~ 1.279）	0.000	1.156（1.027 ~ 1.301）	0.016
SNOT-22评分	1.041（1.009 ~ 1.074）	0.010	-	-
UPSIT评分	0.928（0.882 ~ 0.976）	0.006	-	-
手术时间（≥ 2 h vs. < 2 h）	2.196（1.117 ~ 4.317）	0.023	-	-
EOS	1.445（1.259 ~ 1.657）	0.000	1.540（1.249 ~ 1.898）	0.000
ECP	1.105（1.055 ~ 1.158）	0.000	-	-
总IgE	1.004（1.002 ~ 1.006）	0.000	1.005（1.000 ~ 1.009）	0.041
WBC	1.173（0.991 ~ 1.389）	0.059	-	-
CRP	1.161（1.055 ~ 1.279）	0.002	-	-
IL-5	1.142（1.089 ~ 1.197）	0.000	1.165（1.078 ~ 1.260）	0.000
IL-1β	1.151（1.077 ~ 1.231）	0.000	-	-
NLR	1.349（1.084 ~ 1.680）	0.008	-	-
CD3⁺	0.961（0.926 ~ 0.997）	0.041	-	-
CD4⁺	0.951（0.908 ~ 0.996）	0.036	-	-
CD8⁺	1.076（1.007 ~ 1.150）	0.031	-	-
CD4⁺/CD8⁺	0.237（0.089 ~ 0.633）	0.000	-	-

Risk factors for postoperative recurrence in patients with chronic sinusitis and nasal polyps treated by endoscopic sinus surgery

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