慢性鼻窦炎患者鼻内窥镜术后嗅觉改善不佳的预测模型构建分析

代丽丽; 汤维; 解道宇; 吴宏林; 陈朝辉

doi:10.16766/j.cnki.issn.1674-4152.002324

慢性鼻窦炎患者鼻内窥镜术后嗅觉改善不佳的预测模型构建分析

doi: 10.16766/j.cnki.issn.1674-4152.002324

杭州师范大学附属医院耳鼻咽喉科，浙江杭州 310015

基金项目:

浙江省卫生健康科技计划项目 2021KY896

详细信息

通讯作者:
代丽丽，E-mail：alexwz@163.com

中图分类号: R765.41
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-13
- 网络出版日期: 2022-03-04

Construction and analysis of predictive model of poor olfactory improvement in patients with chronic rhinosinusitis after endoscopic surgery

Department of Otorhinolaryngology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的通过构建慢性鼻-鼻窦炎(chronic rhinosinusitis，CRS)患者鼻内窥镜治疗后嗅觉改善不佳的预测模型，为临床工作提供指导。方法回顾性分析2018年3月—2021年3月于杭州师范大学附属医院耳鼻咽喉科行鼻内镜手术治疗的125例CRS患者的临床资料，所有患者均伴有嗅觉障碍，根据术后嗅觉障碍改善情况分为满意组和不满意组，通过单因素分析筛选影响嗅觉改善的因素并进行logistic多因素分析，根据logistic回归方程构建预测模型，并分析其预测效能。结果本研究最终纳入125例患者临床资料进行分析，其中满意组84例，不满意组41例。Logistic多因素分析提示既往过敏性疾病史(B=1.145，OR=3.141，95% CI：1.282~7.693)、鼻息肉(B=0.905，OR=2.472，95% CI：1.025~5.962)和长期减充血剂(B=1.043，OR=2.837，95% CI：1.164~6.917)是嗅觉恢复的危险因素，术后坚持综合治疗(B= -1.225，OR=0.294，95% CI：0.107~0.807)是嗅觉恢复的保护性因素。列线图模型预测CRS患者鼻内窥镜治疗后嗅觉改善不佳的C-index为0.745(0.739~0.819)，校正曲线显示列线图模型预测可能性绝对误差为0.043。结论过敏性疾病史、鼻息肉、长期减充血剂、术后坚持综合治疗是嗅觉恢复的影响因子，根据上述指标建立的列线图模型可用于CRS患者鼻内窥镜治疗后嗅觉改善情况的预测。
- 慢性鼻-鼻窦炎 /
- 内窥镜鼻窦手术 /
- 嗅觉障碍 /
- 预测模型 /
- 列线图
Abstract: Objective To provide guidance for clinical work by constructing a predictive model of poor olfactory improvement in patients with chronic rhinosinusitis (CRS) after nasal endoscopic treatment. Methods The clinical data of 125 patients with CRS who underwent endoscopic sinus surgery in the Department of Otorhinolaryngology, Affiliated Hospital of Hangzhou Normal University from March 2018 to March 2021 were retrospectively analysed. All patients were accompanied by olfactory disorders. The improvement of olfactory disorders was divided into satisfactory group and unsatisfactory group. Factors affecting olfactory improvement were screened through single-factor analysis, and logistics multi-factor analysis was carried out. A prediction model was constructed according to the logistics regression equation, and its prediction performance was analysed. Results The clinical data of 125 patients, including 84 cases in the satisfactory group and 41 cases in the unsatisfactory group, were analysed. Logistics multivariate analysis revealed that a history of allergic diseases (B=1.145, OR=3.141, 95% CI: 1.282-7.693), nasal polyps (B=0.905, OR=2.472, 95% CI: 1.025-5.962) and long-term reduction congestion (B=1.043, OR=2.837, 95% CI: 1.164-6.917) is a risk factor for olfactory recovery. Adherence to comprehensive treatment (B= -1.225, OR=0.294, 95% CI: 0.107-0.807) is a risk factor for olfactory recovery. The nomogram model predicted that the C-index of CRS patients with poor olfactory improvement after nasal endoscopic treatment was 0.745(0.739-0.819). The calibration curve showed that the absolute error of the prediction probability of the nomogram model was 0.043. Conclusion A history of allergic diseases, nasal polyps, long-term decongestants and post-operative adherence to comprehensive treatment are the factors affecting olfactory recovery. The nomogram model established based on the above indicators can be used for olfactory improvement after nasal endoscopic treatment in patients with CRS patients.
- Chronic rhinosinusitis /
- Endoscopic sinus surgery /
- Olfactory dysfunction /
- Prediction model /
- Nomogram

HTML全文

图 1 CRS患者鼻内窥镜治疗后嗅觉改善不佳的预测列线图

下载: 全尺寸图片幻灯片

图 2 活动校正曲线

下载: 全尺寸图片幻灯片

表 1 2组CRS患者临床资料比较

组别	例数	性别(男/女, 例)	年龄[M(P₂₅, P₇₅), 岁]	吸烟[例(%)]	饮酒[例(%)]	鼻息肉[例(%)]	病程[例(%)]		过敏性疾病[例(%)]
组别	例数	性别(男/女, 例)	年龄[M(P₂₅, P₇₅), 岁]	吸烟[例(%)]	饮酒[例(%)]	鼻息肉[例(%)]	≤3年	＞3年	过敏性疾病[例(%)]
满意组	84	45/39	44(41, 50)	36(42.86)	29(34.52)	26(30.95)	26(30.95)	58(69.05)	24(28.57)
不满意组	41	19/22	46(38, 50)	15(36.59)	17(41.46)	23(56.10)	14(34.15)	27(65.85)	20(48.78)
统计量		0.576^a	0.882^b	0.449^a	0.571^a	7.309^a	0.129^a		4.933^a
P值		0.448	0.379	0.503	0.450	0.007	0.719		0.026

组别	例数	长期减充血剂治疗[例(%)]	术后综合治疗[例(%)]	嗜酸性粒细胞百分比(x±s, %)	中性粒细胞百分比(x±s, %)	淋巴细胞百分比(x±s, %)	JESREC评分[M(P₂₅, P₇₅), 分]		Lund-Mackay评分[M(P₂₅, P₇₅), 分]
满意组	84	21(25.00)	70(83.33)	6.96±2.49	57.92±11.11	29.28±8.43	14(12, 16)		15(12, 18)
不满意组	41	17(41.46)	26(63.41)	7.23±3.14	57.79±13.35	28.73±10.94	14(13, 16)		15(10, 18)
统计量		3.529^a	6.135^a	0.482^c	0.054^c	0.283^c	0.329^b		0.915^b
P值		0.060	0.013	0.632	0.957	0.778	0.742		0.360
注：^a为χ²值，^b为Z值，^c为t值。

下载: 导出CSV

表 2 变量赋值表

变量	赋值方法
嗅觉恢复情况	满意=1，不满意=0
过敏性疾病	是=1，否=0
鼻息肉	是=1，否=0
长期减充血剂	是=1，否=0
术后综合治疗	是=1，否=0

下载: 导出CSV

表 3 2组CRS患者嗅觉改善的logistic多因素分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
过敏性疾病	1.145	0.442	6.271	0.012	3.141	1.282~7.693
鼻息肉	0.905	0.450	4.060	0.044	2.472	1.025~5.962
长期减充血剂	1.043	0.593	5.259	0.022	2.837	1.164~6.917
术后综合治疗	-1.225	0.461	5.645	0.018	0.294	0.107~0.807

下载: 导出CSV

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