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慢性鼻窦炎患者哮喘起病模式和临床转归

2018/01/19

   摘要

   背景:慢性鼻窦炎(CRS)与共患哮喘密切相关。本研究通过患者自我报道和临床特征学研究比较早发型哮喘和迟发型哮喘在CRS人群中的差异。
   方法:进入临床注册系统,CRS患者完成SNOT-22,ACT、miniAQLQ、PROMIS-29以及药物使用问卷。患者自我报道共患哮喘情况以及首次哮喘诊断时间。早发型哮喘和迟发型哮喘分别定义为<18岁和>18岁。通过ANOVA和Kruskal-Wallis检测分析患者的临床情况。
   结果:199名(56.1%)非哮喘患者,71名(20.0%)早发型哮喘和85名(23.9%)迟发型哮喘患者完成调查。BMI在迟发型哮喘患者中更高(p=0.046),而年龄、性别、种族以及吸烟状态与哮喘起病时间无关。哮喘组之间SNOT-22, ACT和miniAQLQ并无显著差异,但迟发型哮喘较非哮喘患者体力状态更差(P=0.008)。与非哮喘患者相比,迟发型哮喘患者鼻息肉发病率显著升高(p<0.001), Lund-Mackay评分更高(p=0.005),口服激素疗程更多(p<0.001),CRS接受内镜手术更多(p=0.008)。与早发型哮喘患者相比,迟发型哮喘患者鼻息肉率更高(p=0.011),CRS口服激素治疗更多(p=0.003)。
   结论:CRS特异性和哮喘特异性患者报道临床情况(PROMS)在组间无明显差异。伴迟发型哮喘CRS患者活动能力更差,鼻息肉发生率更高,需要更多CRS治疗。迟发型哮喘预示CRS情况更严重。

 

(上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译)

(Int Forum Allergy Rhinol. 2018 Jan 5. doi: 10.1002/alr.22064. [Epub ahead of print])
 

 

Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population.

 

Int Forum Allergy Rhinol. 2018 Jan 5. doi: 10.1002/alr.22064. [Epub ahead of print]

Jones C et al.
 
Abstract
BACKGROUND:Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics.
METHODS:At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses.
RESULTS:A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003).
CONCLUSION:While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.
 


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