Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease.
Clinical Characteristics of Patients with Chronic Rhinosinusitis with Nasal Polyps, Asthma, and Aspirin-Exacerbated Respiratory Disease.
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DOI：
10.1016/j.jaip.2016.12.027
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Schleimer RP
中科院分区：
文献类型：
--
作者：
Stevens WW;Peters AT;Hirsch AG;Nordberg CM;Schwartz BS;Mercer DG;Mahdavinia M;Grammer LC;Hulse KE;Kern RC;Avila P;Schleimer RP
阿司匹林加剧的呼吸道疾病（AERD）包括慢性鼻窦炎伴鼻息肉（CRSwNP）、哮喘和对环加氧酶-1（考克斯-1）酶抑制剂不耐受的三联体。AERD的患病率尚不清楚，很少有研究将AERD患者的临床特征与CRSwNP单独、哮喘单独或CRSwNP和哮喘患者进行比较。确定三级医疗机构中AERD的患病率，并确定可将这些患者与CRSwNP+哮喘或CRSwNP患者区分开来的独特临床特征。通过计算机算法搜索伊利诺斯州芝加哥西北大学患者的电子病历，然后进行手动病历审查，以确定459例仅CRSwNP患者，412例CRSwNP+哮喘患者，171例AERD患者和300例仅哮喘患者。人口统计学和临床特征，包括性别，特应性，鼻窦疾病的严重程度进行了表征。CRSwNP患者中AERD的患病率为16%。AERD患者接受鼻窦手术的次数是CRSwNP患者的2倍（p<0.001），并且首次手术时年龄（40±13岁）明显小于CRSwNP患者（43±14岁，p<0.05）。特应性在AERD（84%）或哮喘（85%）患者中的患病率显著高于CRSwNP（66%，p<0.05）。AERD患者（13%）的皮质类固醇依赖性疾病多于CRSwNP+哮喘（4%，p<0.01）或哮喘（1%，p<0.001）。AERD在CRSwNP患者中很常见;即使AERD患者患有CRSwNP和哮喘，其疾病的临床病程与患有CRSwNP和哮喘但对考克斯-1抑制剂耐受的患者不同。
Aspirin exacerbated respiratory disease (AERD) comprises the triad of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and intolerance to inhibitors of the cyclooxygenase-1 (COX-1) enzyme. The prevalence of AERD remains unclear and few studies have compared the clinical characteristics of patients with AERD to those with CRSwNP alone, asthma alone, or both CRSwNP and asthma. To determine the prevalence of AERD within a tertiary care setting, and to identify unique clinical features that could distinguish these patients from those with CRSwNP+Asthma or CRSwNP. Electronic medical records of patients at Northwestern in Chicago, Illinois were searched by computer algorithm and then manual chart review to identify 459 patients with CRSwNP alone, 412 with CRSwNP+Asthma, 171 with AERD, and 300 with asthma only. Demographic and clinical features including sex, atopy, and sinus disease severity were characterized. The prevalence of AERD among CRSwNP patients was 16%. AERD patients had undergone two-fold more sinus surgeries (p<0.001) and were significantly younger at the time of their first surgery (40±13 years) than CRSwNP patients (43±14 years, p<0.05). Atopy was significantly more prevalent in patients with AERD (84%) or asthma (85%) than in CRSwNP (66%, p<0.05). More patients with AERD (13%) had corticosteroid-dependent disease than CRSwNP+Asthma (4%, p<0.01) or asthma (1%, p<0.001). AERD is common among CRSwNP patients; even though AERD patients have CRSwNP and asthma, the clinical course of their disease is not the same as of patients who have CRSwNP and asthma but are tolerant to COX-1 inhibitors.
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