Development of a clinically relevant endoscopic grading system for chronic rhinosinusitis using canonical correlation analysis.
Development of a clinically relevant endoscopic grading system for chronic rhinosinusitis using canonical correlation analysis.
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DOI：
10.1002/alr.21683
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发表时间：
2016-05
影响因子：
6.4
通讯作者：
Smith TL
中科院分区：
文献类型：
--
作者：
DeConde AS;Bodner TE;Mace JC;Alt JA;Rudmik L;Smith TL
诊断性鼻内窥镜检查是慢性鼻窦炎 (CRS) 患者鼻窦炎症的常规测量方法。尽管已经提出并评估了多种分期系统，但并发症状与内镜检查结果之间关联的证据仍然不一致。本研究的目的是确定与症状负担相关的内窥镜属性，并系统地得出加权内窥镜量表，以优化并发症状的预测。报告的基线症状（Sinonasal Outcomes Test-22 {SNOT-22}）和内窥镜评估评分（Lund-Kennedy {LK}）来自参加前瞻性队列研究的 CRS 患者。 SNOT-22 子域和 LK 变量的典型相关分析已完成。共有 629 名患者参与分析，其中 343 名患者既往接受过内窥镜鼻窦手术。在解释数据方差方面，显着的典型相关性优于总体相关性（分别为 33% 和 3%）。第一个典型相关性主要是鼻科症状域和内窥镜息肉评分（r=0.54；p<0.05），而鼻外症状子域与既往无 ESS 患者的水肿评分（r=0.21；p<0.05）以及既往 ESS 患者的出院率（r=0.22；p<0.05）之间也存在显着的典型相关性。所有其他领域和内窥镜变量对典型相关性没有显着贡献。尽管总体症状和内窥镜评分显示出最小的相关性，但症状域和内窥镜属性的加权组合极大地改善了这种相关性。息肉、水肿、分泌物、疤痕和结痂等内窥镜变量的权重的简单近似值分别为 4:2:1:0:0。
Diagnostic nasal endoscopy is a routine measure of sinonasal inflammation in patients with chronic rhinosinusitis (CRS). Although multiple staging systems have been proposed and evaluated, evidence of association between concurrent symptoms and endoscopic findings remains discordant. The goal of this study is to identify the relevant endoscopic attributes associated with symptom burden, and to systematically derive a weighted endoscopic scale that optimizes prediction of concurrent symptoms. Reported baseline symptom (Sinonasal Outcomes Test-22 {SNOT-22}) and endoscopic evaluation scores (Lund-Kennedy {LK}) were obtained from patients with CRS enrolled in a prospective cohort study. Canonical correlation analysis of the SNOT-22 subdomains and LK variables was completed. A total of 629 patients were included in analysis including 343 with prior endoscopic sinus surgery. Significant canonical correlations outperformed aggregate correlations in explaining variance of the data (33% vs. 3%, respectively). The first canonical correlation was dominated by the Rhinologic symptom domain and the endoscopic polyp score (r=0.54; p<0.05) while additional significant canonical correlation was found between the Extra-rhinologic symptom subdomain and the edema score in patients without prior ESS (r=0.21; p<0.05), and discharge in patients with prior ESS (r=0.22; p<0.05). All other domains and endoscopic variables did not significantly contribute to the canonical correlation. Although aggregate symptoms and endoscopic scores demonstrate minimal correlation, a weighted combination of symptom domains and endoscopic attributes greatly improves this correlation. A simple approximation of the weights of each of the endoscopic variables of polyps, edema, discharge, scarring, and crusting, is an approximate ratio of 4:2:1:0:0, respectively.