Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study.
Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study.
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作者：
Tokunaga T;Sakashita M;Haruna T;Asaka D;Takeno S;Ikeda H;Nakayama T;Seki N;Ito S;Murata J;Sakuma Y;Yoshida N;Terada T;Morikura I;Sakaida H;Kondo K;Teraguchi K;Okano M;Otori N;Yoshikawa M;Hirakawa K;Haruna S;Himi T;Ikeda K;Ishitoya J;Iino Y;Kawata R;Kawauchi H;Kobayashi M;Yamasoba T;Miwa T;Urashima M;Tamari M;Noguchi E;Ninomiya T;Imoto Y;Morikawa T;Tomita K;Takabayashi T;Fujieda S
慢性鼻窦炎（CRS）可分为伴有鼻息肉的CRS （CRSwNP）和不伴有鼻息肉的CRS （CRSsNP）。CRSwNP表现出更强的嗜酸性细胞浸润和Th2细胞因子的存在。粘膜嗜酸性粒细胞增多与更严重的症状相关，由于复发往往需要多次手术；然而，即使在嗜酸性CRS (ECRS)，临床过程是可变的。在本研究中，我们希望为难治性CRS的诊断建立客观的临床标准。本研究是由参与日本难治性嗜酸性粒细胞慢性鼻窦炎（JESREC）流行病学调查的15家机构进行的回顾性研究。我们评估了接受内镜鼻窦手术（ESS）治疗的CRS患者，并使用Cox比例风险模型估计复发风险。建立多元logistic回归模型和受试者工作特征曲线，建立ECRS诊断标准。我们分析了1716例接受ESS治疗的患者。为了诊断ECRS， JESREC评分系统评估了单侧或双侧疾病、鼻息肉、血嗜酸性粒细胞增多以及CT扫描中筛窦的显性阴影。评分截止值为11分（敏感性83%，特异性66%）。血嗜酸性粒细胞增多（>5%）、CT扫描发现的筛窦疾病、支气管哮喘、阿司匹林和非甾体类抗炎药物不耐受与复发显著相关。根据我们的算法，我们将CRSwNP细分为非ECRS、轻度、中度和重度ECRS。该分类与预后显著相关。值得注意的是，该算法可以为临床医生在ESS或活检前的CRS难治性提供有用的信息。
Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS. This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We evaluated patients with CRS treated with endoscopic sinus surgery (ESS), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS. We analyzed 1716 patients treated with ESS. To diagnose ECRS, the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (CT) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti‐inflammatory drugs intolerance were associated significantly with recurrence. We subdivided CRSwNP in non‐ECRS, mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy.
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DOI：
10.1016/j.jaci.2012.02.046
发表时间：
2012-08
期刊：
The Journal of allergy and clinical immunology
影响因子：
--
作者：
Takabayashi T;Kato A;Peters AT;Suh LA;Carter R;Norton J;Grammer LC;Tan BK;Chandra RK;Conley DB;Kern RC;Fujieda S;Schleimer RP
通讯作者：
Schleimer RP
慢性鼻窦炎患者鼻息肉组织中抗菌 PLUNC 蛋白表达减少。
影响因子：
12.4
作者：
Seshadri S;Lin DC;Rosati M;Carter RG;Norton JE;Suh L;Kato A;Chandra RK;Harris KE;Chu HW;Peters AT;Tan BK;Conley DB;Grammer LC;Kern RC;Schleimer RP
通讯作者：
Schleimer RP
DOI：
10.1164/rccm.201207-1292oc
发表时间：
2013-01-01
影响因子：
24.7
作者：
Takabayashi, Tetsuji;Kato, Atsushi;Schleimer, Robert P.
通讯作者：
Schleimer, Robert P.
影响因子：
2.8
作者：
Sakashita, Masafumi;Hirota, Tomomitsu;Fujieda, Shigeharu
通讯作者：
Fujieda, Shigeharu
影响因子：
14.2
作者：
Tieu, David D.;Peters, Anju T.;Carter, Roderick T.;Suh, Lydia;Conley, David B.;Chandra, Rakesh;Norton, James;Grammer, Leslie C.;Harris, Kathleen E.;Kato, Atsushi;Kern, Robert C.;Schleimer, Robert P.
通讯作者：
Schleimer, Robert P.