慢性鼻-鼻窦炎伴鼻息肉术后患者发生咽喉反流的危险因素分析以及预测模型构建OA
Risk factors and prediction model construction for laryngopharyngeal reflux in postoperative patients with chronic rhinosinusitis with nasal polyps
目的 探讨慢性鼻-鼻窦炎伴鼻息肉术后患者发生咽喉反流的危险因素,构建预测模型.方法 纳入2022年5月至2024年9月于周口市第一人民医院行鼻内镜手术的慢性鼻窦炎伴鼻息肉(CRSwNP)患者255例,依据术后是否发生咽喉反流分为:喉咽反流(LPR)组(n=93)、非LPR组(n=162),分析影响慢性鼻-鼻窦炎伴鼻息肉术后患者发生咽喉反流的危险因素,并构建预测模型.结果 255例行鼻内镜手术的CRSwNP患者中,术后发生LPR有93例,占36.47%,术后未发生LPR有162例,占63.53%;两组患者体重指数(BMI)、吸烟史、饮酒史、手术时长、鼻中隔偏曲、过敏性鼻炎、支气管哮喘以及鼻窦炎分型情况对比,差异存在统计学意义(P<0.05);将单因素分析筛选出8个因素(BMI、吸烟史、饮酒史、手术时长、鼻中隔偏曲、过敏性鼻炎、支气管哮喘以及鼻窦炎分型)进行多因素Logistic回归分析结果显示,BMI((O^R)=2.435,95%CI:2.021～2.934)、吸烟史((O^R)=2.181,95%CI:1.850～2.572)、手术时长((O^R)=1.935,95%CI:1.713～2.185)、鼻中隔偏曲((O^R)=1.804,95%CI:1.570～2.073)、过敏性鼻炎((O^R)=1.785,95%CI:1.044～2.461)、饮酒史((O^R)=2.166,95%CI:1.866～2.514)、支气管哮喘((O^R)=1.908,95%CI:1.621～2.245)、鼻窦炎分型((O^R)=1.820,95%CI:1.559～2.125)是CRSwNP患者术后发生咽喉反流的危险因素(P<0.05);列线图内部验证一致性指数为0.729,校准曲线与45°参考线重合度较高,受试者操作特征(ROC)曲线下面积(AUC=0.783,95%CI:0.677～0.889),灵敏度为81.25%,特异度为67.50%,具有较高的临床预测价值.结论 慢性鼻-鼻窦炎伴鼻息肉术后患者发生咽喉反流的危险因素主要包括较高的BMI、吸烟史、饮酒史、较长的手术时长、鼻中隔偏曲、过敏性鼻炎、支气管哮喘以及全鼻窦炎,基于上述因素所构建的预测模型,能够有效评估患者的术后咽喉反流风险,为临床早期干预和个性化治疗提供依据.
[Objective]To investigate the risk factors for laryngopharyngeal reflux(LPR)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)after surgery and to construct a prediction model.[Methods]A total of 255 patients with CRSwNP who underwent endoscopic sinus surgery at the First People's Hospital of Zhoukou City from May 2022 to September 2024 were included.They were divided into two groups based on whether LPR occurred after surgery:the LPR group(n=93)and the non-LPR group(n=162).The risk factors for LPR in these patients were analyzed,and a prediction model was constructed.[Results]Among the 255 patients with CRSwNP who underwent endoscopic sinus surgery,93 cases(36.47%)developed LPR after surgery,while 162 cases(63.53%)did not.Comparisons between the two groups in terms of BMI,smoking history,alcohol consumption history,surgical duration,deviated nasal septum,allergic rhinitis,bronchial asthma,and sinusitis classification showed statistically significant differences(P<0.05).Multivariate logistic regression analysis was performed on the eight factors(BMI,smoking history,alcohol consumption history,surgical duration,deviated nasal septum,allergic rhinitis,bronchial asthma,and sinusitis classification)identified through univariate analysis.The results showed that BMI((O^R)=2.435,95%CI:2.021 – 2.934),smoking history((O^R)=2.181,95%CI:1.850–2.572),surgical duration((O^R)=1.935,95%CI:1.713–2.185),deviated nasal septum((O^R)=1.804,95%CI:1.570–2.073),allergic rhinitis((O^R)=1.785,95%CI:1.044–2.461),alcohol consumption history((O^R)=2.166,95%CI:1.866 – 2.514),bronchial asthma((O^R)=1.908,95%CI:1.621 – 2.245),and sinusitis classification((O^R)=1.820,95%CI:1.559–2.125)were risk factors for postoperative LPR in CRSwNP patients(P<0.05).The nomogram internal validation showed a concordance index of 0.729,and the calibration curve had a high degree of overlap with the 45-degree reference line.The area under the ROC curve(AUC=0.783,95%CI:0.677–0.889)indicated a sensitivity of 81.25%and a specificity of 67.50%,demonstrating high clinical predictive value.[Conclusion]The main risk factors for LPR in patients with chronic rhinosinusitis with nasal polyps after surgery include high BMI,smoking history,alcohol consumption history,long surgical duration,deviated nasal septum,allergic rhinitis,bronchial asthma,and pansinusitis.The prediction model based on the above factors can effectively assess the risk of postoperative LPR in patients and provide a basis for early clinical intervention and personalized treatment.
徐靖杰;张晓艳;吴鹏飞
周口市第一人民医院 耳鼻咽喉科,河南 周口 466700周口市第一人民医院 耳鼻咽喉科,河南 周口 466700周口市第一人民医院 耳鼻咽喉科,河南 周口 466700
医药卫生
慢性鼻-鼻窦炎鼻息肉术后咽喉反流危险因素预测模型
chronic rhinosinusitisnasal polypspostoperativelaryngopharyngeal refluxrisk factorsprediction model
《中国医学工程》 2026 (5)
44-49,6
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