摘要
目的 观察慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者术前血清生长分化因子-15(GDF-15)、趋化因子配体26(CCL26)表达变化,建立预测CRSwNP患者术后复发的列线图模型。方法 2021年1月-2023年12月新疆维吾尔自治区人民医院行鼻内镜下息肉切除术的CRSwNP患者1 289例,术前均采用ELISA法测定血清GDF-15、CCL26水平。术后随访6个月,记录鼻腔感染及复发情况,根据复发情况将患者分为复发组和未复发组。比较2组术前血清GDF-15、CCL26水平,Lund-Mackay评分,鼻塞评分,外周血嗜酸性粒细胞(EOS)百分比及鼻中隔偏曲、术后鼻腔感染情况等临床资料;采用Pearson相关法分析CRSwNP患者血清GDF-15与CCL26的相关性;采用多因素logistic回归分析CRSwNP患者术后复发的影响因素,构建CRSwNP患者术后复发的列线图预测模型;绘制ROC曲线、校准曲线、临床决策曲线评估列线图模型预测CRSwNP患者术后复发的效能。结果 随访至2024年6月,失访13例,术后复发102例,未复发1 174例。复发组术前血清GDF-15[(1 346.24±329.53)ng/L]、CCL26[(4.32±1.03)ng/L]水平,Lund-Mackay评分[(20.32±3.26)分],鼻塞评分[(7.02±1.62)分],外周血EOS百分比[(7.95±1.26)%]及鼻中隔偏曲(16.67%)、哮喘(31.37%)、EOS主导型(70.59%)、术后鼻腔感染(22.55%)占比均高于未复发组[(628.43±101.07)ng/L、(2.52±0.61)ng/L、(16.41±3.09)分、(6.65±1.21)分、(6.02±0.71)%、2.98%、14.05%、53.83%、3.83%](t=2.873~51.810,χ^(2)=10.652~65.158,P均<0.05)。CRSwNP患者血清GDF-15与CCL26水平呈正相关(r=0.471,P=0.002)。GDF-15(OR=2.164,95%CI:1.211~3.866,P=0.003)、CCL26(OR=1.900,95%CI:1.148~3.145,P=0.007)、EOS百分比(OR=2.863,95%CI:1.320~6.210,P<0.001)、鼻中隔偏曲(OR=2.279,95%CI:1.215~4.277,P<0.001)、术后鼻腔感染(OR=2.216,95%CI:1.205~4.078,P<0.001)是CRSwNP术后复发的影响因素。列线图模型预测CRSwNP患者术后复发的AUC为0.875(95%CI:0.842~0.904,P<0.001),灵敏度为82.54%,特异度为86.42%。校准曲线显示列线图模型预测结果与观测结果一致,平均绝对误差为0.003。决策曲线远离横纵坐标,预测CRSwNP手术后复发的风险阈值为0~96%,临床净收益较好。结论 CRSwNP患者术前血清GDF-15、CCL26、EOS百分比升高及有鼻中隔偏曲、术后鼻腔感染者易复发,建立的列线图模型对CRSwNP鼻内镜手术后复发具有较好的预测效能。
Objective To observe the preoperative serum levels of growth differentiation factor-15(GDF-15)and chemokine ligand 26(CCL26)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)and to develop a nomogram model for predicting postoperative recurrence.Methods A total of 1289 CRSwNP patients who underwent endoscopic polypectomy in People's Hospital of Xinjiang Uygur Autonomous Region from January 2021 to December 2023 were enrolled.The preoperative serum GDF-15 and CCL26 levels were measured using ELISA.The patients were followed for 6 months postoperatively to record nasal infection and recurrence,and were divided into recurrence and non-recurrence groups based on outcomes.The clinical data including preoperative GDF-15,CCL26,Lund-Mackay score,nasal obstruction score,peripheral blood eosinophil(EOS)percentage,nasal septum deviation,and postoperative nasal infection were compared between groups.Pearson correlation analysis was done to assess the relationship between GDF-15 and CCL26.Multivariate logistic regression analysis was conducted to identify factors influencing recurrence,and a nomogram prediction model was constructed.ROC curves,calibration curves,and decision curve were plotted to evaluate the model's performance to predict the postoperative recurrence in CRSwNP patients.Results By June 2024,13 cases were lost to follow-up,with 102 recurrence and 1174 non-recurrence cases.The recurrence group had higher preoperative serum GDF-15[(1346.24±329.53)ng/L vs.(628.43±101.07)ng/L],CCL26[(4.32±1.03)ng/L vs.(2.52±0.61)ng/L],Lund-Mackay score(20.32±3.26 vs.16.41±3.09),nasal obstruction score(7.02±1.62vs.6.65±1.21),EOS percentage[(7.95±1.26)%vs.(6.02±0.71)%],and higher rates of nasal septum deviation(16.67%vs.2.98%),asthma(31.37%vs.14.05%),eosinophilic-dominated type(70.59%vs.53.83%),and postoperative nasal infection(22.55%vs.3.83%)compared with the non-recurrence group(t=2.873-51.810,χ^(2)=10.652-65.158;all P values<0.05).GDF-15 level was positively correlated with CCL26 level in CRSwNP patients(r=0.471,P=0.002).GDF-15(OR=2.164,95%CI:1.211-3.866,P=0.003),CCL26(OR=1.900,95%CI:1.148-3.145,P=0.007),EOS percentage(OR=2.863,95%CI:1.320-6.210,P<0.001),nasal septum deviation(OR=2.279,95%CI:1.215-4.277,P<0.001),and postoperative nasal infection(OR=2.216,95%CI:1.205-4.078,P<0.001)were the factors influencing recurrence.The nomogram model achieved an AUC of 0.875(95%CI:0.842-0.904,P<0.001),with a sensitivity of 82.54%and a specificity of 86.42%.Calibration curves showed consistency between predicted and observed outcomes with mean absolute error of 0.003.The decision curve was far from the horizontal and vertical axes,indicating a risk threshold range of 0 to 96%for predicting postoperative recurrence of CRSwNP,with favorable clinical net benefits.Conclusion Patient with preoperative high level of GDF-15,high level of CCL26,high EOS percentage,nasal septum deviation and postoperative nasal infection are at high risk for postoperative recurrence of CRSwNP,and the nomogram model based on these factors has a high predictive performance.
作者
郭小平
黄小荣
吴梅
张弓剑
GUO Xiaoping;HUANG Xiaorong;WU Mei;ZHANG Gongjian(Otolaryngology Head and Neck Surgery Center,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang Uygur Autonomous Region 830001,China)
出处
《中华实用诊断与治疗杂志》
2025年第11期981-986,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
新疆维吾尔自治区自然科学基金面上项目(2022D01C588)。
关键词
慢性鼻-鼻窦炎伴鼻息肉
鼻内镜手术
术后复发
生长分化因子-15
趋化因子配体26
列线图模型
chronic rhinosinusitis with nasal polyps
endoscopic sinus surgery
postoperative recurrence
growth differentiation factor-15
chemokine ligand 26
nomogram model
