慢性鼻窦炎伴鼻息肉鼻窦病变的CT分布特征 分析

CT Distribution Patterns of Sinonasal Lesions in Chronic Rhinosinusitis with Nasal Polyps

摘要: 目的：分析慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps, CRSwNP)患者鼻窦CT炎症分布特征及不同炎症分型的影像学差异。方法：回顾性分析81例CRSwNP患者临床资料，根据组织嗜酸性粒细胞浸润程度分为嗜酸粒细胞性慢性鼻窦炎伴鼻息肉(eosinophilic chronic rhinosinusitis with nasal polyps, ECRSwNP)组49例和非嗜酸粒细胞性慢性鼻窦炎伴鼻息肉(non-eosinophilic chronic rhinosinusitis with nasal polyps, non-ECRSwNP)组32例。采用Lund-Mackay评分系统评估各鼻窦区域病变程度，并计算筛窦/上颌窦CT评分比值(ethmoid-to-maxillary ratio，E/M比值)。结果：与non-ECRSwNP组相比，ECRSwNP组Lund-Mackay总评分、后组筛窦评分及E/M比值均显著升高(均P < 0.05)，而non-ECRSwNP组上颌窦评分更高(P < 0.05)。ECRSwNP组呈以筛窦为主的炎症分布模式，non-ECRSwNP组则以上颌窦受累更为突出。结论：CRSwNP患者鼻窦炎症分布存在明显区域差异。ECRSwNP主要表现为筛窦优势受累，尤其以后组筛窦最为显著；non-ECRSwNP则倾向于上颌窦受累。鼻窦CT分区评分及E/M比值有助于评估疾病炎症特征及临床分型。

Abstract: Objective: To analyze the distribution characteristics of sinus inflammation on computed tomography (CT) and the imaging differences among different inflammatory phenotypes in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: A retrospective analysis was conducted on the clinical data of 81 patients with CRSwNP. According to the degree of tissue eosinophilic infiltration, patients were classified into an eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) group (n = 49) and a non-eosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group (n = 32). The severity of lesions in each sinus region was assessed using the Lund-Mackay scoring system, and the ethmoid-to-maxillary ratio (E/M ratio) was calculated. Results: Compared with the non-ECRSwNP group, the ECRSwNP group had significantly higher Lund-Mackay total scores, posterior ethmoid sinus scores, and E/M ratios (all P < 0.05), whereas the maxillary sinus score was significantly higher in the non-ECRSwNP group (P < 0.05). The ECRSwNP group exhibited an ethmoid-dominant pattern of inflammation distribution, while the non-ECRSwNP group showed more prominent maxillary sinus involvement. Conclusion: There are obvious regional differences in sinus inflammation distribution among CRSwNP patients. ECRSwNP is mainly characterized by ethmoid-predominant involvement, especially in the posterior ethmoid sinus, while non-ECRSwNP tends to involve the maxillary sinus. Sinus CT regional scoring and the E/M ratio are helpful for evaluating inflammatory characteristics and clinical phenotyping of the disease.