| 摘要: |
| ［摘要］ 目的 分析慢性鼻窦炎伴鼻息肉（CRSwNP）患者血清活化的白细胞黏附分子（ALCAM）、B7-H4、S100A4水平与病变严重程度及术后复发的关联性。方法 回顾性分析2020年1月至2022年12月杭州市临安区第一人民医院收治的173例慢性鼻窦炎（CRS）患者的临床资料，并根据有无鼻息肉将其分为CRSwNP组（100例）和慢性鼻窦炎不伴鼻息肉（CRSsNP）组（73例）。CRSwNP患者术前接受鼻窦CT检查，并基于检查结果进行Lund-Mackay评分，0～8分为轻度病变，9～16分为中度病变，17～24分为重度病变。采用酶联免疫吸附试验检测患者血清ALCAM、B7-H4、S100A4水平。CRSwNP患者均接受功能性鼻内镜鼻窦手术治疗，术后随访1年，观察疾病复发情况。采用Pearson相关分析血清ALCAM、B7-H4、S100A4水平与术前Lund-Mackay评分的相关性。采用多因素logistic回归分析影响CRSwNP患者术后复发的因素，采用受试者工作特征（ROC）曲线分析血清ALCAM、B7-H4、S100A4水平预测CRSwNP患者术后复发的效能。结果 CRSwNP轻度病变者48例，中度病变者33例，重度病变者19例。CRSwNP组血清ALCAM、B7-H4、S100A4水平显著高于CRSsNP组（P<0.05）。CRSwNP中度病变者和重度病变者血清ALCAM、B7-H4、S100A4水平高于轻度病变者，且重度病变者指标水平高于中度病变者，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，CRSwNP患者血清ALCAM（r=0.436，P=0.006）、B7-H4（r=0.528，P<0.001）、S100A4（r=0.561，P<0.001）水平与术前Lund-Mackay评分呈正相关。100例CRSwNP患者术后1年内复发36例。多因素logistic回归分析结果显示，较高的血清ALCAM、B7-H4、S100A4水平是CRSwNP患者术后复发的独立危险因素（P<0.05）。ROC曲线分析结果显示，血清ALCAM、B7-H4、S100A4三指标联合检测预测CRSwNP患者术后复发的效能较单一指标更优（Z三指标联合-ALCAM=2.840，P=0.005；Z三指标联合-B7-H4=2.736，P=0.006；Z三指标联合-S100A4=2.645，P=0.008），灵敏度为97.22%，特异度为84.37%。结论 CRSwNP患者血清ALCAM、B7-H4、S100A4水平与病变严重程度呈正相关，且较高的指标水平与患者术后复发有关，这有助于临床医师及早识别复发风险较高的患者。 |
| 关键词: 慢性鼻窦炎伴鼻息肉 活化的白细胞黏附分子 B7-H4 S100A4 术后复发 |
| DOI：10.3969/j.issn.1674-3806.2026.07.13 |
| 分类号:R 765.4 |
| 基金项目:2019年度浙江省公益技术应用研究资助项目（编号：LGF19H040009） |
|
| Analysis on correlations of serum ALCAM, B7-H4 and S100A4 levels with disease severity and postoperative recurrence in chronic rhinosinusitis with nasal polyps patients |
|
Cai Dongbo, Zhang Feng, Liu Yongsheng, Wei Liang
|
|
Department of Otolaryngology, the First People′s Hospital of Lin′an District, Hangzhou 311300, China
|
| Abstract: |
| ［Abstract］ Objective To analyze the correlations of serum activated leukocyte cell adhesion molecule(ALCAM), B7 homolog 4(B7-H4) and S100A4 levels with disease severity and postoperative recurrence in chronic rhinosinusitis with nasal polyps(CRSwNP) patients. Methods The clinical data of 173 patients with chronic rhinosinusitis(CRS) who were admitted to the First People′s Hospital of Lin′an District, Hangzhou from January 2020 to December 2022 were respectively analyzed and divided into CRSwNP group(100 patients) and chronic rhinosinusitis without nasal polyps(CRSsNP) group(73 patients) according to whether they had nasal polyps or not. The patients with CRSwNP received sinus computed tomography(CT) examination before surgery, and Lund-Mackay scores were evaluated based on the results of the CT examination: 0-8 points for mild lesions, 9-16 points for moderate lesions, and 17-24 points for severe lesions. The levels of ALCAM, B7-H4 and S100A4 in the serum of the patients were detected by using enzyme-linked immunosorbent assay(ELISA). The CRSwNP patients received functional endoscopic sinus surgery. The patients were followed up for 1 year and the recurrence of their diseases was observed. Pearson correlation was used to analyze the correlations of serum ALCAM, B7-H4 and S100A4 levels with preoperative Lund-Mackay scores. Multivariate logistic regression was applied to analyze the factors influencing postoperative recurrence in patients with CRSwNP. The receiver operating characteristic(ROC) curve was applied to analyze the efficacy of serum ALCAM, B7-H4 and S100A4 levels in predicting postoperative recurrence in patients with CRSwNP. Results Forty-eight cases of mild lesions, 33 cases of moderate lesions, and 19 cases of severe lesions in CRSwNP were included in this study. The levels of serum ALCAM, B7-H4 and S100A4 in the CRSwNP group were significantly higher than those in the CRSsNP group(P<0.05). The levels of serum ALCAM, B7-H4 and S100A4 in patients with moderate and severe lesions in CRSwNP were higher than those in patients with mild lesions in CRSwNP, and the levels of these indicators in patients with severe lesions were higher than those in patients with moderate lesions, with statistically significant differences(P<0.05). The results of Pearson correlation analysis showed that the serum ALCAM level(r=0.436, P=0.006), B7-H4 level(r=0.528, P<0.001), and S100A4 level(r=0.561, P<0.001) in the CRSwNP patients were positively correlated with the preoperative Lund-Mackay scores. Among the 100 patients with CRSwNP, 36 patients experienced recurrence within 1 year after surgery. The results of multivariate logistic regression analysis showed that higher levels of serum ALCAM, B7-H4 and S100A4 were independent risk factors for postoperative recurrence in the CRSwNP patients(P<0.05). The results of ROC curve analysis showed that the combined detection of serum ALCAM, B7-H4 and S100A4 had better efficacy in predicting postoperative recurrence in patients with CRSwNP than the detection of a single indicator(Zthree-indicator-combined-ALCAM=2.840, P=0.005; Zthree-indicator-combined-B7-H4=2.736, P=0.006; Zthree-indicator-combined-S100A4=2.645, P=0.008), with a sensitivity of 97.22% and a specificity of 84.37%. Conclusion The levels of serum ALCAM, B7-H4 and S100A4 in CRSwNP patients are positively correlated with the severity of lesions, and higher levels of these indicators are associated with the patients′ postoperative recurrence. These findings assists clinicians in identifying patients with higher recurrence risk as early as possible. |
| Key words: chronic rhinosinusitis with nasal polyps(CRSwNP) activated leukocyte cell adhesion molecule(ALCAM) B7 homolog 4(B7-H4) S100A4 postoperative recurrence |
