鼻中隔偏曲患者的人口学临床特征及其鼻部共患病特点分析

李云; 岳金静; 黄晶; 许超; 张继友; 冯勃

doi:10.3969/j.issn.2095-5227.2022.12.009

摘要:

背景鼻中隔偏曲(nasal septum deviation，NSD)是耳鼻咽喉科的常见疾病，但相关常见鼻部共患病报道较少。大量文献研究了NSD在慢性鼻窦炎(chronic rhinosinusitis，CRS)、真菌性鼻窦炎(fungal rhinosinusitis，FRS)发生发展中可能存在的作用，但结果并不一致。

目的描述NSD患者的人口学特征、鼻部共患病特点，分析NSD在CRS、FRS发生发展中可能存在的作用。

方法回顾性分析2017年1月- 2020年6月解放军总医院收治的548例NSD患者的临床资料。将鼻中隔偏向侧鼻腔定义为窄侧鼻腔，对侧定义为宽侧鼻腔。比较NSD患者两侧鼻腔CRS、FRS发生率的差异。

结果 548例NSD患者中男性占86.9%，女性占13.1%，平均年龄36.4岁，14 ~ 30岁年龄段患者占40.3%，随年龄增加各年龄段患病人数下降。鼻中隔向左侧偏曲者略多，占55.8%。NSD患者主诉前5位症状为鼻塞(86.9%)、打鼾(17.2%)、头面部疼痛(11.7%)、鼻部过敏症状(10.2%)、流脓涕(9.3%)。59.7%的NSD患者合并鼻部共患病，前5位依次为鼻窦囊肿(28.1%)、慢性鼻窦炎(20.3%)、变应性鼻炎(13.7%)、真菌性鼻窦炎(3.3%)、鼻息肉/腺样体肥大(均为2.2%，共居第5位)。男性患者鼻部共患病前5位依次为鼻窦囊肿(30.3%)、慢性鼻窦炎(19.1%)、变应性鼻炎(13.4%)、腺样体肥大(2.5%)、真菌性鼻窦炎/鼻息肉(均为2.3%，共居第5位)；女性患者鼻部共患病前5位为慢性鼻窦炎(27.8%)、变应性鼻炎(15.3%)、鼻窦囊肿(13.9%)、真菌性鼻窦炎(9.7%)、鼻腔鼻窦良性肿瘤(5.6%)。在111例合并CRS的患者中，CRS在两侧鼻腔的发生率无统计学差异(P=0.163)；在18例合并FRS的患者中，FRS在窄侧鼻腔的发生率明显高于宽侧鼻腔(77.8% vs 27.8%，P=0.007)。

结论 NSD患者男性居多，鼻中隔左向偏曲者略多于右向偏曲者，鼻塞是最常见主诉。近60%的NSD患者合并鼻部共患病，NSD可能是导致CRS、FRS发病的局部因素之一。

Abstract:

Background Nasal septum deviation (NSD) is a common disease in otolaryngology, but there are few literatures about nasal comorbidities of patients with NSD. In addition, a lot of studies have explored the possible role of NSD in the occurrence and development of chronic rhinosinusitis (CRS) and fungal rhinosinusitis (FRS), but the results are controversial.

Objective To describe the demographic characteristics and nasal comorbidities of patients with NSD, and analyze the possible role of NSD in the occurrence and development of CRS and FRS.

Methods Clinical data about patients with NSD admitted to Chinese PLA General Hospital from January 2017 to June 2020 were retrospectively analyzed. The nasal cavity on the side of the deviated was defined as the narrow side nasal cavity, and the opposite side was defined as the wide side. The difference in incidence of CRS, FRS on both sides of the nasal cavity of NSD patients was analyzed.

Results Among 548 patients with NSD, 86.9% were male and 13.1% were female, with average age of 36.4 years. Patients in the 14-30 years old group accunted for 40.3% of the whole sample, and the proportion decreased with the increase of age. The deviation of the nasal septum to the left was slightly higher, accunted for 55.8%. The top five complaints of NSD patients included: nasal obstruction (86.9%), snoring (17.2%), head and face pain (11.7%), nasal allergy symptoms (10.2%), and purulent discharge (9.3%). Totally 59.7% of NSD patients had nasal comorbidities. The top five nasal comorbidities in the NSD patients included: cysts of nasal sinus (28.1%), chronic rhinosinusitis (20.3%), allergic rhinitis (13.7%), fungal rinosinusitis (3.3%), and nasal polyps and adenoid hypertrophy (2.2%). The top five nasal comorbidities in the male patients included: cysts of nasal sinus (30.3%), chronic rhinosinusitis (19.1%), allergic rhinitis (13.4%), adenoid hypertrophy (2.5%), fungal rhinosinusitis and nasal polyps (2.3%). The top five nasal comorbidities in the female included: chronic rhinosinusitis (27.8%), allergic rhinitis (15.3%), cysts of nasal sinus (13.9%), fungal rhinosinusitis (9.7%), and nasal sinus benign tumors (5.6%). In 111 patients with NSD and CRS, there was no significant difference in the incidence of CRS on both sides of the nasal cavity (P=0.163). In 18 patients with NSD complicated with FRS, the incidence of FRS in the narrow nasal cavity was significantly higher than that in the wide nasal cavity (P=0.007).

Conclusion The majority of NSD patients are male, the deviation of the nasal septum to the left is slightly higher than the deviation to the right, and nasal obstruction is the most common complaint. Nearly 60% of NSD patients have nasal comorbidities. NSD may be a factor correlated with the pathogenesis of CRS and FRS.

鼻中隔偏曲患者的人口学临床特征及其鼻部共患病特点分析

Demographic, clinical characteristics and nasal comorbidities of patients with nasal septum deviation