好酸球性副鼻腔炎の疫学と診断

抄録

Chronic rhinosinusitis (CRS) is an extremely common disease in Japan. The standard therapeutic strategies for CRS have been low-grade macrolide therapy and endonasal endoscopic sinus surgery (ESS). Recently a new subtype of CRS has been increasing in Japan. CRS of this subtype which is classified by as eosinophilic chronic rhinosinusitis (ECRS), shows less response to standard therapy and a higher tendency for recurrence. Strong eosinophil infiltration can be found in nasal polyps of ECRS patients.
We conducted a retrospective study in 12 universities to ascertain the diagnostic characteristics of ECRS and to establish clinical diagnostic criteria to distinguish ECRS from CRS. In all, 3,014 patients with CRS who underwent an ESS procedure during the 3 years from 2007 to 2010 were enrolled in this study. Patients were clinically diagnosed as having CRS by their respective ENT medical doctors. We collected clinical data and analyzed the data using statistical methods. Eight hundred and thirty two patients (28%) were diagnosed as having ECRS. We found a significantly high rate of bilateral lesions, nasal polyps, viscous rhinorrhea, olfactory disturbance, and olfactory cleft closure in ECRS. In CT findings, the ethmoid sinus shadow was significantly strong in ECRS patients. As for comorbidity, several diseases (brochial asthma, allergic rhinitis, aspirin-induced asthma and drug allergy) showed a significantly high rate together with ECRS. We calculated the odds ratio and clinical score for ECRS using a multiple classification analysis. Seven items (age of onset, bilateral region, ethmoid shadow, nasal polyps, olfactory cleft closure, drug allergy and percentage of eosinophils in blood) were chosen, because ENT doctors are able to check these easily. We can total up the individual score for every patient to make a diagnosis. Based on these criteria, we can diagnose ECRS if the total score is greater than 5. Now we are revising these criteria.