Statistical analyses
Statistical analysis was performed with the Statistical Package for Social Sciences version 19.0 for Windows (IBM Corp., Armonk, NY). The prevalence of AFRS was calculated as the percentage of patients diagnosed and treated as AFRS among all cases of CRS treated in the same period; the result was presented as a percentage with a 95% confidence interval. Categorical variables are presented as frequency and percentage, while continuous variables are presented as mean ± standard deviation (SD). The quantitative variables were analyzed by the t-test, and the data not normally distributed were analyzed by the Kruskal Wallis.The ratio were tested by the chi square test. The Mann Whitney test and chi square test were used for multiple comparisons of quantitative and ratio. The p value was corrected by Bonferroni. A p -value of <0.05 was considered to reject the null hypothesis.
Results
A total of 2,874 patients underwent endoscopic sinus surgery, including 631 cases of non-invasive fungal sinusitis. 29 patients were re-diagnosed with AFRS, with a mean age of 33.5 (range, 13-53) years, and the median age was 35 years. 69 cases were re-diagnosed with suspect AFRS, with a mean age of 35.4 (range, 12-67) years, and the median age was 34 years. In addition, 533 cases were re-diagnosed with FBS, with a mean age of 53.9 (range, 17-85) years, and the median age was 54 years. There was no significant difference in gender composition among the three groups (p = 0.316). According to the radiology of all patients, the lesions in AFRS and suspect AFRS mostly involved bilateral sinuses and multiple sinuses. The CT Lund Mackay score of the two groups was significantly higher than that in FBS (p < 0.001). Furthermore, there was more bone erosion in AFRS and suspect AFRS, and the proportion of secondary and multiple operations were higher in these two groups than FBS, in which the maximum number of recurrence was five (Table 1).
Compared with AFRS and suspect AFRS, there was no significant difference in age, eosinophils percentage, basophils percentage, galactomannan test positive rate, serum total IgE, recurrence times, and the proportion of allergic rhinitis, asthma and olfactory decline (p > 0.05). However, significant differences were observed in the above indexes between group A and group C, and between group B and group C. Besides age, we also found that there were more cases of blood eosinophils increase in group A (9, 31.0%) and group B (28, 40.6%), which was significantly higher than that in group C (8, 1.5%, p< 0.01). Peripheral basophilic granulocytosis was also observed in group A (4, 13.8%) and group B (15, 21.7%). In addition, the galactomannan test, serum total IgE, recurrence times, the proportion of allergic rhinitis or asthma and the proportion of hypoolfactory in group A and group B were higher than those in group C (p < 0.01) (Table 2).