Kirtsreesakul Virat, Atchariyasathian Viraporn
Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat yai, Songkhla, Thailand.
Am J Rhinol. 2006 Jan-Feb;20(1):95-100.
It is considered that allergy, at least in some cases, is associated with nasal polyps and affects recurrence rate. Our purpose was to determine the effects of aeroallergen hypersensitization on therapeutic response of eosinophil- and noneosinophil-dominated inflammation.
Sixty-eight patients were enrolled. Histopathological investigation and a skin-prick test were done and categorized as eosinophil-dominated inflammation with positive (ESPT+) or negative skin test (ESPT-) and nonesoinophil-dominated inflammation with positive (NESPT+) or negative skin test (NESPT-). Patients were treated over 6 weeks with budesonide nasal spray, 400 microg/day. At 0, 3, and 6 weeks after treatment, nasal symptoms, polyp size, nasal and oral peak expiratory flow (PEF) index and overall assessment within and between groups were evaluated and compared.
At 3 and 6 weeks after treatment, the ESPT- group showed the most, and the NESPT+ group showed the least therapeutic improvement. In comparing between the positive and negative skin tests in each histopathology, the positive skin tests tended to have less improvement than the negative skin tests in all variables. The differences increased over time and reached statistical significance at 6 weeks in the PEF index and overall assessment of eosinophil-dominated inflammation (p = 0.004 and 0.033, respectively) and in sneezing score, postnasal drip score, and overall assessment of noneosinophil-dominated inflammation (p = 0.019, 0.035, and 0.013, respectively).
Nonallergic eosinophilic polyps had the best and allergic noneosinophilic polyps had the worst therapeutic response. Within each histopathology, allergic nasal polyps had less therapeutic response than nonallergic nasal polyps. This augmented effect could be caused by concomitant allergic inflammation.
人们认为过敏至少在某些情况下与鼻息肉有关，并影响复发率。我们的目的是确定气传变应原超敏反应对嗜酸性粒细胞为主型和非嗜酸性粒细胞为主型炎症治疗反应的影响。
纳入68例患者。进行组织病理学检查和皮肤点刺试验，并分为嗜酸性粒细胞为主型炎症伴皮肤试验阳性（ESPT+）或阴性（ESPT-）以及非嗜酸性粒细胞为主型炎症伴皮肤试验阳性（NESPT+）或阴性（NESPT-）。患者接受布地奈德鼻喷雾剂治疗6周，每日400微克。在治疗后0、3和6周，评估并比较各组内和组间的鼻部症状、息肉大小、鼻和口腔呼气峰值流速（PEF）指数以及总体评估。
治疗后3周和6周，ESPT-组改善最为明显，NESPT+组改善最少。在每种组织病理学中比较皮肤试验阳性和阴性时，所有变量中皮肤试验阳性的改善往往比阴性的少。差异随时间增加，在6周时，嗜酸性粒细胞为主型炎症的PEF指数和总体评估（分别为p = 0.004和0.033）以及非嗜酸性粒细胞为主型炎症的打喷嚏评分、鼻后滴漏评分和总体评估（分别为p = 0.019、0.035和0.013）达到统计学意义。
非过敏性嗜酸性鼻息肉治疗反应最佳，过敏性非嗜酸性鼻息肉治疗反应最差。在每种组织病理学中，过敏性鼻息肉的治疗反应比非过敏性鼻息肉差。这种增强效应可能由伴随的过敏性炎症引起。
