Van Zele Thibaut, Holtappels Gabriele, Gevaert Philippe, Bachert Claus
Upper Airway Research Laboratory, and Department of Otorhinolaryngology, Ghent University, Belgium.
Am J Rhinol Allergy. 2014 May-Jun;28(3):192-8. doi: 10.2500/ajra.2014.28.4033.
Surgery for chronic rhinosinusitis with nasal polyps (CRSwNPs) often fails because of recurrence of disease. So far, we do not know if specific cytokine profiles are linked to recurrence after functional endoscopic sinus surgery (FESS) or can predict recurrence. In this study we investigate the cytokine profile in CRSwNPs that underwent FESS for the first time and recurrent CRSwNPs.
Tissue samples (n = 21) of CRSwNP patients with no recurrence after the first surgery were randomly selected out of 131 primary FESS surgeries and compared with tissue samples (n = 15) from patients who had a first and second surgery because of recurrence. Interleukin (IL)-1beta, IgE, specific IgE, IL-5, interferon (IFN) gamma, IL-6, IL-17, transforming growth factor (TGF) beta1, and myeloperoxidase were measured on tissue homogenates.
Levels of IgE, specific IgE to Staphylococcus aureus enterotoxin, eosinophilic cationic protein (ECP), and IL-5 were significantly increased in recurrent versus nonrecurrent CRSwNPs at the moment of the first surgery, whereas IL-17, IL-6, TGF-beta1,and IL-1beta did not show any significant difference. IFN-gamma protein levels were significantly higher in nonrecurrent CRSwNPs. The odds ratio for recurrence of CRSwNPs was reduced to 0.029, if IFN-gamma was present in tissue homogenates. Asthma and aspirin intolerance were significantly more frequent in the recurrent CRSwNPs compared with nonrecurrent CRSwNPs.
Nonrecurrent and recurrent CRSwNPs needing revision surgery have different types of inflammatory patterns. Nonrecurrent CRSwNPs exhibits a mixed pattern of T helper (Th) cytokines with significant higher levels of IFN-gamma and lower concentrations of IgE, ECP, and IL-5 as compared with recurrent CRSwNPs that had a predominant Th2 type of inflammation.
伴有鼻息肉的慢性鼻窦炎（CRSwNPs）手术常因疾病复发而失败。到目前为止，我们尚不清楚特定的细胞因子谱是否与功能性鼻内镜鼻窦手术（FESS）后的复发相关，或者能否预测复发。在本研究中，我们调查首次接受FESS的CRSwNPs和复发性CRSwNPs中的细胞因子谱。
从131例初次FESS手术中随机选取首次手术后无复发的CRSwNP患者的组织样本（n = 21），并与因复发而接受第一次和第二次手术的患者的组织样本（n = 15）进行比较。在组织匀浆中测量白细胞介素（IL）-1β、免疫球蛋白E（IgE）、特异性IgE、IL-5、干扰素（IFN）γ、IL-6、IL-17、转化生长因子（TGF）β1和髓过氧化物酶。
在首次手术时，复发性CRSwNPs与非复发性CRSwNPs相比，IgE、针对金黄色葡萄球菌肠毒素的特异性IgE、嗜酸性阳离子蛋白（ECP）和IL-5水平显著升高，而IL-17、IL-6、TGF-β1和IL-1β无显著差异。非复发性CRSwNPs中IFN-γ蛋白水平显著更高。如果组织匀浆中存在IFN-γ，CRSwNPs复发的优势比降至0.029。与非复发性CRSwNPs相比，复发性CRSwNPs中哮喘和阿司匹林不耐受明显更常见。
需要再次手术的非复发性和复发性CRSwNPs具有不同类型的炎症模式。与以Th2为主型炎症的复发性CRSwNPs相比，非复发性CRSwNPs表现出T辅助（Th）细胞因子的混合模式，IFN-γ水平显著更高，而IgE、ECP和IL-5浓度更低。
