Grgić Marko Velimir, Ćupić Hrvoje, Kalogjera Livije, Baudoin Tomislav
Department of ENT and Head and Neck Surgery, 'Sisters of Mercy' University Medical Center, Zagreb University School of Medicine, Vinogradska 29, Zagreb, Croatia.
Department of Pathology, University Hospital 'Sisters of Mercy' University Medical Center, Zagreb University School of Dentistry, Vinogradska 29, Zagreb, Croatia.
Eur Arch Otorhinolaryngol. 2015 Dec;272(12):3735-43. doi: 10.1007/s00405-015-3519-7. Epub 2015 Jan 30.
Nasal polyps recur in approximately one-third of patients after surgical treatment. It would be beneficial to be able to predict the patients in whom we might expect recurrence and to predict the clinical outcome after surgery. The study included 30 patients operated for nasal polyps. Removed polyps were analyzed by immunohistochemical analysis for IL-5, IgE, vascular endothelial growth factor and eosinophilic infiltration. These parameters together with preoperative CT score were used as independent variables, and subjective score improvement after 2 years was used as a dependent variable in multiple linear regression analysis. Furthermore, the patients were divided into two groups: low and high polyp tissue immunoreactivity. The Chi-squared test was used to determine whether polyp immunoreactivity influences polyp recurrence and subjective score. Preoperative CT score had a slightly positive correlation with subjective score after 2 years. High eosinophil infiltration significantly predicted a higher risk for polyp recurrence. High IL-5 positivity was related to greater risk for polyp recurrence than low IL-5 reactivity but not significantly. IgE and VEGF reactivity in polyp specimens did not have any effect on polyp recurrence. High eosinophilic infiltration in polyps can predict worse outcome after surgical treatment of chronic rhinosinusitis with nasal polyposis. IgE and VEGF do not have prognostic significance to polyp recurrence after surgery. The preoperative extent of disease measured by CT score had a slightly positive correlation with worse outcome after surgery.
手术治疗后，约三分之一的患者鼻息肉会复发。若能预测哪些患者可能复发，并预测手术后的临床结果，将大有裨益。该研究纳入了30例接受鼻息肉手术的患者。对切除的息肉进行免疫组织化学分析，检测白细胞介素-5（IL-5）、免疫球蛋白E（IgE）、血管内皮生长因子（VEGF）及嗜酸性粒细胞浸润情况。在多元线性回归分析中，这些参数与术前CT评分一起作为自变量，术后2年的主观评分改善情况作为因变量。此外，将患者分为两组：息肉组织免疫反应性低和高的组。采用卡方检验来确定息肉免疫反应性是否影响息肉复发和主观评分。术前CT评分与术后2年的主观评分呈轻度正相关。高嗜酸性粒细胞浸润显著预示息肉复发风险更高。与低IL-5反应性相比，高IL-5阳性与息肉复发风险更高相关，但差异无统计学意义。息肉标本中的IgE和VEGF反应性对息肉复发没有任何影响。息肉中高嗜酸性粒细胞浸润可预测鼻息肉慢性鼻窦炎手术治疗后的较差结果。IgE和VEGF对术后息肉复发无预后意义。通过CT评分测量的术前疾病范围与术后较差结果呈轻度正相关。
