Lou Hongfei, Meng Yifan, Piao Yingshi, Wang Chengshuo, Zhang Luo, Bachert Claus
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China.
Am J Rhinol Allergy. 2015 Sep-Oct;29(5):350-6. doi: 10.2500/ajra.2015.29.4231. Epub 2015 Jul 27.
Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical entity with its propensity for recurrence. Tissue eosinophilia is a hallmark of CRSwNP, and its role in polyp recurrence is a subject of much investigation.
The aim of this study was to evaluate the association between clinical parameters, especially tissue eosinophilia and polyp recurrence, and to identify the optimal cutoff value of tissue eosinophilia as a predictor for polyp recurrence in Chinese subjects.
Overall, 387 patients with CRSwNP were enrolled in this retrospective analysis and postoperative follow-up for polyp recurrence was over a period that lasted >24 months (mean [standard deviation], 34.03 ± 4.95 months). The baseline demographic and clinical features and the preoperative computed tomography were compared, and mucosal specimens obtained at endoscopic sinus surgery were assessed for inflammatory cells by using histocytologic staining. Predictive factors associated with polyp recurrence were analyzed by logistic regression analysis, and optimal cutoff points of the predictors were determined by receiver operating characteristic curves and the Youden index.
A total of 55.3% patients (214/387) experienced recurrence. Tissue eosinophilia markedly outweighed other parameters and correlated with polyp recurrence. Receiver operating characteristic curves indicated that a cutoff value of 27% tissue eosinophils predicted recurrence with 96.7% sensitivity and 92.5% specificity (area under the curve = 0.969; p < 0.001); and an absolute count of 55 eosinophils per high power field predicted recurrence with 87.4% sensitivity and 97.1% specificity (area under the curve = 0.969; p < 0.001).
A tissue eosinophil proportion of >27% of total cells or a tissue eosinophil absolute count of >55 eosinophils per high power field may act as a reliable prognostic indicator for nasal polyp recurrence within 2 years after surgery.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）仍是一个具有复发倾向的、具有挑战性的临床实体。组织嗜酸性粒细胞增多是CRSwNP的一个标志，其在息肉复发中的作用是众多研究的主题。
本研究旨在评估临床参数，尤其是组织嗜酸性粒细胞增多与息肉复发之间的关联，并确定组织嗜酸性粒细胞增多作为中国受试者息肉复发预测指标的最佳临界值。
总体而言，387例CRSwNP患者纳入本回顾性分析，息肉复发的术后随访时间超过24个月（平均[标准差]，34.03±4.95个月）。比较基线人口统计学和临床特征以及术前计算机断层扫描，并通过组织细胞染色对内镜鼻窦手术时获取的黏膜标本进行炎性细胞评估。通过逻辑回归分析分析与息肉复发相关的预测因素，并通过受试者工作特征曲线和尤登指数确定预测指标的最佳临界点。
共有55.3%的患者（214/387）出现复发。组织嗜酸性粒细胞增多明显超过其他参数，并与息肉复发相关。受试者工作特征曲线表明，组织嗜酸性粒细胞比例临界值为27%时预测复发的灵敏度为96.7%，特异度为92.5%（曲线下面积=0.969；p<0.001）；每高倍视野嗜酸性粒细胞绝对计数为55时预测复发的灵敏度为87.4%；特异度为97.1%（曲线下面积=0.969；p<0.001）。
组织嗜酸性粒细胞占总细胞数的比例>27%或每高倍视野组织嗜酸性粒细胞绝对计数>55可能作为术后2年内鼻息肉复发的可靠预后指标。
