Kambara Rumi, Minami Takafumi, Akazawa Hitoshi, Tsuji Fumio, Sasaki Takanobu, Inohara Hidenori, Horii Arata
Department of Otolaryngology, Suita Municipal Hospital, Suita, Japan.
Int Arch Allergy Immunol. 2017;173(4):225-232. doi: 10.1159/000479387. Epub 2017 Aug 29.
Chronic rhinosinusitis (CRS) is classified into eosinophilic CRS (ECRS) and non-ECRS. The objectives of this study were to evaluate lower airway inflammation by measuring the fractional concentration of exhaled nitric oxide (FeNO) and to examine the effects of endoscopic sinus surgery (ESS) on FeNO in patients with ECRS compared to non-ECRS.
CRS patients with nasal polyps (23 with ECRS and 22 with non-ECRS) were enrolled into this study. ECRS was diagnosed based on the definition proposed by the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) study group. Several clinical markers including blood eosinophil counts, percent of eosinophils in white blood cells (WBC), number of eosinophils in nasal polyps, JESREC scores, total IgE, FeNO, and Lund-Mackay paranasal sinus CT scores were compared between ECRS and non-ECRS. These markers were also tested before and 2 months after ESS.
FeNO was significantly higher in patients with ECRS than in non-ECRS patients. When all CRS patients were tested, a significant correlation was found between FeNO and eosinophilic markers including blood eosinophil counts, percent of eosinophils in WBC, number of eosinophils in nasal polyps, and JESREC scores. FeNO showed a significant correlation with Lund-Mackay scores only in ECRS patients. Blood eosinophil counts, percent of eosinophils in WBC, and FeNO decreased after ESS only in ECRS patients.
ECRS patients had lower airway inflammation as revealed by an elevated FeNO, which was parallel to the Lund-Mackay CT scores. ESS decreased the blood eosinophils and FeNO, leading to an improvement of the occult pulmonary dysfunction in ECRS patients.
慢性鼻-鼻窦炎（CRS）分为嗜酸性粒细胞性CRS（ECRS）和非ECRS。本研究的目的是通过测量呼出一氧化氮分数浓度（FeNO）来评估下气道炎症，并探讨与非ECRS患者相比，内镜鼻窦手术（ESS）对ECRS患者FeNO的影响。
本研究纳入了患有鼻息肉的CRS患者（23例ECRS患者和22例非ECRS患者）。ECRS根据日本难治性嗜酸性粒细胞性慢性鼻-鼻窦炎流行病学调查（JESREC）研究组提出的定义进行诊断。比较了ECRS和非ECRS之间的几种临床指标，包括血液嗜酸性粒细胞计数、白细胞（WBC）中嗜酸性粒细胞百分比、鼻息肉中嗜酸性粒细胞数量、JESREC评分、总IgE、FeNO和Lund-Mackay鼻窦CT评分。这些指标在ESS前和ESS后2个月也进行了检测。
ECRS患者的FeNO显著高于非ECRS患者。当对所有CRS患者进行检测时，发现FeNO与血液嗜酸性粒细胞计数、WBC中嗜酸性粒细胞百分比、鼻息肉中嗜酸性粒细胞数量和JESREC评分等嗜酸性粒细胞指标之间存在显著相关性。仅在ECRS患者中，FeNO与Lund-Mackay评分存在显著相关性。仅在ECRS患者中，ESS后血液嗜酸性粒细胞计数、WBC中嗜酸性粒细胞百分比和FeNO降低。
FeNO升高表明ECRS患者存在下气道炎症，这与Lund-Mackay CT评分平行。ESS降低了血液嗜酸性粒细胞和FeNO，改善了ECRS患者隐匿性肺功能障碍。
