Liu Chengyao, Zheng Ming, He Fei, Wang Xiangdong, Zhang Luo
Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China.
Am J Rhinol Allergy. 2017 Nov 19;31(6):389-394. doi: 10.2500/ajra.2017.31.4480. Epub 2017 Sep 19.
Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) nasal polyps is a global health concern. Several clinical biomarkers, such as inhaled carbon monoxide and exhaled nitric oxide (NO), have been studied to assess the presence and degree of inflammation in the airway mucosa.
To evaluate the clinical application of exhaled nasal NO (nNO) in distinguishing between CRSwNP and CRSsNP in consideration of the atopic status of patients.
Eighty-eight patients with CRS and 20 healthy volunteers were recruited for this study. The exhaled nNO level was measured by using a hand-held device. Nasal endoscopy (with Lund-Mackay scoring of CRS) and sinus computed tomographies (CT) were used to evaluate the nasal cavity and sinuses of the subjects. Atopic status was confirmed by using skin prick tests (SPTs).
The mean ± standard deviation (SD) levels of nNO in patients with CRSsNP were significantly higher than those in patients with CRSwNP (591 ± 153 ppb versus 360 ± 181 ppb, p < 0.001), whereas patients with CRS exhibited lower levels of nNO compared with the control subjects (449 ± 204 ppb versus 881 ± 161 ppb, p < 0.001). Patients with atopy and with and without nasal polyps exhibited significantly higher levels of nNO compared with patients without atopy (atopic CRSsNP versus nonatopic CRSsNP, 734 ± 120 ppb versus 503 ± 92 ppb [p < 0.001]; atopic CRSwNP versus nonatopic CRSwNP, 518 ± 161 ppb versus 299 ± 150 ppb [p < 0.001]). The levels of nNO were negatively correlated with the Lund-Mackay scores in both atopic (r = -0.45; p = 0.016) and nonatopic (r = -0.600; p < 0.001) patients with CRS. Receiver operating characteristic curves differentiated patients as CRSwNP, CRSsNP, and healthy controls, and in atopic and nonatopic subgroups, with acceptable sensitivity and specificity (>70 to 90%).
Exhaled nNO levels can be used to distinguish between patients with CRSwNP and patients with CRSsNP. However, the atopic status of the patient influenced the use of nNO as a diagnostic or monitoring biomarker in CRS.
伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）和不伴鼻息肉的慢性鼻-鼻窦炎（CRSsNP）是全球关注的健康问题。已对多种临床生物标志物进行研究，如吸入一氧化碳和呼出一氧化氮（NO），以评估气道黏膜炎症的存在及程度。
考虑患者的特应性状态，评估呼出鼻一氧化氮（nNO）在鉴别CRSwNP和CRSsNP中的临床应用。
本研究招募了88例慢性鼻-鼻窦炎患者和20名健康志愿者。使用手持设备测量呼出nNO水平。采用鼻内镜检查（对慢性鼻-鼻窦炎进行Lund-Mackay评分）和鼻窦计算机断层扫描（CT）评估受试者的鼻腔和鼻窦。通过皮肤点刺试验（SPT）确定特应性状态。
CRSsNP患者的nNO平均水平±标准差（SD）显著高于CRSwNP患者（591±153 ppb对360±181 ppb，p<0.001），而慢性鼻-鼻窦炎患者的nNO水平低于对照组（449±204 ppb对881±161 ppb，p<0.001）。与非特应性患者相比，伴有和不伴有鼻息肉的特应性患者的nNO水平显著更高（特应性CRSsNP对非特应性CRSsNP，734±120 ppb对503±92 ppb [p<0.001]；特应性CRSwNP对非特应性CRSwNP，518±161 ppb对299±150 ppb [p<0.001]）。在特应性（r=-0.45；p=0.016）和非特应性（r=-0.600；p<0.001）慢性鼻-鼻窦炎患者中，nNO水平与Lund-Mackay评分呈负相关。受试者工作特征曲线能区分CRSwNP患者、CRSsNP患者和健康对照，以及特应性和非特应性子组，敏感性和特异性均可接受（>70%至90%）。
呼出nNO水平可用于区分CRSwNP患者和CRSsNP患者。然而，患者的特应性状态影响了nNO作为慢性鼻-鼻窦炎诊断或监测生物标志物的应用。
