Lu Hangui, Lin Xin-Sheng, Yao Dan-Mian, Zhuang Ying-Ying, Wen Guo-Feng, Shi Jianbo, Sun Yue-Qi
Department of Otolaryngology, Shantou Central Hospital, Shantou, 515030, China.
Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, Guangdong, China.
Eur Arch Otorhinolaryngol. 2018 Feb;275(2):401-408. doi: 10.1007/s00405-017-4809-z. Epub 2017 Nov 25.
Serum amyloid A (SAA) was involved in the pathogenesis of glucocorticoid resistance in lung diseases. However, their association with systemic corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP) patients remains to be assessed.
This study enrolled 32 CRSwNP patients to evaluate the association between SAA expression in NP and corticosteroid insensitivity, and the value of polyp SAA level for predicting the response to oral corticosteroids in CRSwNP patients. All patients were given a course of oral prednisone (30 mg daily for 2 weeks) and subdivided into glucocorticoid(GC)-sensitive and -insensitive subgroup according to the change in polyp size scores. The polyp specimens were obtained before and after corticosteroid treatment. SAA levels in polyp tissues were evaluated by enzyme-linked immunosorbent assay and quantitative reverse transcription polymerase chain reaction. Regression analysis was performed to analyze the association between SAA protein levels and corticosteroid insensitivity.
13/32 (40.62%) CRSwNP patients were insensitive to the oral corticosteroid therapy. SAA mRNA and protein levels were significantly increased in GC-insensitive NP compared to those in GC-sensitive NP. Tissue SAA protein levels were positively correlated with tissue neutrophil numbers. Regression analysis revealed tissue SAA levels were significantly correlated with corticosteroid insensitivity (P < 0.01). ROC curves indicated that the area under the curve was 0.87. When the polyp SAA protein level was 122.2 ng/ml or higher, the sensitivity and specificity were 76.92 and 73.68%, respectively.
Our findings suggest that increased SAA in NP is associated with reduced response to oral corticosteroids in CRSwNP. SAA levels in NP may have potential value in predicting corticosteroid insensitivity in CRSwNP patients.
血清淀粉样蛋白A（SAA）参与肺部疾病糖皮质激素抵抗的发病机制。然而，它们与鼻息肉慢性鼻-鼻窦炎（CRSwNP）患者全身皮质类固醇不敏感性之间的关联仍有待评估。
本研究纳入32例CRSwNP患者，以评估鼻息肉中SAA表达与皮质类固醇不敏感性之间的关联，以及息肉SAA水平对预测CRSwNP患者口服皮质类固醇反应的价值。所有患者接受一个疗程的口服泼尼松（每日30mg，共2周）治疗，并根据息肉大小评分的变化分为糖皮质激素（GC）敏感和不敏感亚组。在皮质类固醇治疗前后获取息肉标本。通过酶联免疫吸附测定和定量逆转录聚合酶链反应评估息肉组织中的SAA水平。进行回归分析以分析SAA蛋白水平与皮质类固醇不敏感性之间的关联。
13/32（40.62%）例CRSwNP患者对口服皮质类固醇治疗不敏感。与GC敏感的鼻息肉相比，GC不敏感的鼻息肉中SAA mRNA和蛋白水平显著升高。组织SAA蛋白水平与组织中性粒细胞数量呈正相关。回归分析显示组织SAA水平与皮质类固醇不敏感性显著相关（P<0.01）。ROC曲线表明曲线下面积为0.87。当息肉SAA蛋白水平为122.2ng/ml或更高时，敏感性和特异性分别为76.92%和73.68%。
我们的研究结果表明，鼻息肉中SAA升高与CRSwNP患者口服皮质类固醇反应降低有关。鼻息肉中的SAA水平可能对预测CRSwNP患者的皮质类固醇不敏感性具有潜在价值。
