Otolaryngology Section, Department of Neuroscience (DNS), Padova University, Padova, Italy.
Department of Medicine (DIMED), Padova University, Padova, Italy.
Int Forum Allergy Rhinol. 2019 Jul;9(7):813-820. doi: 10.1002/alr.22314. Epub 2019 Feb 20.
There is a dearth of information regarding the histological and hematological differences between primary and recurrent chronic rhinosinusitis with nasal polyps (CRSwNP). The present study analyzed the histological changes in recurrent CRSwNP in terms of eosinophilic infiltrate, subepithelial edema, goblet cell hyperplasia, and basement membrane thickness. Blood levels of eosinophils and basophils were also measured prior to surgery on both primary and recurrent disease.
Thirty-two consecutive adult patients with nasal polyposis treated with primary surgery who subsequently underwent revision surgery were retrospectively enrolled.
At primary surgery, a significant positive correlation (all p < 0.05) emerged between all histopathological parameters, and between tissue eosinophil and blood eosinophil counts. A positive correlation between subepithelial edema scores and blood basophil levels (p < 0.025) also came to light. At revision surgery, only basement membrane thickness correlated positively with: (1) tissue eosinophil count; and (2) goblet cell hyperplasia (both p = 0.001). In recurrent disease, there was again a positive correlation between eosinophil counts in tissue and blood (p < 0.05). The mean tissue eosinophil count in recurrent CRSwNP was significantly lower than in the primary disease (p < 0.001).
Our preliminary results support the hypothesis that tissue remodeling due to surgical and medical treatments for CRSwNP is a dynamic process involving important differences in tissue eosinophil counts between primary and recurrent CRSwNP. How tissue remodeling evolves after CRSwNP treatment warrants further investigation, not only in larger series of patients, but also after stratifying patients by the time elapsing since their treatment.
原发性和复发性慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）之间的组织学和血液学差异信息匮乏。本研究分析了复发性 CRSwNP 中嗜酸性粒细胞浸润、上皮下水肿、杯状细胞增生和基底膜厚度的组织学变化。还在原发性和复发性疾病手术前测量了嗜酸性粒细胞和嗜碱性粒细胞的血液水平。
回顾性纳入 32 例接受初次手术治疗的鼻息肉成年患者，随后接受了修正手术。
初次手术时，所有组织病理学参数之间以及组织嗜酸性粒细胞计数和血液嗜酸性粒细胞计数之间均呈显著正相关（均 p < 0.05）。上皮下水肿评分与血液嗜碱性粒细胞水平之间也呈正相关（p < 0.025）。在修正手术时，仅基底膜厚度与：（1）组织嗜酸性粒细胞计数；和（2）杯状细胞增生呈正相关（均 p = 0.001）。在复发性疾病中，组织和血液中的嗜酸性粒细胞计数再次呈正相关（p < 0.05）。复发性 CRSwNP 中的组织嗜酸性粒细胞计数明显低于原发性疾病（p < 0.001）。
我们的初步结果支持这样一种假设，即 CRSwNP 的手术和药物治疗导致的组织重塑是一个动态过程，在原发性和复发性 CRSwNP 之间，组织嗜酸性粒细胞计数存在重要差异。CRSwNP 治疗后组织重塑如何演变需要进一步研究，不仅需要在更大的患者系列中进行，还需要根据治疗后时间的长短对患者进行分层。
