Marino Michael J, Garcia J Omar, Zarka Matthew A, Lal Devyani
Department of Otorhinolaryngology Mayo Clinic Phoenix Arizona.
Division of Laboratory Medicine Mayo Clinic Phoenix Arizona.
Laryngoscope Investig Otolaryngol. 2019 Nov 13;4(6):573-577. doi: 10.1002/lio2.328. eCollection 2019 Dec.
There is interest in identifying chronic rhinosinusitis (CRS) endotypes that align pathophysiology with clinical observation and outcomes. CRS with polyps (CRSwNP) has classically been studied with reference to tissue eosinophilia, but the role of other cellular infiltrates remains uncharacterized. No particular tissue prognosticators have been described for CRS without nasal polyps (CRSsNP). Predominance of leukocytes seen in surgical tissue may be useful for differentiating CRS subtypes, severity of inflammation, and outcomes.
Structured histopathology reports were examined for 277 patients undergoing endoscopic sinus surgery for CRSwNP (n = 115), CRSsNP (n = 141), and recurrent acute rhinosinusitis (RARS, n = 21). Inflammatory predominance was examined for associations with nasal polyposis, asthma, allergic rhinitis, aspirin exacerbated respiratory disease (AERD), immune deficiency, preoperative Lund-Mackay score, and outcome (SNOT-22 score change).
In order of frequency, the prevalence of predominant inflammatory patterns accounting for 93.5% of CRS patients were: lymphoplasmocytic (n = 111), lymphocytic (n = 74), eosinophilic (n = 50), and lymphoplasmocytic with eosinophilic (n = 24). Eosinophilic predominance was 97.4% specific for nasal polyps (95% confidence interval [CI], 93.4%-99.3%), although sensitivity was 43.4% (95% CI, 33.8%-53.4%). The absence of eosinophilic predominance was 100% sensitive for RARS (95% CI, 82.4%-100%), however specificity was 30.8% (95% CI 25.1%-37.1%). There were no significant differences in preoperative SNOT-22 scores or change postoperatively.
Eosinophilic inflammatory predominance was predictive for nasal polyps and against RARS. Nevertheless, the majority of CRSwNP patients had a different inflammatory predominance, demonstrating heterogeneity in CRS, even among patients with nasal polyps. Symptomatic outcomes were not associated with inflammatory predominance through 12 months follow up.
人们对确定能使病理生理学与临床观察及结果相匹配的慢性鼻 - 鼻窦炎（CRS）内型很感兴趣。伴有鼻息肉的慢性鼻 - 鼻窦炎（CRSwNP）传统上是参照组织嗜酸性粒细胞增多进行研究的，但其他细胞浸润的作用仍未明确。对于不伴有鼻息肉的慢性鼻 - 鼻窦炎（CRSsNP），尚未描述有特定的组织预后指标。手术组织中所见白细胞的优势类型可能有助于区分CRS亚型、炎症严重程度及预后。
对277例接受内镜鼻窦手术的患者的结构化组织病理学报告进行检查，这些患者包括CRSwNP（n = 115）、CRSsNP（n = 141）和复发性急性鼻 - 鼻窦炎（RARS，n = 21）。研究炎症优势类型与鼻息肉病、哮喘、变应性鼻炎、阿司匹林加重的呼吸道疾病（AERD）、免疫缺陷、术前Lund - Mackay评分及预后（SNOT - 22评分变化）之间的关联。
按出现频率排序，占CRS患者93.5%的主要炎症模式的患病率依次为：淋巴细胞 - 浆细胞性（n = 111）、淋巴细胞性（n = 74）、嗜酸性粒细胞性（n = 50）和淋巴细胞 - 浆细胞性伴嗜酸性粒细胞性（n = 24）。嗜酸性粒细胞优势类型对鼻息肉的特异性为97.4%（95%置信区间[CI]，93.4% - 99.3%），尽管敏感性为43.4%（95% CI，33.8% - 53.4%）。无嗜酸性粒细胞优势类型对RARS的敏感性为100%（95% CI，82.4% - 100%），然而特异性为30.8%（95% CI 25.1% - 37.1%）。术前SNOT - 22评分或术后变化无显著差异。
嗜酸性粒细胞性炎症优势类型可预测鼻息肉的存在并排除RARS。然而，大多数CRSwNP患者有不同的炎症优势类型，这表明CRS存在异质性，即使在有鼻息肉的患者中也是如此。通过12个月的随访，症状性预后与炎症优势类型无关。
4级。
