Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Division of Otolaryngology, Kimitsu Central Hospital, Kimitsu, Japan.
Rhinology. 2020 Apr 1;58(2):136-144. doi: 10.4193/Rhin18.225.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease, and its pathogenesis remains controversial. This study aimed to examine the involvement of fungi in CRSwNP pathogenesis.
We enrolled 29 controls and 111 CRSwNP patients. We analyzed fungi in the nasal secretions, serum fungus-specific immunoglobulin E (IgE) levels, and nasal polyp (NP) IgE levels. Moreover, we evaluated the correlation between patients' IgE levels and computed tomography (CT) scores.
There was no difference in fungal detection rate between CRSwNP patients with and without asthma. Specific IgEs against various antigens were highly detectable in NPs of CRSwNP patients. In CRSwNP patients, fungus-specific IgE levels in NPs were correlated with CT scores. Serum fungus-specific IgEs became undetectable after operation in more than half of the CRSwNP patients without asthma but not in those with asthma. Other serum airborne antigen-specific IgEs did not become undetectable after operation.
Fungus-specific IgEs were highly detectable in NPs of CRSwNP patients, and NPs comprised a major region of specific IgE production. Fungi may therefore play an important role in CRSwNP pathogenesis by inducing Th2 immune responses, including IgE synthesis.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种异质性疾病，其发病机制仍存在争议。本研究旨在探讨真菌在 CRSwNP 发病机制中的作用。
我们纳入了 29 名对照者和 111 名 CRSwNP 患者。我们分析了鼻腔分泌物中的真菌、血清真菌特异性免疫球蛋白 E（IgE）水平和鼻息肉（NP）IgE 水平。此外，我们评估了患者 IgE 水平与计算机断层扫描（CT）评分之间的相关性。
在伴有或不伴哮喘的 CRSwNP 患者中，真菌检出率无差异。CRSwNP 患者的 NP 中可高度检测到针对各种抗原的特异性 IgE。在 CRSwNP 患者中，NP 中的真菌特异性 IgE 水平与 CT 评分相关。在无哮喘的 CRSwNP 患者中，超过一半的患者术后血清真菌特异性 IgE 检测不到，但在有哮喘的患者中则不然。其他血清空气传播抗原特异性 IgE 术后检测不到。
CRSwNP 患者的 NP 中可高度检测到真菌特异性 IgE，NP 是特异性 IgE 产生的主要区域。因此，真菌可能通过诱导包括 IgE 合成在内的 Th2 免疫反应，在 CRSwNP 的发病机制中发挥重要作用。
