Savlevich E L, Kurbacheva O M, Egorov V I, Dyneva M E, Shilovskiy I P, Khaitov M R
Central State Medical Academy of Department for Presidential Affairs of the Russian Federation, Moscow, Russia, 121359.
NRC Institute of Immunology FMBA of Russia, Moscow, Russia, 115522.
Vestn Otorinolaringol. 2019;84(6):42-47. doi: 10.17116/otorino20198406142.
Rhinosinusitis with nasal polyps (CRSwNP) is often followed by a range of comorbid states, influence of which on the course of the main pathology process remains insufficiently studied.
To study the gene expression level of cytokines potentially talking part in the development of inflammation in nasal polyps with different phenotypes of CRSwNP.
All the patients with CRSwNP were divided into 4 equal groups, 36 patients in each subgroup: group 1 - CRSwNP without comorbid pathology; group 2 - CRSwNP+atopy; group 3 - CRSwNP + non-allergic bronchial asthma (BA); control group 4 - 36 patients diagnosed with hypertrophic rhinitis without atopy and without bronchial asthma. Using the real-time polymerase chain reaction (Real-Time PCR) method, the study of expression level of mRNA genes coding proteins IL-1β, IL-4, IL-5, IL-13, IL-17F, IL-25, IFN-y, TSLP in polyp tissue was conducted.
The statistically proved difference of expression level of cytokines depending on the CRSwNP phenotype was educed. If CRSwNP and atopy were combined, the gene expression level of all studied cytokines was statistically higher than that of CRSwNP without comorbid pathology; and the expression level of IL-17F, IL-25 and TSLP was more intense that in the group of CRSwNP + BA. There was no difference between the patients with comorbid allergy and comorbid BA regarding the gene expression of IFN-y, IL-5 and IL-13 cytokines. Among different phenotypes of CRSwNP no difference in IL-1β expression level was detected, which evidences of persisting inflammatory process, and the IL-4 gene expression level was lower than the detection level in all the groups.
With different CRSwNP phenotypes different inflammatory patterns are detected, which indicates different character of the pathology process course among these groups of patients. Higher expression level of cytokine genes, which are a marker of epithelial damage of IL-25 and TSLP, is found only among the patients with CRSwNP and atopy. It suggests that forming of CRSwNP without comorbid pathology is connected with other pathologic mechanisms, not with the damage to epithelial barrier. If CRSwNP + BA and CRSwNP + atopy were combined, the expression level of IFN-y, IL-5, IL-13 and IL-17F genes was higher than the one in the group of patients with CRSwNP without comorbid pathology. In view of obtained data, all the patients with CRSwNP shall be screened for bronchial asthma and the allergy diagnostic shall be conducted.
伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）常伴有一系列共病状态，但其对主要病理过程的影响仍研究不足。
研究可能参与不同表型CRSwNP鼻息肉炎症发展的细胞因子的基因表达水平。
所有CRSwNP患者分为4组，每组36例：第1组 - 无共病的CRSwNP；第2组 - CRSwNP+特应性；第3组 - CRSwNP+非过敏性支气管哮喘（BA）；对照组4 - 36例诊断为肥厚性鼻炎且无特应性和无支气管哮喘的患者。采用实时聚合酶链反应（Real-Time PCR）方法，对息肉组织中编码蛋白IL-1β、IL-4、IL-5、IL-13、IL-17F、IL-25、IFN-γ、TSLP的mRNA基因表达水平进行研究。
得出细胞因子表达水平根据CRSwNP表型存在统计学差异。若CRSwNP与特应性合并，所有研究细胞因子的基因表达水平在统计学上高于无共病的CRSwNP；且IL-17F、IL-25和TSLP的表达水平比CRSwNP+BA组更强。合并过敏和合并BA的患者在IFN-γ、IL-5和IL-13细胞因子的基因表达方面无差异。在CRSwNP的不同表型中，未检测到IL-1β表达水平的差异，这证明炎症过程持续存在，且IL-4基因表达水平低于所有组的检测水平。
不同CRSwNP表型检测到不同的炎症模式，这表明这些患者组的病理过程特征不同。仅在CRSwNP和特应性患者中发现细胞因子基因表达水平较高，这些细胞因子是IL-25和TSLP上皮损伤的标志物。这表明无共病的CRSwNP的形成与其他病理机制有关，而非与上皮屏障损伤有关。若CRSwNP+BA和CRSwNP+特应性合并，IFN-γ、IL-5、IL-13和IL-17F基因的表达水平高于无共病的CRSwNP患者组。鉴于所获数据，所有CRSwNP患者均应筛查支气管哮喘并进行过敏诊断。
