Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Clin Otolaryngol. 2020 Jul;45(4):574-583. doi: 10.1111/coa.13536. Epub 2020 Apr 13.
Eosinophilic chronic rhinosinusitis (ECRS) is a histological subtype of CRS that is generally recognised as being more difficult to manage. Patients with ECRS tend to have greater disease severity and poorer treatment outcomes after sinus surgery when compared with non-ECRS patients. The histopathology and biomarker assessments of ECRS are often unavailable prior to surgery and may be impractical and costly to analyse. Thus, the primary objective of this study was to understand clinical comorbidities associated with ECRS.
DESIGN/SETTING: We searched three independent databases for articles that reported clinical CRS comorbidities associated with tissue eosinophilia. Data from studies with the same reported comorbidities were pooled, and a forest plot analysis was used to assess potential associations with four different conditions including allergic rhinitis, ASA sensitivity, asthma and atopy. The association between the phenotype of nasal polyps and ECRS was also quantified as a secondary objective. ECRS cut-off levels were as defined by papers included.
MAIN OUTCOME/RESULTS: Eighteen articles were identified. The presence of nasal polyps (the first numbers in brackets represent odds ratios) (5.85, 95% CI [3.61, 9.49], P < .00001), ASA sensitivity (5.63, 95% CI [3.43, 9.23], P < .00001), allergic rhinitis (1.84, 95% CI [1.27, 2.67], P = .001) and asthma (3.15, 95% CI [2.61, 3.82], P < .00001) were found to be significantly associated with tissue eosinophilia. Atopy, however, was not significantly associated with tissue eosinophilia (1.71, 95% CI [0.59, 4.95], P = .32).
Certain clinical disease characteristics such as ASA sensitivity, allergic rhinitis and asthma are more associated with CRS patients with eosinophilia when compared to those without eosinophilia. The phenotype of nasal polyps was also associated with ECRS. It is important for surgeons to recognise these comorbidities to ensure correct diagnoses, management and follow-up are implemented.
嗜酸性慢性鼻-鼻窦炎（ECRS）是一种组织学亚型的慢性鼻-鼻窦炎，通常被认为更难治疗。与非 ECRS 患者相比，ECRS 患者在鼻窦手术后往往病情更严重，治疗效果更差。在手术前，ECRS 的组织病理学和生物标志物评估通常不可用，而且分析起来既不实际也昂贵。因此，本研究的主要目的是了解与 ECRS 相关的临床合并症。
设计/设置：我们在三个独立的数据库中搜索了报告与组织嗜酸性粒细胞有关的临床 CRS 合并症的文章。将具有相同报告合并症的研究的数据合并，并使用森林图分析评估了四种不同情况（过敏性鼻炎、ASA 敏感性、哮喘和特应性）之间的潜在关联。鼻息肉表型与 ECRS 的关联也作为次要目标进行了量化。ECRS 的截止值由纳入的论文定义。
主要结果/结论：确定了 18 篇文章。存在鼻息肉（括号内的第一个数字代表比值比）（5.85，95%置信区间[3.61，9.49]，P<.00001）、ASA 敏感性（5.63，95%置信区间[3.43，9.23]，P<.00001）、过敏性鼻炎（1.84，95%置信区间[1.27，2.67]，P=.001）和哮喘（3.15，95%置信区间[2.61，3.82]，P<.00001）与组织嗜酸性粒细胞显著相关。然而，特应性与组织嗜酸性粒细胞无显著相关性（1.71，95%置信区间[0.59，4.95]，P=.32）。
与非嗜酸性粒细胞慢性鼻-鼻窦炎患者相比，某些临床疾病特征，如 ASA 敏感性、过敏性鼻炎和哮喘，与 CRS 伴嗜酸性粒细胞的患者更相关。鼻息肉的表型也与 ECRS 相关。外科医生识别这些合并症对于确保正确诊断、管理和随访非常重要。
