鼻息肉复发性慢性鼻-鼻窦炎患者鼻分泌物中夏科-莱登晶体蛋白的预测意义。
Predictive Significance of Charcot-Leyden Crystal Protein in Nasal Secretions in Recurrent Chronic Rhinosinusitis with Nasal Polyps.
机构信息
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
出版信息
Int Arch Allergy Immunol. 2021;182(1):65-75. doi: 10.1159/000510120. Epub 2020 Sep 14.
INTRODUCTION
The recurrence occurs frequently among patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and predictors that could be conveniently detected during practice in outpatient service are needed.
OBJECTIVE
We aimed to illustrate that the concentration of Charcot-Leyden crystal (CLC) in nasal secretions can effectively and noninvasively predict polyp recurrence.
METHODS
108 patients with CRSwNP were divided into recurrence (n = 68) and recurrence-free (n = 40) groups. Preoperative CLC concentrations in nasal secretions were collected and detected by ELISA. Polyp tissues were harvested during biopsy or endoscopic sinus surgery and were evaluated for inflammatory cells by histopathological staining. Demographic information and the clinical characteristics of each patient were reviewed for associations with recurrence. Binary logistic regression analysis was performed to determine predictive factors for polyp recurrence. Receiver operating characteristic (ROC) curves and the Youden index were performed to determine their predictive values. Survival analysis was performed to compare recurrence risk of patients with different CLC concentrations.
RESULTS
Sixty-eight (62.96%) patients developed recurrence during a 12- to 33-month postoperative follow-up. CLC concentrations in nasal secretions were positively correlated with eosinophil percent in polyp tissue and peripheral blood and were significantly higher in patients of the recurrence group than in the patients of the recurrence-free group (p < 0.001). Binary logistic regression and ROC curve demonstrated that CLC protein in nasal secretions is predictive of polyp recurrence. According to the Youden index, a CLC concentration of 34.24 ng/mL can predict postoperative polyp recurrence with 92.6% sensitivity and 87.5% specificity. Patients with CLC concentrations higher than the cutoff value yielded a higher risk of recurrence (p < 0.001, HR = 11.31, 95% CI: 6.41-19.98).
CONCLUSIONS
CLC protein in nasal secretions may serve as a promising noninvasive biomarker to predict CRSwNP recurrence.
简介
慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者常出现复发，需要找到可在门诊实践中方便检测到的预测指标。
目的
本文旨在阐明鼻分泌物中夏科-莱登晶体（CLC）的浓度可以有效、无创地预测息肉复发。
方法
将 108 例 CRSwNP 患者分为复发组（n = 68）和无复发组（n = 40）。采集术前鼻分泌物中 CLC 浓度，采用 ELISA 法检测。通过鼻内镜或鼻窦手术获取息肉组织，进行组织病理学染色评估炎症细胞。回顾性分析患者的人口统计学信息和临床特征，评估与复发的相关性。采用二元逻辑回归分析确定息肉复发的预测因素。绘制受试者工作特征（ROC）曲线和约登指数，评估其预测价值。采用生存分析比较不同 CLC 浓度患者的复发风险。
结果
术后 1233 个月随访期间，68 例（62.96%）患者复发。鼻分泌物中的 CLC 浓度与息肉组织和外周血中的嗜酸性粒细胞百分比呈正相关，且复发组患者显著高于无复发组（p < 0.001）。二元逻辑回归和 ROC 曲线分析显示，鼻分泌物中的 CLC 蛋白可预测息肉复发。根据约登指数，鼻分泌物中 CLC 浓度为 34.24ng/mL 时预测术后息肉复发的灵敏度为 92.6%，特异度为 87.5%。CLC 浓度高于临界值的患者复发风险更高（p < 0.001，HR = 11.31，95%CI：6.4119.98）。
结论
鼻分泌物中的 CLC 蛋白可能成为预测 CRSwNP 复发的一种有前途的非侵入性生物标志物。
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