Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.
Clin Exp Allergy. 2020 Dec;50(12):1362-1371. doi: 10.1111/cea.13747. Epub 2020 Oct 12.
There is clinical evidence for impaired lung function in chronic rhinosinusitis with nasal polyps (CRSwNP) patients, which may be due to a high incidence of asthma comorbidity. The lung function characteristics of non-asthmatic CRSwNP patients are not known. Small airway dysfunction (SAD) is involved in the pathogenesis of asthma. However, whether SAD is detected in non-asthmatic patients with CRSwNPs remains unclear.
This study analysed the lung function of non-asthmatic patients with CRSwNPs and evaluated its clinical relevance in CRSwNPs.
The clinical data for 191 consecutive CRSwNP patients (73 asthmatic and 118 non-asthmatic) and 30 control subjects were prospectively collected. The patients were followed up for at least 3 years (mean [standard deviation], 42.47 ± 8.38 months). Serum and tissue total IgE levels were measured in 95 and 93 patients, respectively. Tissue eosinophil counts were documented in 63 patients.
Non-asthmatic CRSwNP patients had decreased forced expiratory flow at 75% of the FVC (FEF ) and FEF compared to the control subjects, and this difference was related to the severity of CRSwNP. The risk factors for impaired lung function in asthmatic and non-asthmatic patients were duration of asthma and smoking. A multivariate logistic analysis showed that decreased FEF was associated with the recurrence of non-asthmatic CRSwNPs. The lung function of CRSwNP patients negatively correlated with the degree of type-2 inflammation, which was defined by the levels of Eos and IgE in polyp tissues and blood. The SAD of non-asthmatic CRSwNP patients was related to serum IgE levels.
This study provides evidence that non-asthmatic CRSwNP patients may have SAD, which correlated with the severity and recurrence of CRSwNP. The decreased lung function of patients with CRSwNP was related to the degree of type-2 inflammation.
慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者存在肺功能受损的临床证据，这可能与哮喘合并症的高发病率有关。非哮喘 CRSwNP 患者的肺功能特征尚不清楚。小气道功能障碍（SAD）与哮喘的发病机制有关。然而，非哮喘 CRSwNPs 患者是否存在 SAD 尚不清楚。
本研究分析了非哮喘 CRSwNP 患者的肺功能，并评估了其在 CRSwNP 中的临床相关性。
前瞻性收集了 191 例连续 CRSwNP 患者（73 例哮喘和 118 例非哮喘）和 30 例对照者的临床资料。患者随访至少 3 年（平均[标准差]，42.47±8.38 个月）。分别测量了 95 例和 93 例患者的血清和组织总 IgE 水平。记录了 63 例患者的组织嗜酸性粒细胞计数。
与对照组相比，非哮喘 CRSwNP 患者的用力呼气流量在 75%用力肺活量（FEF ）和 FEF 时降低，且这种差异与 CRSwNP 的严重程度有关。哮喘和非哮喘患者肺功能受损的危险因素是哮喘持续时间和吸烟。多变量 logistic 分析显示，FEF 降低与非哮喘 CRSwNP 的复发有关。CRSwNP 患者的肺功能与 2 型炎症的严重程度呈负相关，2 型炎症由息肉组织和血液中 Eos 和 IgE 的水平定义。非哮喘 CRSwNP 患者的 SAD 与血清 IgE 水平有关。
本研究提供的证据表明，非哮喘 CRSwNP 患者可能存在 SAD，其与 CRSwNP 的严重程度和复发有关。CRSwNP 患者的肺功能下降与 2 型炎症的程度有关。
