Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
Int Forum Allergy Rhinol. 2021 May;11(5):846-856. doi: 10.1002/alr.22702. Epub 2020 Oct 4.
In this study we aimed to identify inflammatory patterns and predictors associated with clinical outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) patients with different blood and tissue eosinophilia.
A total of 535 CRSwNP patients were enrolled, and the expression of 35 biomarkers, together with eosinophil and neutrophil counts in nasal polyps, were analyzed in a subset of 249 patients. Patients were stratified on the basis of blood (≥0.5 × 10 /L) and tissue (>10%) eosinophilia. Logistic regression models were applied to identify predictors of uncontrolled disease at least 1 year after surgery. Uncontrolled disease was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020.
Among 535 patients, 38.5% showed inconsistent blood and tissue eosinophilia. In 249 CRSwNP patients, subjects with concomitant blood and tissue eosinophilia (group 1) showed marked mucosal type 2 inflammation, characterized by high levels of interleukin (IL)-5, IL-13, and eotaxin-1, whereas subjects with normal blood and tissue eosinophil levels (group 4) demonstrated significant local neutrophilic inflammation with high expression of granulocyte colony-stimulating factor and subjects with selective tissue eosinophilia (group 2) showed intermediate and mixed eosinophilic and neutrophilic inflammation. Subjects with isolated blood eosinophilia (group 3) showed low expression of vascular endothelial growth factor and IL-10. Asthma, prior sinus surgery, and blood eosinophilia were the top 3 predictors for postsurgical uncontrolled disease. For subgroup analysis, sex in group 1, asthma in group 2, tissue IL-10 and immunoglobulin E in group 3, and prior sinus surgery in group 4 were the strongest predictors of uncontrolled disease, respectively.
Different blood and tissue eosinophilia revealed distinct tissue inflammatory patterns in CRSwNP patients.
本研究旨在确定伴有不同血液和组织嗜酸性粒细胞增多的慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的炎症模式和与临床结局相关的预测因素。
共纳入 535 例 CRSwNP 患者，对其中 249 例患者的鼻息肉中 35 种生物标志物的表达以及嗜酸性粒细胞和中性粒细胞计数进行了分析。根据血液（≥0.5×10 /L）和组织（>10%）嗜酸性粒细胞增多，将患者分为不同亚组。应用逻辑回归模型来确定术后至少 1 年疾病控制不佳的预测因素。根据 2020 年欧洲鼻-鼻窦炎和鼻息肉意见书，将疾病控制不佳定义为。
在 535 例患者中，38.5%表现为血液和组织嗜酸性粒细胞不一致增多。在 249 例 CRSwNP 患者中，同时伴有血液和组织嗜酸性粒细胞增多的患者（组 1）表现出明显的黏膜 2 型炎症，其特征为白细胞介素（IL）-5、IL-13 和 eotaxin-1 水平升高，而血液和组织嗜酸性粒细胞水平正常的患者（组 4）表现出明显的局部中性粒细胞炎症，粒细胞集落刺激因子表达水平较高，仅组织嗜酸性粒细胞增多的患者（组 2）表现出中等程度和混合性嗜酸性粒细胞与中性粒细胞炎症。孤立性血液嗜酸性粒细胞增多的患者（组 3）表现出血管内皮生长因子和 IL-10 低表达。哮喘、既往鼻窦手术和血液嗜酸性粒细胞增多是术后疾病控制不佳的前 3 个预测因素。对于亚组分析，组 1 中为性别，组 2 中为哮喘，组 3 中为组织 IL-10 和免疫球蛋白 E，组 4 中为既往鼻窦手术，分别为疾病控制不佳的最强预测因素。
不同的血液和组织嗜酸性粒细胞在 CRSwNP 患者中揭示了不同的组织炎症模式。
