Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon.
Department of Pathology, Oregon Health & Science University, Portland, Oregon.
Am J Rhinol Allergy. 2021 Sep;35(5):647-655. doi: 10.1177/1945892420987439. Epub 2021 Jan 11.
Chronic rhinosinusitis (CRS) is often differentiated by histopathologic phenotypes (eosinophilic versus neutrophilic), which may impact disease severity measures and outcomes. As such, it has been suggested that counts of cellular elements be included as part of a standard pathological report following endoscopic sinus surgery (ESS).
This cross-sectional study evaluated associations of mucosal eosinophilia and neutrophilia with measures of quality-of-life (QoL) and olfactory function.
Patients with medically refractory CRS completed the SNOT-22 survey and Brief Smell Identification Test (BSIT) at enrollment. In addition, baseline Lund-Mackay computed tomography (CT) and Lund-Kennedy endoscopy scores were collected. Ethmoid mucosa was biopsied during ESS and reviewed using microscopy to quantify densest infiltrate of eosinophils or neutrophils per high-powered-field (HPF). Eosinophilic CRS (eCRS) and neutrophilic CRS (nCRS), both with and without nasal polyposis (NP), were compared across SNOT-22 and BSIT scores.
77/168 patients demonstrated mucosal eosinophilia (eCRS) while a total of 42/168 patients demonstrated mucosal neutrophilia (nCRS). After adjusting for polyp status, 35/168 had eCRSsNP, 42/168 eCRSwNP, 75/168 non-eCRSsNP, 16/168 non-eCRSwNP. Additionally, 22/161 were noted to have nCRSsNP, 20/161 nCRSwNP, 84/161 non-nCRSwNP, and 35/161 non-nCRSsNP. A small subset of patients demonstrated both eosinophilia and neutrophilia: 14 CRSwNP and 7 CRSsNP. When evaluating average Lund-Mackay Scores (LMS), significant differences existed between non-eCRSsNP and eCRSsNP (p = 0.006). However, after controlling for nasal polyps, eosinophilia did not significantly associate with differences in the Lund-Kennedy Score. Neutrophilia did not significantly associate with any changes in LMS or LKS after controlling for NP. Eosinophilic and neutrophilic histopathologic subtypes did not significantly associate with differences in baseline SNOT-22 or BSIT measures after controlling for NP.
Neither the presence of mucosal eosinophilia nor mucosal neutrophilia demonstrated significant associations with SNOT-22 quality-of-life or BSIT olfactory function scores when controlling for comorbid nasal polyposis.
慢性鼻-鼻窦炎（CRS）通常通过组织病理学表型（嗜酸性粒细胞与中性粒细胞）进行区分，这可能会影响疾病严重程度的评估和结局。因此，有人建议在鼻内镜鼻窦手术（ESS）后，将细胞成分计数作为标准病理报告的一部分。
本横断面研究评估了鼻黏膜嗜酸性粒细胞和中性粒细胞增多与生活质量（QoL）和嗅觉功能评估之间的相关性。
经药物治疗无效的 CRS 患者在入组时完成 SNOT-22 量表和简短嗅觉识别测试（BSIT）。此外，还收集了基线 Lund-Mackay 计算机断层扫描（CT）和 Lund-Kennedy 内镜评分。在 ESS 期间对筛窦黏膜进行活检，并使用显微镜评估每个高倍视野（HPF）中最密集的嗜酸性粒细胞或中性粒细胞浸润程度。比较伴有或不伴鼻息肉（NP）的嗜酸性 CRS（eCRS）和中性粒细胞 CRS（nCRS）患者的 SNOT-22 和 BSIT 评分。
168 例患者中有 77 例（46%）表现为鼻黏膜嗜酸性粒细胞增多（eCRS），168 例患者中有 42 例（25%）表现为鼻黏膜中性粒细胞增多（nCRS）。调整 NP 状态后，35 例（21%）为伴有 NP 的 eCRSsNP，42 例（25%）为伴有 NP 的 eCRSwNP，75 例（45%）为不伴有 NP 的 eCRSsNP，16 例（10%）为不伴有 NP 的 eCRSwNP。此外，161 例患者中有 22 例（14%）为伴有 NP 的 nCRSsNP，20 例（12%）为伴有 NP 的 nCRSwNP，84 例（52%）为不伴有 NP 的 nCRSwNP，35 例（22%）为不伴有 NP 的 nCRSsNP。一小部分患者同时表现为嗜酸性粒细胞增多和中性粒细胞增多：14 例 CRSwNP 和 7 例 CRSsNP。评估平均 Lund-Mackay 评分（LMS）时，非 eCRSsNP 与 eCRSsNP 之间存在显著差异（p=0.006）。然而，在控制 NP 后，嗜酸性粒细胞增多与 Lund-Kennedy 评分的变化没有显著关联。在控制 NP 后，中性粒细胞增多与 LMS 或 LKS 的任何变化均无显著关联。在控制 NP 后，嗜酸性粒细胞和中性粒细胞组织病理学亚型与基线 SNOT-22 或 BSIT 测量值之间无显著相关性。
在控制合并的 NP 后，鼻黏膜嗜酸性粒细胞增多或中性粒细胞增多均与 SNOT-22 生活质量或 BSIT 嗅觉功能评分无显著相关性。
