Zhu Z Z, Wang W Q, Chen Y J, Lyu W
Department of Otorhinolaryngology Head and Neck Surgery,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Mar 7;56(3):249-255. doi: 10.3760/cma.j.cn115330-20200628-00532.
To investigate the histopathological and hematological changes in reoperation of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP). A total of 41 patients with CRSwNP who underwent two consecutive endoscopic sinus surgeries in Peking Union Medical College Hospital from February 1999 to April 2019 were included retrospectively, including 25 males and 16 females, aged (40.7±13.6) years at the former surgery and (47.0±13.2) years at the recurrent surgery. The peripheral blood cell count results were collected. Differential inflammatory cells in nasal polyp tissue sections were counted and characteristics of tissue remodeling were scored. Paired test was used to compare the hematological and histological data of the two surgeries in the same cohort. ' rank correlation coefficient was used to determine the correlation between tissue and peripheral blood eosinophil contents. In histopathological tissue sections of nasal polyps, the mean tissue eosinophil, lymphocyte and total inflammatory cell counts per high power field significantly decreased (54.04±34.67 76.97±65.59, 35.27±16.61 50.01±26.94, 128.88±41.32 176.38±80.59, value was 2.413, 2.923, 3.445, respectively, all <0.05), whereas the percentages of different inflammatory cell types remained unchanged when comparing the recurrent surgery with the former surgery. There was a significant reduction of basement membrane thickness and goblet cell hyperplasia score in the recurrent surgery (1.29±0.84 2.00±0.84, 1.81±1.31 2.44±1.10, value was 5.367, 2.714, respectively, all <0.05). Subgroup analysis suggested that changes in asthmatic cases, younger cases and cases without previous surgery were more remarkable than non-asthmatics, older cases and cases with previous surgery, respectively. There was no significant change in peripheral white blood cell counts and differential cell percentages, except a small increase of blood monocyte percentage. Correlation analysis showed that tissue eosinophil content correlated positively with blood eosinophil content at each surgery. In the recurrent surgery of CRSwNP, tissue eosinophil, lymphocyte and total inflammatory cell counts decrease significantly compare with that of the former surgery. The histological inflammatory load decreases with improvement of tissue remodeling, which could be attributed to the integrated treatment with surgery and medications.
探讨复发性慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）再次手术的组织病理学和血液学变化。回顾性纳入1999年2月至2019年4月在北京协和医院连续接受两次鼻内镜鼻窦手术的41例CRSwNP患者，其中男性25例，女性16例，首次手术时年龄为（40.7±13.6）岁，复发手术时年龄为（47.0±13.2）岁。收集外周血细胞计数结果。对鼻息肉组织切片中的炎性细胞进行分类计数，并对组织重塑特征进行评分。采用配对检验比较同一队列两次手术的血液学和组织学数据。采用秩相关系数确定组织和外周血嗜酸性粒细胞含量之间的相关性。在鼻息肉组织病理学切片中，每高倍视野的平均组织嗜酸性粒细胞、淋巴细胞和总炎性细胞计数显著降低（54.04±34.67对76.97±65.59、35.27±16.61对50.01±26.94、128.88±41.32对176.38±80.59，P值分别为2.413、2.923、3.445，均<0.05），而复发手术与首次手术相比，不同炎性细胞类型的百分比保持不变。复发手术中基底膜厚度和杯状细胞增生评分显著降低（1.29±0.84对2.00±0.84、1.81±1.31对2.44±1.10，P值分别为5.367、2.714，均<0.05）。亚组分析表明，哮喘患者、年轻患者和未行过手术患者的变化分别比非哮喘患者、老年患者和行过手术患者更显著。外周血白细胞计数和分类细胞百分比无显著变化，仅血单核细胞百分比略有增加。相关性分析表明，每次手术时组织嗜酸性粒细胞含量与血嗜酸性粒细胞含量呈正相关。在CRSwNP再次手术中，与首次手术相比，组织嗜酸性粒细胞、淋巴细胞和总炎性细胞计数显著降低。组织学炎症负荷随组织重塑改善而降低，这可能归因于手术和药物的综合治疗。
