Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Rhinology. 2021 Jun 1;59(3):284-291. doi: 10.4193/Rhin20.649.
Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders.
A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤ ≤ ≤5, and no rescue medication.
One hundred CRS patients (mean age 47.4 +- 14.1 years, 45% male) were enrolled. Univariable logistic regression showed local total IgE less than 5.21; and serum eosinophils less than 2.2% associated with macrolide response. Multivariate models showed local total IgE maintained an independent association with macrolide response, with an ability to discriminate between responders and non-responders of 63%. Serum total IgE, nasal secretion IL-5, serum neutrophil, nasal polyp, asthma, allergy, and aspirin hypersensitivity showed no association with LDM response.
Low total IgE level in the nasal secretion but not in the serum, predict LDM response.
低剂量大环内酯类（LDM）具有抗炎作用和抗中性粒细胞活性，但 LDM 治疗慢性鼻-鼻窦炎（CRS）的患者选择仍存在争议。本研究旨在评估预测 LDM 反应者的因素。
进行了一项前瞻性队列研究。CRS 患者接受罗红霉素（150mg），每日一次，持续 12 周。收集鼻分泌物和血清学。使用受试者工作特征曲线分析和多变量逻辑回归评估 9 个 LDM 反应预测因素：鼻分泌物 IgE、鼻分泌物 IL-5、血清 IgE、血清嗜酸性粒细胞、血清中性粒细胞、鼻息肉、哮喘、过敏和阿司匹林过敏。大环内酯类反应者为鼻窦鼻-鼻结局测试 22 评分改善、症状视觉模拟评分≤≤≤5 和无需抢救药物。
100 例 CRS 患者（平均年龄 47.4+-14.1 岁，45%为男性）入组。单变量逻辑回归显示局部总 IgE 小于 5.21；和血清嗜酸性粒细胞小于 2.2%与大环内酯类药物反应相关。多变量模型显示局部总 IgE 与大环内酯类药物反应具有独立相关性，能够区分反应者和非反应者的能力为 63%。血清总 IgE、鼻分泌物 IL-5、血清中性粒细胞、鼻息肉、哮喘、过敏和阿司匹林过敏与 LDM 反应无关。
鼻分泌物中的总 IgE 水平较低（而非血清中的）可预测 LDM 反应。
