Luo Xin, Xu Zhaofeng, Zuo Kejun, Deng Jie, Gao Wenxiang, Jiang Lijie, Xu Lei, Huang Zhaoqi, Shi Jianbo, Lai Yinyan
Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China.
Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, 510080, PR China.
World Allergy Organ J. 2021 Apr 16;14(4):100531. doi: 10.1016/j.waojou.2021.100531. eCollection 2021 Apr.
Nowadays, the heterogeneity of chronic rhinosinusitis (CRS) has attracted extensive attention. The histological patterns and clinical characteristics may vary greatly in different areas and among different groups of people. Prior studies found a shift from the neutrophilic inflammatory pattern to the eosinophilic inflammatory pattern in Asian cities. This study set out with the aim of investigating the changes that have occurred in the past 18 years of southern China and exploring the causes.
Tissues, clinical, and demographic characteristics were obtained from 473 patients (91 in 2000-2001, 170 in 2010-2011, 212 in 2017-2018) who satisfied the criteria of diffuse (bilateral) chronic rhinosinusitis. The clinical characteristics, including the previous history of allergic rhinitis and asthma, and the major symptoms of rhinosinusitis, were collected. Formalin-fixed nasal tissue was obtained from each patient for calculating inflammatory cells. We also performed immunohistochemistry to evaluate the expression levels of eosinophilic cationic protein (ECP), IgE, myeloperoxidase (MPO), and other Type 1, Type 2, and Type 3 related inflammatory cytokines.
The comorbidity of asthma and atopic disease was higher in 2017-2018 compared to 2000-2001. The histological characteristics revealed a significant increase in tissue eosinophils and decrease in neutrophils in 2017-2018 as compared with 2000-2001. Meanwhile, the proportion of eosinophilic CRS (eCRS) increased significantly from 2000 to 2001 to 2017-2018 ( = 0.03). The tissue eosinophil increase was higher in overweight patients (Body Mass Index, BMI≥24) as compared with non-overweight. There was an increasing trend of ECP, IL-13 and IL-17. Besides, IFN-γ and TNF-α decreased.
There was an eosinophilic shift of diffuse rhinosinusitis inflammatory pattern in southern China over the last 18 years. The proportion of eCRS and difficult-to-treat rhinosinusitis has steadily increased, which is associated with the increase of Type 2, Type 3 cytokines and the decrease of Type 1 cytokines. This study also provided firstly evidence of a strong relationship between overweight and eosinophil shift in the southern Chinese population.
如今，慢性鼻-鼻窦炎（CRS）的异质性已引起广泛关注。其组织学模式和临床特征在不同地区和不同人群中可能有很大差异。先前的研究发现亚洲城市中存在从中性粒细胞炎症模式向嗜酸性粒细胞炎症模式的转变。本研究旨在调查中国南方过去18年发生的变化并探究其原因。
从473例符合弥漫性（双侧）慢性鼻-鼻窦炎标准的患者（2000 - 2001年91例，2010 - 2011年170例，2017 - 2018年212例）获取组织、临床和人口统计学特征。收集临床特征，包括既往变应性鼻炎和哮喘病史以及鼻-鼻窦炎的主要症状。从每位患者获取福尔马林固定的鼻组织以计算炎症细胞。我们还进行了免疫组织化学以评估嗜酸性阳离子蛋白（ECP）、免疫球蛋白E（IgE）、髓过氧化物酶（MPO）以及其他1型、2型和3型相关炎症细胞因子的表达水平。
与2000 - 2001年相比，2017 - 2018年哮喘和特应性疾病的合并症更高。组织学特征显示，与2000 - 2001年相比，2017 - 2018年组织嗜酸性粒细胞显著增加，中性粒细胞减少。同时，嗜酸性粒细胞性CRS（eCRS）的比例从2000 - 20××年到2017 - 2018年显著增加（P = 0.03）。超重患者（体重指数，BMI≥24）的组织嗜酸性粒细胞增加高于非超重患者。ECP、白细胞介素 - 13（IL - 13）和白细胞介素 - 17（IL - 17）呈上升趋势。此外，干扰素 - γ（IFN - γ）和肿瘤坏死因子 - α（TNF - α）下降。
