Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Int Forum Allergy Rhinol. 2023 Jan;13(1):15-24. doi: 10.1002/alr.23042. Epub 2022 Jun 28.
Patients with chronic rhinosinusitis (CRS) may have persistence of polyps, discharge, or edema after endoscopic sinus surgery (ESS). Inflammation in CRS can be classified into three endotypes, with the presence of polyps associated with the type 2 endotype. Here, we evaluate the endotypic underpinnings of discharge or edema without polyps after ESS.
At a visit 6-12 months post ESS, patients underwent endoscopy and completed the CRS-PRO and SNOT-22. Luminex analysis of middle meatal mucus obtained at that visit was performed for IFN-γ, ECP, and IL-17a. Type 1, 2, and 3 endotypes were defined as greater than the 90th percentile expression of each marker, respectively, in controls. Wilcoxon rank-sum and chi-squared tests were used to compare cytokine levels and endotype prevalence between those with and without endoscopic findings.
A total of 122 CRS patients completed a clinical exam (median: 8.2 months post ESS). Of the 122 patients, 107 did not have polyps on endoscopy. Of these 107 patients, 48 had discharge, 44 had edema, and 46 had neither discharge nor edema. Compared with those patients without any findings, patients with discharge or edema reported significantly worse severity as measured by CRS-PRO (10.5 vs. 7.0, p = 0.009; 12.0 vs. 7.0, p < 0.001; respectively), and had higher post-ESS IFN-γ, ECP, and IL-17a. Patients with discharge had higher prevalence of only T1 and T3 endotypes, while patients with edema had higher prevalence of only the T3 endotype.
Post-ESS discharge or edema in the absence of polyps was associated with higher patient-reported outcome severity and was more strongly associated with type 1 or 3 inflammation.
慢性鼻-鼻窦炎（CRS）患者内镜鼻窦手术后（ESS）可能存在息肉残留、分泌物或水肿。CRS 的炎症可分为三种表型，其中息肉的存在与 2 型表型有关。在这里，我们评估 ESS 后无息肉的分泌物或水肿的表型基础。
在 ESS 后 6-12 个月就诊时，患者接受了内镜检查，并完成了 CRS-PRO 和 SNOT-22 评分。对该次就诊时从中鼻道黏液中获得的样品进行了 Luminex 分析，以检测 IFN-γ、ECP 和 IL-17a。1 型、2 型和 3 型表型分别定义为在对照组中各标志物表达大于第 90 百分位数。使用 Wilcoxon 秩和检验和卡方检验比较了有内镜发现和无内镜发现的患者之间的细胞因子水平和表型发生率。
共有 122 例 CRS 患者完成了临床检查（中位数：ESS 后 8.2 个月）。在 122 例患者中，107 例患者在内镜下无息肉。在这 107 例患者中，48 例有分泌物，44 例有水肿，46 例既无分泌物也无水肿。与无任何发现的患者相比，有分泌物或水肿的患者报告的 CRS-PRO 评分严重程度明显更高（10.5 比 7.0，p=0.009；12.0 比 7.0，p<0.001），且 ESS 后 IFN-γ、ECP 和 IL-17a 水平更高。有分泌物的患者仅 T1 和 T3 表型的发生率较高，而有水肿的患者仅 T3 表型的发生率较高。
ESS 后无息肉的分泌物或水肿与更高的患者报告结局严重程度相关，与 1 型或 3 型炎症的相关性更强。
