Lin Yi-Tsen, Lin Chih-Feng, Liao Chun-Kang, Yeh Te-Huei
Department of Otolaryngology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
Department of Otolaryngology, National Taiwan University Yunlin Branch, Yunlin, Taiwan.
Eur Arch Otorhinolaryngol. 2023 Dec;280(12):5379-5389. doi: 10.1007/s00405-023-08118-2. Epub 2023 Jul 13.
Endotype-driven treatment has been introduced in the management of chronic rhinosinusitis with nasal polyps (CRSwNP), and an understanding of the associations between phenotypes and endotypes of CRSwNP will be beneficial in identifying responders. We aimed to determine the correlations between clinical manifestations and type 2 inflammatory mediators of sinonasal tissues.
Adult patients undergoing endoscopic sinus surgery for bilateral CRSwNP were prospectively enrolled. Tissue eosinophilia and type 2 mediator expression in tissue homogenates were assessed and correlated with clinical features, including symptoms, comorbidities, blood eosinophil counts, specific allergen immunoglobulin (IgE) testing, computed tomography (CT) scan findings, and Sino-Nasal Outcome Test-22 scores.
A total of 93 subjects were recruited in our study. Fifty-nine (63.4%) cases were identified as the eosinophilic endotype, demonstrating with higher rates of comorbidity of asthma, blood eosinophilia and a high ethmoid-maxillary ratio on CT images. To correlate of phenotypes with the inflammatory mediator profile, multivariate analyses revealed the associations of IgE expression in nasal polyp tissues with allergen sensitization (p = 0.042), CT ethmoid-maxillary ratio (p = 0.001) and tissue eosinophil counts (p = 0.022); the association of interleukin (IL-5) expression with the blood eosinophil percentage (p = 0.020); and the association of IL-13 expression with white blood cell count (p = 0.002) and central compartment-type inflammation (p < 0.001).
We demonstrated associations of IgE and IL-5 expression with clinical features of eosinophilic-type inflammation and a significantly elevated level of IL-13 in patients with central-compartment-type CRSwNP. These observations may be useful when considering the use of type 2 biologic treatment and require further validation studies.
内型驱动治疗已被引入慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的管理中，了解CRSwNP的表型与内型之间的关联将有助于识别反应者。我们旨在确定鼻窦组织的临床表现与2型炎症介质之间的相关性。
前瞻性纳入因双侧CRSwNP接受鼻内镜鼻窦手术的成年患者。评估组织嗜酸性粒细胞增多和组织匀浆中2型介质的表达，并将其与临床特征相关联，包括症状、合并症、血液嗜酸性粒细胞计数、特异性变应原免疫球蛋白（IgE）检测、计算机断层扫描（CT）扫描结果和鼻鼻窦结局测试-22评分。
我们的研究共纳入93名受试者。59例（63.4%）被确定为嗜酸性粒细胞内型，在哮喘、血液嗜酸性粒细胞增多合并症以及CT图像上筛骨-上颌窦比例较高方面表现更为突出。为了将表型与炎症介质谱相关联，多变量分析揭示了鼻息肉组织中IgE表达与变应原致敏（p = 0.042）、CT筛骨-上颌窦比例（p = 0.001）和组织嗜酸性粒细胞计数（p = 0.022）之间的关联；白细胞介素（IL-5）表达与血液嗜酸性粒细胞百分比（p = 0.020）之间的关联；以及IL-13表达与白细胞计数（p = 0.002）和中央隔型炎症（p < 0.001）之间的关联。
我们证明了IgE和IL-5表达与嗜酸性粒细胞型炎症的临床特征之间的关联，以及中央隔型CRSwNP患者中IL-13水平显著升高。这些观察结果在考虑使用2型生物治疗时可能有用，并且需要进一步的验证研究。
