Department of Otorhinolaryngology, Toho University Graduate School of Medicine, Tokyo, Japan; Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan; Division of Molecular Genetics, Research Center for Medical Science, The Jikei University School of Medicine, Tokyo, Japan.
Division of Molecular Genetics, Research Center for Medical Science, The Jikei University School of Medicine, Tokyo, Japan.
Auris Nasus Larynx. 2024 Apr;51(2):286-294. doi: 10.1016/j.anl.2023.09.007. Epub 2023 Oct 13.
There is heterogeneity in the pathophysiology of chronic rhinosinusitis (CRS). Obtaining a detailed understanding of patient profiles in specific regions can provide valuable information not only for clinical practice but also future research plans. The aim of this study was to investigate the characteristics of patients who underwent endoscopic sinus surgery (ESS) for CRS.
This retrospective, single-center study examined the features of 453 patients with CRS who underwent ESS in the Tokyo area of Japan. The study evaluated various factors in patients with CRS including sex and age, the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score, the recurrence rate of CRS, comorbidities of asthma and/or allergic diseases, and IgE sensitization to 12 inhaled allergens.
Age-related declines in the sensitization rate to inhaled allergens were observed, and the most notable age-related decrease in specific IgE antibodies was observed for house dust mites (HDM) (p = 8.3 × 10). Sensitization to HDM, cat dander, and various types of fungi, including Aspergillus, was frequently observed in the CRS with asthma group, with rates of 54%, 17%, and 17%, respectively. We found that 23% of the patients had recurrence. In the recurrence group, the positive rates of specific IgE antibodies for birch and cat dander were significantly higher than in the no recurrence group. Bronchial asthma was identified as an important factor for recurrence. Among male patients, the recurrence group was younger than the no-recurrence group (p = 0.0032). Severe eosinophilic CRS (ECRS) showed early recurrence after surgery, with over the half of the patients experiencing at least one recurrence within 2 years post-surgery. Among patients with ECRS, the recurrence rate for females was 1.92 times higher than for males.
Our study revealed the influences of age and sex on various clinical phenotypes of CRS patients undergoing ESS. There was a high sensitization rate to cat dander in both the recurrence and asthma groups. Further research on diverse disease etiologies is necessary to improve therapeutic strategies for patients with CRS.
慢性鼻-鼻窦炎（CRS）的病理生理学存在异质性。深入了解特定地区患者的特征不仅可为临床实践提供有价值的信息，也可为未来的研究计划提供参考。本研究旨在探讨接受内镜鼻窦手术（ESS）治疗的 CRS 患者的特征。
本回顾性单中心研究纳入了 453 例在日本东京地区接受 ESS 治疗的 CRS 患者。研究评估了 CRS 患者的各种特征，包括性别和年龄、日本难治性嗜酸性粒细胞性慢性鼻-鼻窦炎（JESREC）评分、CRS 复发率、哮喘和/或过敏疾病合并症以及对 12 种吸入性过敏原的 IgE 致敏情况。
观察到与年龄相关的吸入性过敏原致敏率下降，屋尘螨（HDM）特异性 IgE 抗体的年龄相关性下降最为显著（p=8.3×10）。哮喘合并 CRS 患者中，HDM、猫皮屑和包括曲霉属在内的各种真菌的致敏率分别为 54%、17%和 17%。我们发现有 23%的患者复发。在复发组中，桦树和猫皮屑特异性 IgE 抗体的阳性率明显高于无复发组。支气管哮喘被确定为复发的重要因素。在男性患者中，复发组比无复发组年轻（p=0.0032）。重度嗜酸性粒细胞性 CRS（ECRS）患者术后复发较早，超过一半的患者在术后 2 年内至少复发一次。在 ECRS 患者中，女性的复发率是男性的 1.92 倍。
本研究揭示了年龄和性别对接受 ESS 治疗的 CRS 患者各种临床表型的影响。复发组和哮喘组对猫皮屑的致敏率均较高。需要进一步研究不同的疾病病因，以改善 CRS 患者的治疗策略。
