Chen W, Bai Y, Fang P, Chen J, Wang X, Li Y, Luo X, Xiao Z, Iyer R, Shan F, Yuan T, Wu M, Huang X, Fang D, Yang Q, Zhang Y
Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Rhinology. 2024 Jun 1;62(3):370-382. doi: 10.4193/Rhin23.402.
Elevated body mass index (BMI) has been recognized as an important contributor to corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to delineate the effects of elevated BMI on immunological endotype and recurrence in CRSwNP individuals.
A total of 325 patients with CRSwNP undergoing FESS were recruited and stratified by BMI. H&E staining was employed for histological evaluation. Characteristics of inflammatory patterns were identified by immunohistochemical staining. The predictive factors for recurrence were determined and evaluated by multivariable logistic regression analysis and the receiver operating characteristic (ROC) curves across all subjects and by weight group.
In all patients with CRSwNP, 26.15% subjects were classified as overweight/obese group across BMI categories and exhibited a higher symptom burden. The upregulated eosinophil/neutrophil-dominant cellular endotype and amplified type 2/ type 3 coexisting inflammation was present in overweight/obese compared to underweight/normal weight controls. Additionally, a higher recurrent proportion was shown in overweight/obese patients than that in underweight/normal weight cohorts. Multivariable logistic regression analysis identified BMI as an independent predictor for recurrence. The predictive capacity of each conventional parameter (tissue eosinophil and CLCs count, and blood eosinophil percentage) alone or in combination was poor in overweight/obese subjects.
Overweight/obese CRSwNP stands for a unique phenotype and endotype. Conventional parameters predicting recurrence are compromised in overweight/obese CRSwNP, and there is an urgent need for novel biomarkers that predict recurrence for these patients.
体重指数（BMI）升高已被认为是慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者糖皮质激素不敏感的重要因素。我们旨在明确BMI升高对CRSwNP患者免疫表型和复发的影响。
共招募325例接受功能性内镜鼻窦手术（FESS）的CRSwNP患者，并根据BMI进行分层。采用苏木精-伊红（H&E）染色进行组织学评估。通过免疫组织化学染色确定炎症模式特征。通过多变量逻辑回归分析以及所有受试者和不同体重组的受试者工作特征（ROC）曲线确定并评估复发的预测因素。
在所有CRSwNP患者中，26.15%的受试者根据BMI分类被归为超重/肥胖组，且症状负担更高。与体重过轻/正常体重的对照组相比，超重/肥胖组存在嗜酸性粒细胞/中性粒细胞为主的细胞内型上调以及2型/3型炎症共存加剧的情况。此外，超重/肥胖患者的复发率高于体重过轻/正常体重组。多变量逻辑回归分析确定BMI是复发的独立预测因素。在超重/肥胖受试者中，单独或联合使用每个传统参数（组织嗜酸性粒细胞和杯状细胞计数以及血液嗜酸性粒细胞百分比）的预测能力都很差。
超重/肥胖的CRSwNP代表一种独特的表型和内型。预测复发的传统参数在超重/肥胖的CRSwNP中受到影响，迫切需要新的生物标志物来预测这些患者的复发情况。
