Liu Peiqiang, Xu Yu
Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China.
Department of Rhinology and Allergy, Renmin Hospital of Wuhan University, Wuhan, China.
Eur Arch Otorhinolaryngol. 2025 Mar;282(3):1327-1334. doi: 10.1007/s00405-024-09130-w. Epub 2024 Dec 13.
The objective of this study was to elucidate the relationship between adenoid hypertrophy (AH) and glucocorticoid resistance, and to investigate the potential reasons for the suboptimal therapeutic response to intranasal glucocorticoids (INS) in pediatric patients with AH.
The present study enrolled a cohort of 110 patients diagnosed with AH, all of whom underwent adenoidectomy at Renmin Hospital of Wuhan University between June 2023 and September 2023. Immunohistochemistry and real-time quantitative polymerase chain reaction (RT-qPCR) were employed to assess the levels of inflammatory cytokines, and glucocorticoid receptors (GR, including GRα and GRβ) in adenoidal tissues. The Pearson correlation analysis was employed to ascertain the relationship between the levels of GR and inflammatory cytokines. The receiver operating characteristic (ROC) curve to evaluate the predictive efficacy of inflammatory cytokines in serum in assessing the glucocorticoid sensitivity and the expression of GR.
Compared with the AH not associated with allergic rhinitis (AH-nAR) group, patients with AH-AR exhibit heightened eosinophilic inflammation and comorbid symptoms of AR. In patients with AH-nAR and those with poor glucocorticoid response, adenoidal tissues showed lower GRα expression and higher GRβ expression. Furthermore, IL-1β, CXCL-1, and CXCL-2 were simultaneously associated with a negative correlation with GRα, and a positive correlation with GRβ. Compared with IL-1β and CXCL-2, CXCL-1 in serum demonstrated a more significant predictive accuracy in discerning glucocorticoid sensitivity and evaluating the expression of GRα and GRβ.
In patients with AH-nAR and those with poor glucocorticoid response, evidence of glucocorticoid resistance is observed within adenoidal tissues. Serum CXCL-1 may serve as a potential predictive biomarker for glucocorticoid resistance in AH patients, suggesting that surgical intervention should be more heavily considered for this cohort of patients.
本研究旨在阐明腺样体肥大（AH）与糖皮质激素抵抗之间的关系，并探究小儿AH患者对鼻用糖皮质激素（INS）治疗反应欠佳的潜在原因。
本研究纳入了110例被诊断为AH的患者，所有患者均于2023年6月至2023年9月在武汉大学人民医院接受了腺样体切除术。采用免疫组织化学和实时定量聚合酶链反应（RT-qPCR）评估腺样体组织中炎性细胞因子和糖皮质激素受体（GR，包括GRα和GRβ）的水平。采用Pearson相关性分析确定GR水平与炎性细胞因子之间的关系。采用受试者工作特征（ROC）曲线评估血清炎性细胞因子在评估糖皮质激素敏感性和GR表达方面的预测效能。
与非变应性鼻炎相关腺样体肥大（AH-nAR）组相比，变应性鼻炎相关腺样体肥大（AH-AR）患者表现出更高的嗜酸性粒细胞炎症和AR合并症状。在AH-nAR患者和糖皮质激素反应不佳的患者中，腺样体组织显示出较低的GRα表达和较高的GRβ表达。此外，IL-1β、CXCL-1和CXCL-2均与GRα呈负相关，与GRβ呈正相关。与IL-1β和CXCL-2相比，血清CXCL-1在辨别糖皮质激素敏感性和评估GRα和GRβ表达方面具有更显著的预测准确性。
在AH-nAR患者和糖皮质激素反应不佳的患者中，在腺样体组织中观察到糖皮质激素抵抗的证据。血清CXCL-1可能作为AH患者糖皮质激素抵抗的潜在预测生物标志物，这表明对于该组患者应更着重考虑手术干预。
