Yu Sophie E, Olonisakin Tolani F, Moore John A, Chiang Simon, Lee Stella E
Division of Otolaryngology - Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Am J Rhinol Allergy. 2025 Mar;39(2):118-127. doi: 10.1177/19458924241311354. Epub 2025 Jan 10.
Thymic stromal lymphopoietin (TSLP) plays an important role in mediating the type-2-inflammatory response. This study examined how TSLP and interleukin (IL)-4 levels in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) correlated with clinical and postoperative outcomes.
Solid-phase sandwich ELISA was used to analyze TSLP and IL-4 levels in mucus (n = 47), plasma (n = 17), polyp (n = 30), inferior (n = 25), and middle (n = 26) turbinate tissue collected during functional endoscopic sinus surgery (FESS) in CRSwNP patients (n = 76) and controls (n = 11). Inclusion criteria includes patients with medical treatment refractory CRSwNP confirmed by endoscopy or maxillofacial CT. Exclusion criteria include history of immunodeficiency, coagulation disorders, fungal sinusitis, or cystic fibrosis. Levels of TSLP and IL-4 were correlated with SNOT-22, UPSIT, and fractional exhaled nitric oxide (FeNO) using MannWhitney U two-tailed test and linear regression with Spearman correlation coefficient test.
TSLP is elevated in the inferior turbinates (effect size = 2.695, p = 0.0007) of CRSwNP patients compared to controls. IL-4 is expressed at elevated levels in the inferior (effect size = 3.092, p < 0.0001) and middle turbinates (effect size = 2.041, p = 0.019) compared to controls. Mucus TSLP (r = 0.4013, p = 0.0153) and IL-4 (r = 0.6138, p < 0.0001) positively correlate with preoperative FeNO levels. Lower TSLP in the inferior (r = -0.5179, p = 0.0231) and middle turbinates (r = -0.5075, p = 0.0224) and lower IL-4 in the inferior turbinates (r = -0.5205, p = 0.0223) correlate with a greater improvement in SNOT-22 post-FESS.
TSLP and IL-4 are elevated in patients with CRSwNP and correlated with increased preoperative FeNO levels and decreased sinonasal quality of life benefit after FESS. Expression of TSLP and IL-4 may play a role in guiding postoperative expectations in patients with treatment refractory CRSwNP.
胸腺基质淋巴细胞生成素（TSLP）在介导2型炎症反应中起重要作用。本研究探讨了慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的TSLP和白细胞介素（IL）-4水平与临床及术后结果之间的相关性。
采用固相夹心酶联免疫吸附测定法（ELISA）分析76例CRSwNP患者及11例对照在功能性鼻内镜鼻窦手术（FESS）期间采集的黏液（n = 47）、血浆（n = 17）、息肉（n = 30）、下鼻甲（n = 25）和中鼻甲（n = 26）组织中的TSLP和IL-4水平。纳入标准包括经内镜或颌面CT确诊的药物治疗无效的CRSwNP患者。排除标准包括免疫缺陷病史、凝血障碍、真菌性鼻窦炎或囊性纤维化病史。使用Mann-Whitney U双尾检验以及Spearman相关系数检验的线性回归分析TSLP和IL-4水平与鼻窦炎症状测试-22（SNOT-22）、嗅觉识别测试（UPSIT）和呼出一氧化氮分数（FeNO）之间的相关性。
与对照组相比，CRSwNP患者下鼻甲中的TSLP升高（效应量 = 2.695，p = 0.0007）。与对照组相比，下鼻甲（效应量 = 3.092，p < 0.0001）和中鼻甲（效应量 = 2.041，p = 0.019）中的IL-4表达水平升高。黏液TSLP（r = 0.4013，p = 0.0153）和IL-4（r = 0.6138，p < 0.0001）与术前FeNO水平呈正相关。下鼻甲（r = -0.5179，p = 0.0231）和中鼻甲（r = -0.5075，p = 0.0224）中较低的TSLP以及下鼻甲中较低的IL-4（r = -0.5205，p = 0.0223）与FESS术后SNOT-22的更大改善相关。
CRSwNP患者的TSLP和IL-4升高，且与术前FeNO水平升高以及FESS术后鼻窦生活质量获益降低相关。TSLP和IL-4的表达可能在指导药物治疗无效的CRSwNP患者的术后预期中发挥作用。
