重度阻塞性睡眠呼吸暂停低通气综合征患者血清同型半胱氨酸及脑源性神经营养因子水平与认知功能的相关性研究

目的探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)血清中同型半胱氨酸(Hcy)和脑源性神经营养因子(BDNF)水平与认知功能的关系。方法随机抽取60例重度OSAHS患者,使用蒙特利尔认知评估量表(MoCA)评估认知功能,根据评估结果分为认知障碍组(18例)和认知正常组(42例),30例健康体检者为对照组。利用ELISA法测定各组血清中Hcy和BDNF水平。结果认知障碍组与认知正常组和对照组比较,MoCA总分、视空间与执行能力、注意力、抽象及延迟回忆存在差异(P < 0.01),而命名、语言能力及定向评分无明显差异(P>0.05)。认知障碍组血清Hcy水平(34.12±2.85)较认知正常组(30.88±2.10)增高,而血清BDNF水平(9.00±1.67)较认知正常组(11.64±1.73)降低。认知障碍组最低动脉血氧饱和度(LSaO₂)、睡眠呼吸暂停低通气指数(AHI)与认知正常组存在差异(P < 0.01)。认知障碍组血清Hcy与MoCA总分(r=-0.880, P=0.000)、LSaO₂(r=-0.595, P=0.009)及BDNF(r=-0.818, P=0.000)呈负相关,与AHI(r=0.681, P=0.002)呈正相关;血清BDNF与MoCA总分(r=0.751, P=0.000)及LSaO₂(r=0.521, P=0.026)呈正相关,与AHI(r=-0.553, P=0.017)呈负相关。血清Hcy和BDNF水平预测认知功能障碍ROC曲线下面积分别为0.902和0.927。结论OSAHS患者血清Hcy和BDNF水平的改变与认知障碍的形成有一定相关性,可作为生物标志物用于认知障碍的早期诊断和预测。     

枸杞多糖通过调控TLR9/AP-1信号通路对变应性鼻炎大鼠Th1/Th2细胞因子及鼻黏膜中嗜酸性粒细胞炎症的影响

目的 探究枸杞多糖通过调控Toll样受体9/激活蛋白-1(TLR9/AP-1)信号通路对变应性鼻炎大鼠Th1/Th2细胞因子、鼻黏膜中嗜酸性粒细胞炎症的影响。方法 选取60只SPF级SD雄性大鼠,随机分为正常(A)组,模型(B)组,糠酸莫米松(C)组,枸杞多糖(D)组,TLR9/AP-1信号通路抑制剂(E)组,TLR9/AP-1信号通路抑制剂联合枸杞多糖(F)组,每组各10只,对B、C、D、E、F组采用卵清蛋白致敏法建立变应性鼻炎模型,A组不建立该模型。建模成功后,对C组给予1喷/侧的糠酸莫米松喷鼻治疗,对D组灌胃100 mg/kg的枸杞多糖,对E组灌胃20 mg/kg AP-1抑制剂SP100030,对F组给予SP100030联合枸杞多糖,A、B组同期给予灌胃同体积生理盐水,对大鼠鼻部症状进行评分,HE染色法检测鼻黏膜组织病理形态及嗜酸性粒细胞并计数,ELISA法检测大鼠血清中Th1/Th2细胞因子水平,免疫印迹法检测鼻黏膜组织中TLR9/AP-1信号通路相关蛋白表达。结果 与A组相比,B组鼻部症状评分、鼻黏膜中嗜酸性粒细胞数目、血清IL-4含量显著升高(P<0.05),血清中INF-γ含量显著降低(P<0.05);与B组比较,C、D两组鼻部症状评分、鼻黏膜中嗜酸性粒细胞数目、血清IL-4含量显著降低(P<0.05),血清中INF-γ含量显著升高(P<0.05),且D组比C组变化显著(P＜0.05);A组大鼠鼻黏膜组织结构完整,B组鼻黏膜上皮结构紊乱且不完整,出血及嗜酸性粒细胞等炎性细胞浸润;与B组相比,C、D组病理状态明显改善,嗜酸性粒细胞明显减少;与A组比较,B组鼻黏膜组织中TLR9、AP-1蛋白表达显著升高(P<0.05),与B组比较,C、D组鼻黏膜组织中TLR9、AP-1蛋白表达显著降低(P<0.05),且D组比C组变化显著(P＜0.05),而E组与D组相比无明显差异(P＞0.05),F组比E组降低明显(P<0.05)。结论 枸杞多糖可有效调控变应性鼻炎大鼠Th1/Th2细胞因子水平、减轻鼻黏膜中嗜酸性粒细胞炎症,其机制可能与抑制TLR9/AP-1信号通路有关。     

NLRP3炎性小体在非嗜酸性慢性鼻窦炎伴鼻息肉中的表达及临床意义

目的 研究核苷酸结合寡聚化结构域样受体蛋白3(NOD-like receptors protein 3,NLRP3)炎性小体及相关因子在嗜酸性慢性鼻窦炎伴鼻息肉(eosCRSwNP)与非嗜酸性慢性鼻窦炎伴鼻息肉(non-eosCRSwNP)中的表达水平差异,进一步分析NLRP3与non-eosCRSwNP临床预后关系。方法 鼻内镜手术收集44例慢性鼻窦炎伴鼻息肉(CRSwNP)患者鼻息肉组织,通过组织HE染色将其分为22例eosCRSwNP患者和22例non-eosCRSwNP患者;同期收集18例鼻中隔偏曲患者下鼻甲黏膜组织,用逆转录聚合酶链式反应(RT-PCR)检测NLRP3炎性小体和IL-1β的mRNA水平;利用免疫组化观察NLRP3的蛋白表达情况。收集患者术前VAS评分、Land-Mackay评分、Lund-Kennedy评分及CRSwNP患者随访复发信息等。结果 免疫组化结果显示non-eosCRSwNP和eosCRSwNP中均有NLRP3蛋白表达且染色程度高于对照组(P＜0.05)。Non-eosCRSwNP组中NLRP3和白介素-1β(IL-1β)的mRNA表达水平明显升高(P＜0.05)。尤其,在复发型non-eosCRSwNP中免疫组化NLRP3表达程度与术前VAS评分、Land-Mackay评分及Lund-Kennedy评分比较呈正相关性(P＜0.05)。结论 研究表明NLRP3炎性小体及促炎因子IL-1β在non-eosCRSwNP中的表达显著,NLRP3表达程度与临床症状体征严重程度之间存在正相关性。因此,NLRP3炎性小体在预判non-eosCRSwNP复发上具有潜在临床价值。     

舌骨位置与多导睡眠监测指标及腭咽成形术后疗效的相关性分析

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者舌骨位置与多导睡眠监测(PSG)参数指标以及腭咽成形手术疗效相关性,探讨舌骨位置对OSAHS患者疾病程度及腭咽成形手术预后的影响。方法收集2020年6月—2021年10月47例不同程度OSAHS行改良悬雍垂腭咽成形术(H-UPPP)患者术前上气道CT影像及术前、术后3个月PSG数据资料,回顾性分析颏下点至舌骨下缘的垂直距离(MH-v)、下颌骨颏棘至舌骨水平距离(MH-h)以及Friedman舌位(FTP)与阻塞性睡眠呼吸暂停低通气指数(AHI)、平均血氧饱和度(AvSpO₂)、最低血氧饱和度(LSpO₂)及血氧饱和度低于90%累积时间占总睡眠时间比(CT90)相关性,并进一步分析FTP、MH-v与H-UPPP手术疗效的相关性。结果MH-v与AHI、LSpO₂和AvSpO₂均呈中等程度相关(r=0.540, P=0.000;r=-0.523, P=0.000;r=-0.514, P=0.000),MH-v与CT90呈弱相关(r=0.495,P=0.000);MH-h与上述PSG指标均无相关性(P＞0.05);FTP与AHI、LSpO₂、AvSpO₂及CT90均呈弱相关(ρ=0.329, P=0.024;ρ=-0.309, P=0.034;ρ=-0.370, P=0.01;ρ=0.325, P=0.026)。在H-UPPP手术有效组与无效组的MH-h比较差异无统计学意义(t=-0.448,P=0.656),MH-v差异具有统计学意义(t=-5.908, P=0.000),而两组之间FTP比较差异无统计学意义(χ²=1.540,P=0.215),MH-v受试者工作特征ROC曲线下面积为0.884,在预测H-UPPP手术有效性方面具有中等诊断价值。结论作为影响OSAHS患者病情的解剖学因素,CT影像中的舌骨位置MH-v相比FTP与PSG诸多指标具有更好的相关性,对预测H-UPPP手术有效性具有一定的价值。     

外周血B细胞活化因子水平对变应性鼻炎患者病情严重程度的预测价值

目的 探讨外周血B细胞活化因子(BAFF)对变应性鼻炎(AR)病情严重程度的预测价值。方法 选取2019 年 1 月—2019 年 10 月收治的80例AR患者作为病例组，根据症状评分将患者分为轻度组和中-重度组；同期选取无AR因鼻骨骨折或行鼻中隔偏曲矫正术患者50例作为对照组，分析并比较不同组中血清BAFF的表达水平。采用受试者工作特征曲线分析血清BAFF对AR患者病情严重程度的预测价值。结果 AR组中血清BAFF浓度明显高于对照组(P＜0.05)。相比于轻度AR组患者，血清BAFF浓度在中-重度组明显升高，差异具有统计学意义(P＜0.05)。AR患者血清BAFF水平与外周血嗜酸性粒细胞数目及比例、总IgE水平、视觉模拟评分(VAS)及鼻部症状总评分(TNSS)呈正相关。受试者工作特征曲线结果显示,相比于总IgE水平，血清BAFF在区分AR患者疾病方面具有一定优势，敏感度为0.550，特异度为0.825。结论 AR患者外周血 BAFF 浓度增加，与疾病嗜酸性炎症程度相关，且可作为预测病情严重程度的标志物。     

小鼠上下气道一致的变应性气道炎症动物模型的建立

目的 建立小鼠上下气道一致的变应性气道炎症模型。方法 16只雌性Balb/c小鼠随机分为模型组(A组)和对照组(B组),每组各8只。A组以40 μg卵白蛋白(ovalbumin,OVA)+200 mgAl (OH)₃+200 μLPBS溶液,分别于第1、3、5、7、9、11、13天腹腔注射,共7次,从第20天起以10 μL OVA (1 mg/mL)滴鼻激发,每周3次,连续3周,最后1次滴鼻激发后24 h以2% OVA 5 mL雾化吸入激发,连续5 d。B组以0.9%生理盐水代替OVA。整个造模周期为42 d。根据黏膜纤毛缺失程度,将上皮细胞状态分为4级(0~3级),末次激发后评价小鼠模型的症状、特异性IgE浓度及鼻肺黏膜的病理改变。结果 A组鼻、肺部症状评分与B组相比,差异具有统计学意义(P＜0.01)。A组鼻、肺部黏膜破坏程度(1、2级)与B组相比,差异均具有统计学意义(P＜0.01),而3级均无统计学意义(P＞0.05)。A组鼻、肺灌洗及血清中OVA sIgE浓度均较B组明显增高(P＜0.01)。A组鼻、肺部嗜酸粒细胞和杯状细胞均较B组明显增高(P＜0.01)。A组鼻、肺嗜酸粒细胞数目呈显著正相关(r=0.775,P＜0.01),杯状细胞数也呈正相关(r=0.723,P＜0.05)。结论 本造模方法能够成功建立小鼠症状学、免疫学及病理学3方面上下气道一致的AAI模型。     

趋化因子受体4及其配体12在下咽鳞状细胞癌中的表达及其临床意义

目的 探究趋化因子受体4(CXCR4)及趋化因子配体12(CXCL12)在下咽鳞状细胞癌(HSCC)中的表达及其临床意义。方法 以2017年1月—2022年11月收治的90例HSCC患者为研究对象,以HSCC患者手术切除的HSCC组织、癌旁组织为实验材料,采用免疫组织化学染色法检测HSCC组织和癌旁组织中CXCR4、CXCL12的表达情况;采用实时荧光定量PCR(qRT-PCR)法检测HSCC组织和癌旁组织中CXCR4 mRNA、CXCL12 mRNA水平;收集并记录HSCC患者临床病理特征,分析CXCR4、CXCL12表达水平与患者临床病理特征的关系;采用Pearson分析CXCR4与CXCL12水平相关性。结果 CXCR4在HSCC组织中的表达率为60.00%,明显高于癌旁组织的17.78%(P＜0.05);CXCL12在HSCC组织中的表达率为57.78%,明显高于癌旁组织的24.44%(P＜0.05)。HSCC组织中CXCR4、CXCL12水平均与淋巴结是否转移、TNM分期、分化程度有关(P＜0.05)。与癌旁组织相比较,HSCC组织CXCR4、CXCL12水平均显著升高(P＜0.05)。Pearson分析显示,HSCC患者中CXCR4水平与CXCL12水平呈正相关(r=0.538,P＜0.05)。结论 CXCR4、CXCL12在HSCC组织中呈高表达,两者与HSCC淋巴结转移、分化程度、TNM分期有关。     

慢性鼻窦炎伴鼻息肉患者组织嗜酸性粒细胞与血清特异性IgE的相关性

目的 分析慢性鼻窦炎伴鼻息肉(CRSwNP)患者组织嗜酸性粒细胞与血清特异性免疫球蛋白E(sIgE)的关系及其临床特征。方法 选取2019年6月—2021年6月行功能性鼻窦内镜手术的192例CRSwNP患者，根据血清sIgE检测结果分为sIgE阳性组和sIgE阴性组，比较两组患者组织嗜酸性粒细胞计数、术前VAS评分、Lund-Mackay评分及Lund-Kennedy评分。结果 两组在性别、年龄比较无统计学意义(P>0.05);sIgE阳性与否和嗜酸性粒细胞是否浸润在例数上比较差异无统计学意义(P>0.05);在临床学特征方面，sIgE阳性嗜酸性粒细胞浸润组和其他3组比较在术前VAS评分(P<0.05),Lund-Mackay评分及Lund-Kennedy评分差异具有统计学意义(P<0.05)。结论 CRSwNP患者组织嗜酸性粒细胞浸润程度与过敏反应关系并不确定。患者嗜酸性粒细胞浸润同时合并sIgE阳性主客观症状加重。     

放线菌在儿童扁桃体组织中的临床病理观察

目的 观察放线菌在儿童扁桃体组织中的分布,探讨儿童慢性扁桃体炎病原体的多样性。方法 回顾性分析2019年1月—2020年12月因慢性扁桃体炎或扁桃体肥大施行手术的儿童223例,根据病史分成两组,其中A组128例,B组95例。按照不同年龄段组(2～4岁、5～7岁、≥8岁)进行亚组分析,观察比较两组扁桃体病理切片中放线菌团块存在情况。结果 观察到放线菌团块的阳性病例47例(21.9%),其中A组37例(28.9%),B组10例(10.5%),两组差异具有统计学意义(P<0.05)。发现不同年龄组中放线菌团阳性数随年龄增长而增多,≥8岁年龄组中放线菌团块的阳性率达25例(36.8%),总体呈正相关趋势(r_s=0.249,P<0.05),这种正相关趋势主要体现在A组患儿中(r_s=0.278,P<0.05),B组病例不同年龄组中放线菌团阳性率无显著差异(P>0.05)。结论 放线菌在慢性扁桃体炎患儿的扁桃体组织中较为常见,而且其阳性率随着年龄的增长而升高,临床诊疗中抗生素选择上应考虑针对放线菌的药物。     

男性阻塞性睡眠呼吸暂停低通气综合征患者血液学指标与睡眠呼吸暂停低通气指数的关系

目的 了解男性阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的血液常规及生化指标和睡眠呼吸暂停低通气指数（AHI）的关系。方法 对2011年1月—2019年12月住院手术治疗且入院前整夜睡眠监测数据完整的474例成年男性患者进行回顾性研究。根据AHI将患者分为4组：A组（AHI<30次/h,56例）、B组（30次/h≤AHI<60次/h,162例）、C组（60次/h≤AHI<90次/h,217例）和D组（AHI≥90次/h,39例）。收集的数据包括睡眠参数、Epworth嗜睡量表评分（ESS）、血液常规及生化指标和人口统计学特征。结果 4组患者的红细胞计数、血小板计数、白细胞计数、中性粒细胞、谷丙转氨酶（ALT）、谷草转氨酶（AST）、AST/ALT、葡萄糖、尿酸、甘油三酯、高密度脂蛋白差异均具有统计学意义（P<0.05）;高密度脂蛋白和甘油三酯与AHI的线性相关性较好,且前者呈负相关,后者呈正相关（r=-0.252,r=0.192）;多元线性回归分析表明红细胞计数（β=0.140,P=0.004）和甘油三酯（β=0.122,P=0.017）与AHI独立相关,多个相关系数R²=0.332。结论 高密度脂蛋白、甘油三酯与AHI的线性相关性较好,且前者呈负相关（r=-0.252）,后者呈正相关（r=0.192）,红细胞计数、甘油三酯与AHI独立相关,有潜力成为判断经多导睡眠监测（PSG）检查后诊断为OSAHS患者综合严重程度的辅助指标。     

Nasal polyps in eosinophilic granulomatosis with polyangiitis: Structured histopathology and CD105 expression

PurposeDistinguishing the prodromal nasal polyposis of eosinophilic granulomatosis with polyangiitis (EGPA) from chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenge for rhinologists and rheumatologists. It has recently been reported that angiogenesis and CD105 expressed on vascular endothelial cells could have a role in the pathogenesis and development of nasal polyps.This exploratory study examined the structured histopathology of nasal polyps in patients with EGPA and CRSwNP, comparing CD105 expression in their nasal tissue with that of a control group with no chronic sinonasal inflammation.MethodsA structured histopathological study was performed on surgical specimens of nasal tissue from 32 adults (13 with EGPA, 14 with CRSwNP, 5 controls), considering CD105 as a marker to determine microvessel density (MVD).ResultsThe mean eosinophil count was higher in EGPA patients with tissue inflammation (p = .002), and in CRSwNP patients with sub-epithelial edema (p = .009). Neutrophil infiltration was significantly associated with severe tissue inflammation in EGPA patients (p = .04), but with the absence of fibrosis in CRSwNP patients (p = .04). In the EGPA group, CD105-MVD correlated with tissue eosinophil count (p = .05). Mean CD105-MVD was significantly higher in EGPA patients with mucosal ulceration (p = .004). In the CRSwNP group, a CD105-MVD correlated positively and significantly with tissue eosinophil count (p = .01).ConclusionAlongside the known abundance of eosinophils, other cells might contribute to inflammatory processes. Neutrophils may amplify inflammation, eosinophil recruitment and tissue damage. CD105 expression in CRSwNP and EGPA nasal polyps supports the hypothesized involvement of angiogenesis in the pathogenesis and development of nasal polyps.     

变应性气道疾病对嗜酸性鼻息肉炎性亚型界定的影响

目的　探讨不同炎性亚型慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps,CRSwNP）患者临床和组织病理学特点及其发病机制,初步探究外周血嗜酸性粒细胞（eosinophils,Eos）比例在分类中的作用,进而探究合并症（变应性鼻炎、支气管哮喘）对鼻息肉炎性亚型界定的影响。方法　回顾性分析182例确诊为 CRSwNP患者的临床资料。根据术后鼻息肉组织病理检测结果,分为Eos浸润组（ECRSwNP）与非Eos浸润组（non-ECRSwNP）。对两组患者血Eos百分比、血中性粒细胞百分比、血清总IgE、鼻窦CT Lund-Mackay评分及鼻内镜手术翻修率分别进行统计学分析,比较两组的差异;将血清总IgE、血Eos百分比、鼻息肉Eos浸润程度及鼻窦CT评分之间进行相关性分析;采用ROC曲线方法计算曲线下面积及ECRSwNP的诊断截断值;将研究对象按照不同合并症构成进行分组,分析不同合并症时ECRSwNP的诊断截断值变化情况。以SPSS 17.0软件进行数据统计分析。结果  ECRSwNP具有较高的鼻内镜手术翻修率及变应性鼻炎和支气管哮喘合并率,两组差异具有统计学意义（P <0.05）;两种炎性亚型的鼻息肉患者鼻窦CT评分、血Eos百分比及血总IgE之间差异具有统计学意义（U 分别为1028.00、1143.50、800.00,P 均<0.05）,两组之间血中性粒细胞百分比差异不具有统计学意义（U =2155.50,P =0.232）;血Eos百分比和组织Eos浸润程度之间及鼻窦CT评分与二者之间存 在显著相关性（r =0.538、0.568、0.419,P 均<0.05）,其他指标之间相关性无统计学意义。同时合并变应性鼻炎和支气管哮喘可显著增高血Eos百分比,相比无合并症及仅合并变应性鼻炎差异具有统计学意义（U分别为541.50、689.00,P均<0.05）,其他情况差异不具有统计学意义。不同合并症时ECRSwNP血Eos百分比截断值范围是3.05%～4.8%。结论　ECRSwNP及non-ECRSwNP具有不同的临床及组织病理学特点。合并变应性疾病可增高鼻息肉血Eos百分比,并影响以血Eos百分比为诊断指标的鼻息肉炎性亚型的界定。     

Impact of allergy on phenotypic and endotypic profiles of nasal polyposis

ObjectivesTo assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsA single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging. Inflammatory endotypes were determined on biomarker analysis (IgE, IgA, IL-5, IL-9, ECP, EDN) in blood and nasal secretions. Eosinophil counts were obtained in blood, nasal secretions and polyps.ResultsPhenotype and endotype profiles were comparable in patients with (n = 15) or without (n = 42) allergy. Only asthma with high total IgE blood concentration showed association with allergy.ConclusionsThe present results suggest that allergy is not directly involved in the clinical expression and specific inflammatory pathways of CRSwNP. New therapies target inflammation signaling pathways, and identifying accurate blood and tissue biomarkers will be the line of research most likely to improve treatment of CRSwNP.     

Comparison of subjective and objective assessment of glucocorticoid response in nasal polyps: a preliminary study

Background: Glucocorticoids (GC) therapeutic response in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) varies markedly.

Aims/Objectives: To compare the utility between subjective and objective assessment of GC sensitivity in reflecting the impact of GC on systemic and local eosinophilia in CRSwNP patients.

Material and methods: Twenty-six patients with CRSwNP were enrolled. All patients were given 30?mg of prednisone once daily for 7 days and subsequently classified into subjectively GC-sensitive and -insensitive subgroup or objectively GC-sensitive and -insensitive subgroup. The numbers of eosinophils and neutrophils in blood and polyp tissues were compared between GC-sensitive and GC-insensitive subgroup.

Results: 17/26 (65.4%) patients were subjectively and 8/26 (30.8%) patients objectively sensitive to GC treatment. The absolute number and percentage of eosinophils in blood were decreased both in GC-sensitive and -insensitive subjects after GC treatment. In addition, a significant reduction in tissue eosinophil percentage was only observed in objectively GC-sensitive subjects after GC treatment. Furthermore, the change of tissue eosinophil percentage in objectively GC-sensitive subjects was significantly higher than that in objectively GC-insensitive subjects.

Conclusions and significance: Objective assessment may better reflect oral GC response in tissue eosinophilic inflammation than subjective assessment in patients with CRSwNP.     

The expression of cancerous inhibitor protein phosphatase 2A in chronic rhinosinusitis with nasal polyps

Conclusion: The study suggests that cancerous inhibitor of protein phosphatase 2A (CIP2A) expression and eosinophilia associate with chronic rhinosinusitis with nasal polyps with aspirin exacerbated respiratory disease (CRSwNP?+?AERD). Further studies with a larger sample size are needed to evaluate further the role of CIP2A and related pathways in CRSwNP?+?AERD.

Objectives: Low prostaglandin E2 levels putatively associate with CRSwNP?+?AERD and decreased c-Myc levels. The aim of this study was to evaluate the expression and revision-predictive role of oncoprotein CIP2A, another c-Myc modulator, in CRSwNP with/without AERD, and in antrochoanal polyps.

Method: Ninety retrospective archival objective glasses of nasal polyp tissue from CRSwNP or ACP patients were used for assessing mucosal eosinophilia. Of this population, 90 archival nasal polyp specimens were available for immunohistochemical staining with a polyclonal anti-CIP2A antibody, together with 19 control nasal mucosa specimens. CIP2A staining intensity and tissue eosinophilia were assessed by two blinded observers with a light microscope. Subject characteristics from 90 patients and 19 controls were obtained from patient records and additionally by a questionnaire from controls. The follow-up data was available from patient records of 84 patients and 16 controls.

Results: The expression of epithelial CIP2A was detected both in control inferior turbinate mucosa and nasal polyps. The expression was significantly lower in the CRSwNP?+?AERD group compared to controls and CRSwNP without AERD (p?p?p?>?0.05), whereas previous surgery, allergic rhinitis, and use of corticosteroids did predict the need for revision surgery (p?相似文献   

Prognostic role of blood eosinophil and basophil levels in allergic fungal rhinosinusitis (AFRS)

PurposeAllergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography.Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS.Materials and methodsA consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed.ResultsSinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not.ConclusionsConsidering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.     

The serum squamous cell carcinoma antigen level in inverted sinonasal papilloma and nasal polyps patients

ObjectiveTo clarify whether the serum squamous cell carcinoma antigen (SCCA) levels of patients with inverted papilloma (IP) are different from patients with nasal polyps (NP) and rhinitis.Materials and methodsSerum SCCA levels were measured in 30 patients with IP and 30 patients with NP at one day before surgery and seven days after surgery and measured in 28 patients with rhinitis.ResultsElevated serum SCCA levels (>1.5 ng/ml) were found in 80.0% of patients in the IP group, 6.7% of patients in the NP group and 14.3% of patients in the rhinitis group, which was a significant difference. The medians of serum SCCA levels in the IP, NP and rhinitis groups were 3.9, 0.8 and 1.1 ng/ml, respectively, which was a significant difference. The SCCA level in IP group was not significantly correlated according to Krouse Staging. There was a significant difference in serum SCCA levels between the pre- and postoperative stages in the IP group, at 3.9 and 0.8 ng/ml, respectively, while in the NP group the levels were 0.8 and 1.0 ng/ml, not significantly different. With regard to the IP diagnosis in the IP and NP group based on the SCCA level (>1.5 ng/ml), sensitivity and specificity was 80.0% and 93.3%, respectively.ConclusionsThe serum SCCA level in patients with IP was elevated and then it decreased after surgery. This was different from NP and rhinitis patients who mostly had normal levels, which did not change.     

Role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps

Background/Objective: The pathophysiological and prognostic role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps (CRSwNP) emerging from recent studies was investigated.

Material and Methods: The main available evidence and largely-recent publications were critically analyzed.

Results: Several authors reported a direct association between blood eosinophilia and CRSwNP recurrence rates. In some large series, a direct association between recurrent CRSwNP and blood basophil values emerged too. CRSwNP patients’ blood eosinophil and basophil values were strongly related. It was also found that preoperative neutrophil-to-lymphocyte, eosinophil-to-lymphocyte, and basophil-to-lymphocyte ratios were significantly higher in patients who experienced a disease relapse than in those who did not. In histologically-confirmed eosinophilic-type CRSwNP treated with endoscopic sinus surgery, mean blood eosinophil values dropped significantly from before to after the surgical procedure.

Conclusions/Significance: CRSwNP endotypes have different inflammatory profiles reflected in the relative proportions of different types of blood cells. The available data support the theory that blood eosinophil and basophil levels should be included in the routine preoperative work-up of CRSwNP patients in order to give patients accurate prognostic information, adopt rational follow-up protocols after surgery, and provide dedicated postoperative medical treatments.