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 allergic airway diseases on definition of eosinophilic nasal polyps' inflammatory subtypes

OBJECTIVE To compare the clinical characteristics between eosinophilic and noneosinophilic CRSwNP and identify the predictors of eosinophilic CRSwNP. The impact of comorbidity (allergic rhinitis-AR, bronchial asthma-BA) on the predictors was also studied. METHODS Histologic characteristics of surgical samples were analyzed in 182 CRSwNP patients, who were classified into eosinophilic CRSwNP (ECRSwNP) group and noneosinophilic CRSwNP (non-ECRSwNP) group. Factors associated with ECRSwNP were selected by correlation analyses. The optimal cutoff points of the predictors were determined by a receiver operating characteristic curve. Based upon the different comorbidity, four groups were divided to study the impact of comorbidity on the optimal cutoff points of the predictors. RESULTS Patients with ECRSwNP had significant higher rate of revision FESS, significant higher concurrent rate of allergic rhinitis and bronchial asthma than non-ECRSwNP patients (all P<0.05). There were significant differences in Ratio of Lund-Mackay scores, peripheral blood eosinophil percentage and serum total IgE between ECRSwNP group and non-ECRSwNP group except the peripheral blood neutrophilic percentage (U value were 1028.00, 1143.50, 800.00 respectively, all P<0.05). Peripheral blood eosinophilic percentage had the highest significant correlation with degree of infiltration of eosinophils in nasal polyps (r =0.538, 0.568, both P<0.05) and there also existed significant correlation between degree of infiltration of eosinophils in nasal polyps and Lun-Mackay score (r =0.419, P<0.05). Comorbidity of AR and BA could impact the peripheral blood eosinophil percentage. According to the different combination of comorbidity, the range of the optimal cutoff points of peripheral blood eosinophil percentage was 3.05%-4.8%. CONCLUSION ECRSwNP and non-ECRSwNP displayed significant differences in certain clinical features. Comorbidity of AR and BA could increase the peripheral blood eosinophil percentage, that may impact the diagnosis of the subtype of ECRSwNP.