白细胞介素-21与复发性鼻息肉组织中IgE的相关性分析

目的 研究在中国人IgE与慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）术后复发的关系，并进一步分析与复发性鼻息肉局部IgE产生相关的免疫分子。方法 回顾性选取73例就诊于首都医科大学附属北京同仁医院并进行鼻内镜手术的CRSwNP患者和24例正常对照，术后随访3年以上，比较随访期间复发与未复发患者的临床特征、组织IgE、白细胞介素（interleukin，IL）-4、IL-21和CD40配体（CD40 ligand，CD40L）的表达情况，并分析IL-4、IL-21和CD40L与疾病复发和IgE的相关性。结果 复发组患者合并哮喘的比例（30.3%）显著高于未复发组（10%）（P<0.05），且IgE浓度257.40（143.00~ KU/L显著高于未复发组 〖98.89（43.56~255.20）KU/L]（P<0.01），CD40L、IL-4和IL-21组间差异无统计学意义。73例患者的IL-21与CD40L（r=0.440，P<0.001）和IgE（r=0.290，P=0.01）均呈正相关，CD40L和IL-4在两组间均与组织IgE无相关性。在未复发组，IL-21与组织IgE无相关性，在复发组与IgE呈正相关（r=0.374，P=0.029）。结论 鼻息肉组织中升高的总IgE浓度与术后疾病的复发相关，IL-21可能参与到了复发患者局部IgE产生的过程。

Analysis for the relationship between interleukin-21 and tissue IgE in recurrent nasal polyps

Objective To investigate the relationship between tissue total IgE and postoperative recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) and to further analyze the associated immunological molecules contributing to IgE production. Methods We retrospectively enrolled 73 CRSwNP patients and 24 healthy volunteers as a control group, and compared the clinical characteristics and the levels of tissue IgE, interleukin-4, IL-21 and CD40 ligand of the patients after endoscopic sinus surgery for 3 years. Sequentially, we analyzed the correlation between IgE and these immunological molecules. Results The presence of asthma comorbidity was significantly more frequent in recurrent CRSwNPs than non-recurrent group (30.3% vs 10%). The IgE levels in recurrent group257.40(143.00-776.05)KU/L] was also significantly higher than that in non-recurrent group98.89(43.56-255.20)KU/L], while the levels of CD40L, IL-4 and IL-21 showed no differences between the two groups. Among the 73 CRSwNPs (regardless of recurrence or non-recurrence), IL-21 significantly related to CD40L (r=0.440, P<0.001) and IgE(r=0.290,P=0.01). IL-21 significantly related to IgE in the recurrent group while not in non-recurrent group. CD40L and IL-4 showed no relationship with IgE neither in recurrent nor non-recurrent group. Conclusion Increased levels of IgE in nasal polyps related to the recurrence of CRSwNPs. IL-21, not CD40L and IL-4, might contribute to the IgE production in recurrent CRSwNPs.