慢性鼻窦炎鼻息肉预后判断的客观指标的研究

The study of objective biomarkers for prognosis of chronic sinusitis and nasal polyps

目的本研究中我们打算将与慢性鼻窦炎鼻息肉预后有关的病因病理因素应用于167例慢性鼻窦炎鼻息肉患者临床疗效观察中,以扩大病例数标本量来进一步验证前期研究结果,以求获得更准确的量效关系。方法收集近6年来在我科行鼻内镜手术的167例慢性鼻窦炎鼻息肉患者的病因病史资料,采用HE染色和免疫组化SP法分别检测167例慢性鼻窦炎鼻息肉患者鼻黏膜病变组织中嗜酸性粒细胞浸润程度和Cu/ZnSOD阳性表达程度。并与临床疗效联系起来进行统计分析,研究我们所筛选出的病因病理因素与临床疗效的相关性。结果我们将慢性鼻窦炎鼻息肉患者临床疗效与鼻黏膜病变组织中嗜酸性粒细胞浸润程度和Cu/ZnSOD阳性表达程度联系起来进行等级相关和logistic回归分析,发现嗜酸性粒细胞浸润程度及Cu/ZnSOD免疫组化阳性染色强度对鼻内镜手术疗效有显著影响(前者χ~2=102.336,P<0.001;后者χ~2=98.678,P<0.001),预测正确的百分率为90%。结论 (1)鼻黏膜病变组织中嗜酸性粒细胞浸润程度为"-"或"+"者;或Cu/ZnSOD免疫组化阳性染色强度为"++"或"+++"者,患者预后良好或治愈;(2)鼻黏膜病变组织中嗜酸性粒细胞浸润程度为"++"或"+++"者;或Cu/ZnSOD免疫组化阳性染色强度为"-"或"+"者,手术疗效不好,易复发。因此这些物质可作为慢性鼻窦炎和鼻息肉预后判断的客观指标。

Objective We intend to enlarge sample size to study the differential quantitive expression of Cu/ZnSOD and eosinophils in nasal mucosa of chronic sinusitis and nasal polyps by use of immunohistochemisty test and HE test, in order to explore the correlations of these objective biomarkers and prognosis of chronic sinusitis and nasal polyps. Methods One hundred and sixty- seven cases of chronic sinusitis and nasal polyps with their paraffin-embedded tissue samples had been collected since 2008. The expression of Cu/ZnSOD and eosinophils in nasal mucosa of chronic sinusitis and nasal polyps were detected by immunohistochemical staining and HE test respectively. Results Rank correlation and logistic regression analysis showed that the positive intensity of Cu/ ZnSOD and eosinophils expression intensity were linked with clinical curative effect. We found the eosinophils expression intensity and positive intensity of Cu/ZnSOD were significantly correlated with postoperative therapeutic efficacy （P〈0.001）. Conclusion If the eosinophils expression intensity is ＂-＂or＂＋＂; or the positive intensity of Cu/ZnSOD is ＂＋＋ ＂or＂＋＋＋ ＂in nasal mucosa, the prognosis of patients of chronic sinusitis and nasal polyps is good. On the contrary, if the eosinophils expression intensity is ＂＋＋＂or＂＋＋＋＂; or the positive intensity of Cu/ZnSOD is ＂-＂or ＂＋＂, the prognosis is poor. So these biomarkers could be objective？diagnostic？indexes？for？ prognosis prediction？before surgery of chronic sinusitis and nasal polyps.