CRSwNP患者YKL-40、TLR4基因表达及嗜酸性粒细胞水平与复发的相关性

Correlation between YKL-40,LR4 gene expression,eosinophi level and relapse in patients with chronic sinusitis with nasal polyps

目的分析慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者几丁质酶3样蛋白1(YKL-40)、Toll样受体4(TLR4)基因表达、核因子活化B细胞κ轻链增强子(NF-κB)水平及嗜酸性粒细胞(EOS)水平与疾病复发的相关性。方法纳入2016年5月至2019年1月本院收治的159例CRS患者资料,按是否伴鼻息肉分为伴息肉组(n=84)、不伴息肉组(n=75),选取同期本院收治的71例单纯外伤性鼻中隔偏曲患者作为对照组,同时将伴息肉组患者按治疗后是否复发分为复发组(n=45)及非复发组(n=39)。实时荧光定量PCR法(Q-PCR)检测伴息肉组、不伴息肉组和对照组YKL-40、TLR4、NF-k B基因表达及EOS水平;采用多元Logistic分析影响CRSwNP患者复发的危险因素。结果伴息肉组YKL-40、TLR4、NF-k B的mRNA水平、外周血及组织EOS比例较未伴息肉组和对照组高,差异具有统计学意义(P<0.05);84例伴息肉组患者截至随访日期共有45例复发,复发率为53.57%;复发组和非复发组在年龄、性别、外周血淋巴细胞比例、流涕评分及鼻塞评分比较,差异无统计学意义(P>0.05);而复发组合并哮喘比例、嗅觉障碍评分、YKL-40、TLR4、NF-k B的mRNA水平及外周血、组织EOS比例较非复发组高,组织淋巴细胞比例及组织浆细胞较复发组低,差异均有统计学意义(P<0.05);高YKL-40、TLR4、NF-k B的mRNA表达量及组织EOS增多是影响CRSwNP患者复发的独立危险因素(P<0.05)。结论 YKL-40、TLR4、NF-k B及组织EOS比例在CRSwNP中呈高表达,可作为影响CRSwNP预后复发的独立危险因素,对临床预测CRSwNP患者病情发展有重要意义。

Objective To analyze the correlation between the gene expression of Chitinase-3-like protein 1(YKL-40)and Toll-like receptor 4(TLR4),the levels of nuclear factor kappa B and Eosinophi(EOS)and disease relapse in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods The clinical data of 159 CRS patients admitted to our hospital from May 2016 to January 2019 were included.They were divided into the polyps group(n=84)and the non-polyps group(n=75)according to whether they were accompanied by polyps.And 71 patients with pure traumatic nasal deviation who were admitted to our hospital at the same time were selected as the control group.At the same time,patients in polyps group were divided into the relapse group(n=45)and the non-relapse group(n=39)according to whether they relapsed after treatment.Real-time fluorescent quantitation polymerase chain reaction(RT-qPCR)was used to detect the YKL-40,TLR4 and NF-κB gene expression and EOS level of patients in the polyps group,the non-polyps group and the control group.The multivariate Logistic model was used to analyze the risk factors affecting the relapse of patients with CRSwNP.Results The YKL-40,TLR4,mRNA level of NF-k B and the percentage of EOS in peripheral blood and tissues in the polyps group were higher than those in the non-polyps group and the control group.The difference was statistically significant(P<0.05).As of the follow-up date,84 patients in the polyp group had 45 recurrences,and the recurrence rate was 53.57%There was no significant difference in age,gender,ratio of lymphocyte in peripheral blood,running nose score and nasal congestion score between the relapse group and the non-relapse group.However,the proportion of asthma,dysosmia score,YKL-40,TLR4,mRNA level of NF-κB,and the percentage of EOS in peripheral blood and tissues in the relapse group were higher than those in the non-relapse group,and the proportion of lymphocytes in tissue and plasma cells in tissue were lower than those in the relapse group,and the difference was statistically significant(P<0.05).High expression levels of YKL-40,TLR4,and mRNA of NF-k B,and increased EOS in tissue are independent risk factors that affect the relapse of CRSwNP patients(P<0.05).Conclusion The YKL-40,TLR4,NF-κB and EOS rate in tissue are highly expressed in patients with CRSwNP,which can used as independent risk factors affecting the prognosis relapse of CRSwNP,and is of great significance for clinical prediction of the disease progression of CRSwNP patients.