慢性鼻窦炎伴鼻息肉合并哮喘患者临床特征及转录组分析

Clinical characteristics and transcriptome analysis of patients with chronic rhinosinusitis with nasal polyps and asthma

目的探讨慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with polyps,CRSwNP)合并哮喘(asthma,AS)患者的临床特征,并比较CRSwNP合并AS组(CRSwNP+AS组)组与CRSwNP不伴AS组(CRSwNP-AS组)的转录组表达差异。方法纳入北京协和医院于2016年2月~2018年2月收治的CRSwNP患者201例,比较CRSwNP+AS与CRSwNP-AS患者的临床特征差异,通过RNA-Seq分析二者转录组差异。结果 CRSwNP+AS占22.9%,CRSwNP-AS占77.1%。与CRSwNP-AS相比,CRSwNP+AS在嗜酸性粒细胞型鼻息肉、合并过敏性鼻炎或阿司匹林不耐受的比例、筛窦CT评分及CT总分、外周血及组织嗜酸性粒细胞计数及百分比上均显著高于CRSwNP-AS组。RNA-Seq结果显示,与CRSwNP-AS组相比,CRSwNP+AS组上调的基因主要与2型免疫炎症反应及组织重塑有关,如CLCA1、COL6A5、IGHE、CCL7、CCL24、CCL26、CCR3、IL-5、IL13等。结论 CRSwNP+AS患者临床表现更重,鼻息肉组织嗜酸性粒细胞浸润更高,2型免疫反应相关基因表达更高。

OBJECTIVE To explore the clinical characteristics of patients of chronic rhinosinusitis with nasal polyps(CRSwNP) and asthma(AS),and to compare the differences in transcriptome expression between CRSwNP with asthma(CRSwNP+AS) and CRSwNP without asthma(CRSwNP-AS) by RNA-Seq.METHODSThe clinical data of 201 patients diagnosed with CRSwNP in Peking Union Medical College Hospital from February 2016 to February 2018 were collected.Comparisons were made to investigate the differences between CRSwNP+AS and CRSwNP-AS in clinical characteristics and transcriptome expression.RESULTS CRSwNP+AS accounted for 22.9% and CRSwNP-AS accounted for 77.1% of the patients in our study.Compared with CRSwNP-AS,the proportion of eosinophilic chronic rhinosinusitis with nasal polyps(ECRSwNP),allergic rhinitis and aspirin intolerance,ethmoid sinus CT score and total CT score,as well as peripheral blood and tissue eosinophil count and percentage were significantly higher in the CRSwNP+AS group.RNA-Seq results showed that the up-regulated genes were mainly related to T-helper 2 inflammation and tissue remodeling,such as CLCA1,COL6A5,IGHE,CCL7,CCL24,CCL26,IL5,IL13,etc.CONCLUSION CRSwNP+AS have more severe clinical manifestations,higher eosinophil infiltration in nasal polyp tissue,and higher expression of type 2 immune response related genes.