免疫炎症指标预测慢性鼻窦炎伴鼻息肉患者术后复发风险价值研究

Value of immune inflammatory indicators in predicting postoperative recurrence of chronic rhinosinusitis with nasal polyps

目的 探讨免疫炎症指标预测慢性鼻窦炎伴鼻息肉(CRSwNP)患者术后复发风险临床价值。方法 回顾性分析丽水市人民医院2018年1月至2020年5月收治行手术治疗的154例CRSwNP患者临床资料,根据术后有无复发分组,比较2组一般资料和免疫炎症指标水平,采用受试者工作特征(ROC)曲线评价免疫炎症指标用于术后复发风险预测的临床价值。结果 (1)154例患者中术后复发68例,复发率为44.2%;术后复发组阿司匹林过敏比例、伴哮喘比例、Davos评分、Lund-Mackay评分及嗅觉功能评分均高于术后未复发组(P<0.05);(2)术后复发组组织标本白细胞介素(IL)-5、人嗜酸性粒细胞阳离子蛋白(ECP)/髓过氧化物酶(MPO)、金属蛋白酶组织抑制剂1(TIMP1)、趋化因子(CCL)2、CCL3、CCL4、组织/血清标本总免疫球蛋白E(IgE)水平及黏膜固有层水肿程度评分均高于术后未复发组(P<0.05);(3) ROC分析结果显示,组织标本总IgE、IL-5、ECP/MPO及CCL4水平均可用于CRSwNP患者术后复发风险预测(P<0.05);其中组织标本总IgE水平曲线下面积(AUC)最高为0.85,最佳诊断临界值为127.89 pg/ml,敏感度和特异度分别为83.1%、61.3%。结论 CRSwNP患者患者组织标本总IgE、IL-5、ECP/MPO及CCL4均可用于术后复发风险预测。

Objective To investigate the clinical value of immune inflammatory indicators in predicting risk of postoperative recurrence in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods The clinical data of 154 CRSwNP patients who underwent surgery in our hospital between January 2018 and May2020 were reviewed.The patients were divided into the recurrence group and the non-recurrence group according to postoperative recurrence.The general data and levels of immune-inflammatory indicators were compared between the two groups.Receiver operating characteristic(ROC) curve was used to evaluate the clinical value of immune inflammatory indicators in predicting the risk of postoperative recurrence risk.Results(1) Of the 154patients,68 experienced recurrence after surgery,corresponding to a recurrence rate of 44.2%.The proportion of aspirin allergy or asthma,Davos score,Lund-Mackay score and olfactory score in the recurrence group were all higher than those in the non-recurrence group(P <0.05).(2) The recurrence group showed higher levels of interleukin(IL)-5,human eosinophil cationic protein(ECP)/myeloperoxidase(MPO),tissue inhibitor of metalloproteinase 1(TIMP1),C-C chemokine ligand(CCL) 2,CCL3,and CCL4 in tissue samples,higher total immunoglobulin E(IgE) levels in tissue and serum samples,and higher severity score of lamina propria edema,compared with the non-recurrence group(P<0.05).(3) ROC curve analysis showed that the levels of total IgE,IL-5,ECP/MPO and CCL4 in tissue samples predictedthe risk of postoperative recurrence in CRSwNP patients(P<0.05).Among these,the total IgE level in tissue samples yielded the greatest area under the curve(AUC=0.85),with an optimal diagnostic Cut-off value of 127.89 pg/ml,a sensitivity of 83.1% and a specificity of 61.3%,respectively.Conclusion The total Ig E,IL-5,ECP/MPO and CCL4 in tissue samples from patients with CRSwNP can predict the risk of postoperative recurrence.