免疫球蛋白E嗜酸性粒细胞在慢性鼻-鼻窦炎伴鼻息肉表达及对个体化精准治疗的意义

Expression of specific immunoglobulin E and eosinophil in nasal polyp of chronic rhinosinustis and guiding significance for individualized precise treatment

目的分析免疫球蛋白E(IgE)、嗜酸性粒细胞(EOS)在慢性鼻-鼻窦炎(CRS)伴鼻息肉(CRSwNP)中表达及对个体化精准治疗的指导意义。方法回顾分析医院2020年1月至2022年1月诊治的CRS患者150例(CRSwNP共102例、CRSsNP共48例),将其纳入观察组;另在同期招募健康管理中心100名年龄及性别匹配的健康志愿者作为对照组。检测血清IgE水平、外周血EOS计数及比例,进行鼻腔CT、术腔Lund-Kennedy及视觉模拟评分(VAS)评分。比较分析2组患者IgE、EOS水平,探讨CRSwNP、CRSsNP患者治疗前IgE、EOS、鼻腔CT及术后术腔Lund-Kennedy、VAS评分情况,并分析相关性。结果观察组患者血清IgE水平、外周血EOS计数、外周血EOS比例均高于对照组(P均<0.05)。CRSwNP患者治疗前血清IgE水平、外周血EOS计数、外周血EOS比例、鼻腔CT评分均高于CRSsNP(P均<0.05)。术后3个月、6个月CRSwNP、CRSsNP患者的Lund-Kennedy、VAS评分比较差异均无统计学意义(P均>0.05)。Spearman相关性分析显示,CRSwNP患者血清IgE水平、外周血EOS计数、外周血EOS比例与鼻腔CT评分呈正相关(P<0.05);血清IgE水平、外周血EOS计数、外周血EOS比例与Lund-Kennedy、VAS评分无相关性(P>0.05)。结论IgE、EOS在CRSwNP患者中高表达,其水平与治疗前鼻腔CT评分有关,但与术后Lund-Kennedy、VAS评分无关,术前检查有助于判定CRS亚型,指导个体化精准治疗。

Objective To analyze the expression of immunoglobulin E(IgE)and eosinophils(EOS)in chronic sinusitis chronic rhinosinusitis(CRS)with nasal polyps(CRSwNP)and its guiding significance for individualized precise treatment.Methods One hundred and fifty patients with CRS(102 patients with CRSwNP and 48 patients with CRSsNP)diagnosed and treated in our hospital from January 2020 to January 2022 were retrospectively analyzed and included in the observation group.In addition,100 age and sex-matched healthy volunteers from the health management center were recruited as the control group.Serum IgE level,peripheral blood EOS count and proportion were detected,and nasal CT,Lund-Kennedy and visual analogue scale(VAS)scores were performed.The levels of IgE and EOS in the two groups were compared and analyzed,and the IgE,EOS,nasal CT and Lund-Kennedy and VAS scores in the patients with CRSwNP and CRSsNP before treatment were discussed,and the correlation was analyzed.Results The serum IgE level,peripheral blood EOS count and peripheral blood EOS ratio in the observation group were higher than those in the control group(all P<0.05).The serum IgE level,peripheral blood EOS count,peripheral blood EOS ratio and nasal CT score of CRSwNP patients before treatment were higher than those of CRSsNP patients(all P<0.05).There were no significant differences in Lund-Kennedy and VAS scores between patients with CRSwNP and CRSSNP at 3 and 6 months after the operation(all P>0.05).Spearman correlation analysis showed that the serum IgE level,peripheral blood EOS count,peripheral blood EOS ratio in CRSwNP patients were positively correlated with nasal CT Score(P<0.05).There were no correlation between serum IgE level,peripheral blood EOS count,peripheral blood EOS ratio and Lund-Kennedy and VAS scores(P>0.05).Conclusion IgE and EOS are highly expressed in CRSwNP patients,and their levels are related to nasal CT scores before treatment,but not to Lund-Kennedy and VAS scores after operation.The preoperative examination is helpful to determine CRS subtype and guide individualized and accurate treatment.