慢性鼻窦炎患者血清和鼻腔分泌物中分泌型卷曲相关蛋白5的表达水平及临床价值研究

Study on the Expression Level and Clinical Value of Secretory FrizzledrelatedProtein 5 in Serum and Nasal Secretions in Patients withChronic Rhinosinusitis

目的 探讨慢性鼻窦炎(chronic rhinosinusitis,CRS)患者血清和鼻腔分泌物中分泌型卷曲相关蛋白5(secretory frizzled-related protein 5,SFRP5)的表达水平及临床价值。方法 选取2020年7月~2022年6月南通大学第四附属医院收治的CRS伴鼻息肉(CRS with nasal polyps,CRSwNP)患者123例为研究对象,根据息肉组织染色病理结果分为嗜酸性粒细胞性CRSwNP(eosinophilic CRSwNP,ECRSwNP)组(n=69)和非嗜酸性粒细胞性CRSwNP(noneosinophilicECRSwNP,nECRSwNP)组(n=54)。另选取同期体检正常的健康者55例为对照组。酶联免疫吸附实验(enzyme linked immunosorbent assay,ELISA)检测血清、鼻腔分泌物SFRP5水平;多重线性回归分析CRSwNP患者外周血嗜酸性粒细胞水平的影响因素;受试者工作特征(receiver operating characteristic,ROC)曲线评估辅助型T2(Th2)细胞、鼻腔分泌物SFRP5及联合检测对ECRSwNP的诊断价值。结果 ECRSwNP组、nECRSwNP组免疫球蛋白E(immunoglobulin E,IgE)(160.23±21.25 IU/ml,123.49±20.62 IU/ml),Th1细胞(45.64%±5.53%,56.83%±7.20%),Th2细胞(13.78%±3.12%,7.05%±1.47%)水平高于对照组(107.51±19.20 IU/ml,20.45%±5.06%,4.31%±0.81%),差异有统计学意义(q=20.175,5.770;33.085,45.085;34.398,9.391,均P <0.05);ECRSwNP组IgE,Th2细胞水平高于nECRSwNP组,Th1细胞水平低于nECRSwNP组,差异有统计学意义(q=13.986,24.320,14.622,均P <0.05)。ECRSwNP组嗜酸性粒细胞水平[0.35(0.26,0.59)×10^(9)/L]高于nECRSwNP组[0.15(0.09,0.18)×10^(9)/L]和对照组[0.11(0.08,0.16)×10^(9)/L],差异具有统计学意义(H=8.966,10.071,均P <0.05)。对照组、nECRSwNP组和ECRSwNP组血清SFRP5(13.08±1.74 ng/ml,9.51±1.84 ng/ml,6.72±1.26 ng/ml)、鼻腔分泌物中SFRP5水平(24.72±3.73 ng/ml,17.64±3.09 ng/ml,9.46±2.45 ng/ml)依次降低,差异有统计学意义(F=241.18,378.074,均P <0.05)。Pearson分析结果显示,CRSwNP患者血清、鼻腔分泌物中SFRP5与嗜酸性粒细胞水平呈负相关(r=-0.496,-0.601,均P <0.05)。多重线性回归显示,Th2细胞、鼻腔分泌物SFRP5水平为CRSwNP患者嗜酸性粒细胞水平的主要影响因素(t=2.388,-2.993,均P <0.05)。Th2细胞、鼻腔分泌物SFRP5及联合检测诊断ECRSwNP的曲线下面积(area under curve,AUC)为0.829(95%CI:0.749~0.909),0.841(95%CI:0.765~0.901)和0.905(95%CI:0.839~0.950),联合检测的AUC高于单一指标的AUC(Z=2.012,2.100,均P <0.05)。结论ECRSwNP患者血清及鼻腔分泌物SFRP5表达水平较低,Th2细胞水平较高。鼻腔分泌物SFRP5和Th2细胞水平联合检测对ECRSwNP有较高诊断价值。

Objective To investigate the expression of secretory frizzled-related protein 5(SFRP5)in serum and nasal secretions of patients with chronic rhinosinusitis(CRS)and their clinical significance.Methods 123 patients with CRS with nasal polyps(CRSwNP)admitted to the Fourth Affiliated Hospital of Nantong University from July 2020 to June 2022 were selected as the study subjects.According to the stained pathological results of nasal polyps tissue,they were divided into eosinophilic CRSwNP(ECRSwNP)group(n=69)and non-eosinophilic CRSwNP(nECRSwNP)group(n=54).Another 55 healthy patients with normal physical examination in the same period were selected as the control group.Serum and nasal secretion SFRP5 levels were measured by enzyme linked immunosorbent assay(ELISA).Factors influencing peripheral blood eosinophil levels in patients with CRSwNP were analyzed by multiple linear regression.The identifying value of T helper 2(Th2)cell,nasal secretion SFRP5 level and the combination of both on ECRSwNP was analyzed by receiver operating characteristic(ROC)curve.Results The levels of immunoglobulin E(IgE)(160.23±21.25 IU/ml,123.49±20.62 IU/ml),Th1 cell(45.64%±5.53%,56.83%±7.20%),and Th2 cell(13.78%±3.12%,7.05%±1.47%)in ECRSwNP group and nECRSwNP group were higher than those in the control group(107.51±19.20 IU/ml,20.45%±5.06%,4.31%±0.81%),the differences were statistically significant(q=20.175,5.770;33.085,45.085;34.398,9.391,all P<0.05).The levels of IgE and Th2 cell were higher than those in the nECRSwNP group,and the level of Th1 cell was lower than that in the nECRSwNP group,and the differences were statistically significant(q=13.986,24.320,14.622,all P<0.05).The level of eosinophils in the ECRSwNP group[0.35(0.26,0.59)×10^(9)/L]was higher than that in the nECRSwNP group[0.15(0.09,0.18)×10^(9)/L]and control group[0.11(0.08,0.16)×10^(9)/L],and the differences were statistically significant(H=8.966,10.071,all P<0.05).The level of SFRP5 in serum(13.08±1.74 ng/ml,9.51±1.84 ng/ml,6.72±1.26 ng/ml)and nasal secretions(24.72±3.73 ng/ml,17.64±3.09 ng/ml,9.46±2.45 ng/ml)were reduced in the control group,nECRSwNP group,and ECRSwNP group in that order,and the differences were statistically significant(F=241.181,378.074,all P<0.05).Pearson analysis showed that SFRP5 in serum and nasal secretion of CRSwNP patients was negatively correlated with eosinophil(r=-0.496,-0.601,all P<0.05).Multiple linear regression showed that Th2 cell and nasal secretion SFRP5 levels were the main influencing factors for the level of eosinophils in patients with CRSwNP(t=2.388,-2.993,all P<0.05).The area under curve(AUC)of Th2 cells,nasal secretions SFRP5,and combined detection for diagnosing ECRSwNP were 0.829(95%CI:0.749~0.909),0.841(95%CI:0.765~0.901),and 0.905(95%CI:0.839~0.950),respectively.The AUC detected in combination was higher than that of a single indicator(Z=2.012,2.100,all P<0.05).Conclusion The expression of SFRP5 in serum and nasal secretions of ECRSwNP patients was decreased,while the level of Th2 cells was elevated.The combined detection of SFRP5 and Th2 cell in nasal secretions has certain diagnostic value for ECRSwNP.