外周血EOS、IL-21、CCL4与慢性鼻-鼻窦炎伴鼻息肉患者术后复发的相关性

Correlation between peripheral blood EOS,IL⁃21,CCL4 and postoperative recurrence in patients with chronic rhinosinusitis and nasal polyps

目的探究外周血嗜酸性粒细胞数(EOS)、白细胞介素-21(IL-21)、趋化因子4(CCL4)与慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者术后复发的相关性。方法回顾性选取青岛市第八人民医院2020年1月至2022年6月收治的86例行慢性鼻-鼻窦炎伴鼻息肉切除术患者,收集所有患者的一般资料,对患者进行外周血EOS、IL-21、CCL4检测;并对患者进行随访1年,统计其复发情况,根据患者的术后复发情况将患者分为复发组(n=34)与正常组(n=52)。比较两组的临床资料和外周血EOS、IL-21、CCL4水平;采用Pearson相关性分析探讨外周血EOS、IL-21、CCL4与CRSwNP患者鼻窦CT Lund-Mackay评分的相关性;采用受试者工作特征(ROC)曲线评估CRSwNP患者术后复发的预测价值。结果随访期间共记录到术后复发患者34例,占比39.53%,未复发患者52例,占比60.47%。两组患者的嗜酸性粒细胞型鼻息肉例数、鼻窦CT Lund-Mackay评分、外周血EOS、IL-21、CCL4水平进行比较,差异有统计学意义(t=4.250、5.300、3.890、3.089、3.499,P<0.05)。多因素logistic回归分析结果显示外周血EOS、IL-21、CCL4水平均是CRSwNP患者术后复发的独立危险因素(P<0.05)。Pearson相关性分析结果显示,外周血EOS、IL-21、CCL4水平与CRSwNP患者鼻窦CT Lund-Mackay评分具有相关性(r=0.433、0.681、0.547,P<0.05)。ROC曲线结果显示,外周血EOS、IL-21、CCL4及三者联合对预测CRSwNP患者术后复发的AUC面积分别为:0.725、0.686、0.709、0.834,且联合预测的灵敏度和特异度最高,效果最好(P<0.05)。结论外周血EOS、IL-21、CCL4与CRSwNP患者病情程度具有相关性,通过外周血EOS、IL-21、CCL4预测慢性鼻-鼻窦炎伴鼻息肉患者术后复发具有一定的预测价值。

Objective To investigate the correlation between peripheral blood eosinophile count(EOS),interleukin⁃21(IL⁃21),chemokine 4(CCL4)and postoperative recurrence in patients with chronic rhi⁃nosinusitis with nasal polyps(CRSwNP).Methods A total of 86 patients with chronic rhinosinusitis who un⁃derwent nasal polypectomy were admitted to the Eighth Peoples Hospital of Qingdao from January 2020 to June 2022.General data for all patients were collected,and levels of peripheral blood EOS,IL⁃21 and CCL4 were measured.The patients were followed up for one year to track recurrence.Based on recurrence status,patients were divided into a recurrence group(n=34)and a normal group(n=52).Clinical data and peripheral blood lev⁃els of EOS,IL⁃21 and CCL4 were compared between the two groups.Pearson correlation analysis was used to explore the relationship between peripheral blood EOS,IL⁃21,CCL4 and sinus CT Lund⁃Mackay scores in pa⁃tients with CRSwNP.The predictive value of postoperative recurrence in patients with CRSwNP was assessed using receiver operating characteristic(ROC)curves.Results During the follow⁃up period,34 patients with recurrence were recorded,accounting for 39.53%,and 52 patients without recurrence,accounting for 60.47%.Patients were divided into two groups:the relapse group(n=34)and the normal group(n=52)based on their postoperative recurrence.The number of eosinophilic nasal polyps,sinus CT Lund⁃Mackay score,EOS,IL⁃21 and CCL4 levels in peripheral blood were compared between the two groups,and the differences were statistical⁃ly significant(t=4.250,5.300,3.890,3.089,3.499,P<0.05).Multivariate logistic regression analysis showed that EOS,IL⁃21 and CCL4 levels in peripheral blood were independent risk factors for postoperative recurrence in patients with CRSwNP(P<0.05).Pearson correlation analysis indicated that peripheral blood EOS,IL⁃21 and CCL4 levels were correlated with sinus CT Lund⁃Mackay scores in patients with CRSwNP(r=0.433,0.681,0.547,P<0.05).ROC curve results showed that the AUC area of peripheral blood EOS,IL⁃21,CCL4 and their combination in predicting postoperative recurrence in patients with CRSwNP was 0.725,0.686,0.709 and 0.834,respectively,with the combined prediction showing the highest sensitivity and specificity and the best effect(P<0.05).Conclusion Peripheral blood EOS,IL⁃21 and CCL4 levels are correlated with the sever⁃ity of disease in patients with CRSwNP.These markers also have predictive value in anticipating postoperative recurrence in patients with chronic rhinosinusitis with nasal polyps.