Effect of nursing intervention on rehabilitation of patients with chronic sinusitis and nasal polyps after nasal endoscopy

BACKGROUND Chronic sinusitis is a kind of chronic suppurative inflammation of the sinus mucosa.Nasal endoscopy is a good method to treat nasal polyps.However postoperative rehabilitation and care should not be neglected.AIM To investigate the Effect of nursing intervention on the rehabilitation of patients with chronic sinusitis and nasal polyps(CSNPS)after nasal endoscopy.METHODS A total of 129 patients with CSNPS hospitalized from February 2017 to February 2019 were studied.Using the digital parity method,we investigated nursing cooperation strategies for endoscopic surgery.The comparison group(64 cases):Surgical nursing was carried out with traditional nursing measures;experimental group(65 cases):Surgical nursing was carried out by traditional nursing countermeasures+comprehensive nursing measures.We compared postoperative recovery rates,nursing satisfaction rates,and nasal cavity ratings between the two groups.RESULTS Experimental group patients with CSNPS had a significantly higher recovery rate(98.46%)compared to the control group(79.69%).This difference was statistically significant(χ2=11.748,P<0.05).Additionally,the satisfaction rate with treatment was also significantly higher in the experimental group(98.46%)compared to the control group(79.69%),with a statistically significant difference(χ2=11.748,P<0.05).Before nursing,there was no significant difference in sinus nasal cavity scores between the experimental group(20.29±7.25 points)and the control group(20.30±7.27 points)(t=0.008,P>0.05).However,after nursing,the sinus nasal cavity score in the experimental group(8.85±3.22 points)was significantly lower than that in the control group(14.99±5.02 points)(t=8.282,P<0.05).CONCLUSION Comprehensive nursing intervention in patients with CSNPS can significantly improve the total recovery rate after endoscopic surgery.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Dysregulation of E-cadherin in Chronic Rhinosinusitis with Nasal Polyps

E-cadherin is a key epithelial protein and adhesive molecule. This study detected the E-cadherin expression in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and controls, and analyzed its possible role in the pathogenesis of CRSwNP. The expression of E-cadherin was detected by using Western blotting and immunohistochemistry in controls and patients with CRSwNP. Computed tomography (CT) scan findings were scored. The results showed that the E-cadherin expression was up-regulated in patients with CRSwNP as compared with controls (P=0.039) and the positive staining was predominantly localized on the epithelial cell membrane. E-cadherin level was correlated negatively with Lund-Mackay scores in patients with CRSwNP (r=–0.604, P=0.005). It is suggested that E-cadherin may be involved in the pathogenesis of CRSwNP and correlated with disease severity.

Utilization of RNA sequencing to investigate olfactory dysfunction in chronic rhinosinusitis without nasal polyps:A pilot study

Objectives:Prior research on olfactory dysfunction in chronic rhinosinusitis(CRS)has focused on patients with polyps and suggests that direct inflammation of the olfactory cleft mucosa plays a contributory role.The purpose of this study was to evaluate gene expression in superior turbinate mucosal specimens,comparing normosmic and dysosmic CRS patients without polyps(CRSsNP).Methods:Tissue samples were obtained from the superior turbinates of patients with CRSsNP at the time of endoscopic sinus surgery.Samples subsequently underwent RNA sequencing and functional analysis to investigate biological pathways associated with differentially expressed genes between dysosmic(n=7)and normosmic(n=4)patients.Results:Differential gene expression analysis comparing dysosmic and normosmic CRSsNP patients showed upregulation of 563 genes and downregulation of 327 genes.Using stringent criteria for multiple comparisons,one upregulated gene(Immediate Early Response 3[IER3])had an false discovery rate(FDR)correction adjustedP value considered statistically significant(P<0.001,fold change 2.69).Reactome functional analysis revealed eight biological pathways significantly different between dysosmic and normosmic patients(P<0.05,FDR correction)including IL-4 and IL-13 signaling,IL-10 signaling,and rhodopsin-like receptors.Conclusions:RNA sequencing of the superior turbinates in patients with CRSsNP can provide valuable information regarding biological pathways and genes involved in olfactory dysfunction.This study supports literature suggesting that Type 2 inflammation may play a role in olfactory dysfunction in at least some patients with CRSsNP.This study also prompts questions regarding the role of IL-10,rhodopsin-like receptors,andIER3 in the pathogenesis of olfactory dysfunction.

Enhanced oxidative stress is associated with tissue neutrophilia and poor steroid response in chronic rhinosinusitis with nasal polyps

Objective:To analyze the oxidative stress status and its association with tissue neutrophilia and oral steroid response in chronic rhinosinusitis with nasal polyps(CRSwNP)patients.Methods:The levels of total oxidant status(TOS)were detected in the sinonasal tissues by using specific assay kits.Tissue neutrophil was examined by immunohistochemical staining,and oxidant status index(OSI)was evaluated in polyps tissues,and the messenger RNA(mRNA)levels of superoxide dismutase 2(SOD2),aldehyde dehydrogenase 1(ALDH1A1),and microsomal glutathione S‐transferase 1(MGST1)were examined using quantitative real‐time polymerase chain reaction in the sinonasal tissues.The receiver operating characteristics(ROCs)curve of ALDH1A1,MGST1,and SOD2 mRNA levels were evaluated to determine the steroid response of CRSwNP patients.Results:The levels of TOS and OSI were significantly higher in CRSwNP and CRSsNP than in normal controls,and OSI in polyps tissues was positively associated with tissue neutrophilia and poor steroid response.The ALDH1A1,MGST1,and SOD2 mRNA levels showed comparable accuracy as predictors of poor steroid response indicated by the area under the curve.Conclusion:These findings provided evidence that the increased level of oxidative stress contributes to enhanced tissue neutrophilia and poor steroid response in CRSwNP patients.

Clinical and histopathologic features of biofilm-associated chronic rhinosinusitis with nasal polyps in Chinese patients

Background Biofilms have given new insights to the understanding of pathogenesis of chronic rhinosinusitis （CRS）. However, the link between biofilms formation and local inflammatory response remains poorly defined in CRS with nasal polys. The aim of this study was to determine the potential association of the presence of biofilms in the nasal mucosal tissues with clinical features in Chinese patients, which had CRS with nasal polyps （CRSwNP）. Methods A total of 19 patients with CRSwNP and 12 patients with non-CRS were subjected to endoscopic surgery and their nasal mucosal tissue specimens were examined histologically and by scanning electron microscopy （SEM）. Their demographic and clinical features were recorded. Results Thirteen （68.4%） out of the 19 specimens from patients with CRSwNP, but none from control patients, were positive for biofilms that displayed typical characteristics of bacterial and fugal structures. The presence of biofilms in the nasal mucosal tissues was associated with significantly greater values of purulent nasal discharge and preoperative Lund-Kennedy scores, higher levels of serum total IgE and percentages of subjects with endoscopic surgery （ESS） history in patients with CRSwNP, and more severe inflammation in the nasal mucosal tissues of patients with CRSwNP. Conclusion Our study demonstrated the presence of biofilms in the nasal mucosal tissues of many patients, contributing to the understanding of the pathogenic process of CRSwNP in Chinese patients.

Expression of IL-17 and Syndecan-1 in Nasal Polyps and Their Correlation with Nasal Polyps

Nasal polyp(NP) is a common chronic inflammatory disease of the nasal cavity and sinuses. Although some authors have suggested that NP is related to inflammatory factors such as interleukin(IL)-1β, IL-5, IL-8, granulocyte-macrophage colony-stimulating factor(GM-CSF), tumor necrosis factor(TNF)-α, and IL-17, the mechanisms underlying the pathogenesis and progression of NP remain obscure. This study investigated the expression and distribution of IL-17 and syndecan-1 in NP, and explored the roles of these two molecules in the pathogenesis of eosinophilic chronic rhinosinusitis with nasal polyps(Eos CRSwNP) and non-Eos CRSwNP. Real-time PCR and immunohistochemistry were used to detect the expression of IL-17 and syndecan-1 in samples [NP, unciform process(UP) from patients with CRS, and middle turbinate(MT) from healthy controls undergoing pituitary tumor surgery]. The results showed that the expression levels of IL-17 and syndecan-1 were upregulated in both NP and UP tissues, but both factors were higher in NP tissues than in UP tissues. There was no significant difference in IL-17 levels between the Eos CRSw NP and non-Eos CRSwNP samples, and syndecan-1 levels were increased in the non-Eos CRSwNP tissues as compared with those in Eos CRSwNP tissues. In all of the groups, there was a close correlation between the expression of IL-17 and syndecan-1 in nasal mucosa epithelial cells, glandular epithelial cells, and inflammatory cells, suggesting that IL-17 and syndecan-1 may play a role, and interact with each other, in the pathogenesis of non-Eos CRSwNP.

Effects of IL-17 on Expression of GRO-α and IL-8 in Fibroblasts from Nasal Polyps

Recent studies indicated that interleukin（IL）-17, growth-related oncogene（GRO）-α and IL-8 play an important role in the pathogenesis of nasal polyps. However, the effects of the increased amount of IL-17 and the production of GRO-α and IL-8 in human nasal polyp fibroblasts are not completely understood. This study aimed to determine the effects of the increased IL-17 on the changes of GRO-α and IL-8 expression in human nasal polyp fibroblasts and further investigate the mechanism of neutrophil infiltration in nasal polyps. Nasal polyp fibroblasts were isolated from six cases of human nasal polyps, and the cells were stimulated with five different concentrations of IL-17. Real-time fluorescence quantitative polymerase chain reaction（RT-PCR） was used to detect the mRNA expression of GRO-α and IL-8. The mRNA of GRO-α and IL-8 was expressed in unstimulated controls and remarkably increased by stimulation with IL-17. Moreover, the levels of GRO-α and IL-8 produced by fibroblasts were increased gradually with the increases in IL-17 concentrations. The present study showed that nasal fibroblasts can produce GRO-α and IL-8, and their production is remarkably enhanced by IL-17 stimulation, thereby clarifying the mechanism of the IL-17 mediated neutrophil infiltration in nasal polyps. These findings might provide a rationale for using IL-17 inhibitors as a treatment for nasal inflammatory diseases such as nasal polyps.

Expression of Tenascin and Fibronectin in Nasal Polyps

To explore the role of tenascin (TN ) and fibronectin (FN ) in the pathophysiology of nasal polyps (NP) ,the expression of TN and FN in NP from 34patients and inferior turbinates from 2 0 patients with deviation of nasal septum was imm unohistochem ically studied.In patients with NP,the relations between expression and histopathological features,eosinophils(EOS) infil- tration,clinical staging and the size of NP were analyzed.Our study showed that the gray score of TN and FN expression was16 3.10± 10 .5 4 and16 3.2 4± 11.5 2 in NP respectively,whereas itwas 175 .4 9± 9.2 9and173.93± 7.92 in inferior turbinates respectively.The difference between two groups was significant (P<0 .0 1) .The expression of TN and FN in edematous type was signifi- cantly stronger than that in cystic and glandular type and fibrous type (P<0 .0 5 ) .The association between FN expression and EOS infiltration was significant (r=- 0 .6 0 ,P <0 .0 1) .The expres- sion of TN and FN did not correlate with clinical staging and size(P>0 .0 5 ) .It was suggested that abnormal ECM m ight contribute to proliferation of epithelia,accum ulation of EOS and edem a formation,thereby causing development of NP.

Expression of COX-2 and transcription factor CCAAT enhancer binding proteinβin refractory sinusitis with nasal polyps and its significance

Objective To study the expression and significance of COX-2 and C/EBP-βin refractory sinusitis with nasal polyps,and to explore the relationship between them and the recurrence of sinusitis with nasal polyps.Methods The protein expression of COX-2 and C/EBP-βin 20 cases of refractory sinusitis with nasal polyps,20 cases of sinusitis with nasal polyps and 20 cases of normal nasal mucosa were detected by western blot,and the relationship between the two was compared.Results The expression levels of COX-2 and C/EBP-βin refractory sinusitis with nasal polyps were significantly different from those in refractory sinusitis with nasal polyps(P<0.05);The expression levels of COX-2 and C/EBP-βin sinusitis tissues with nasal polyps were significantly different from those in normal nasal mucosa tissues(P<0.05);The expression levels of COX-2 and C/EBP-βin each group were significantly correlated(P<0.05).Conclusions The high expression of COX-2 and C/EBP-βmay be closely related to postoperative recurrence of sinusitis patients with nasal polyps.Both may be used as objective indicators to judge the postoperative follow-up and recurrence tendency of patients with sinusitis with nasal polyps..

Eosinophilic chronic rhinosinusitis in East Asians

Chronic rhinosinusitis(CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be divided into eosinophilic CRS(ECRS) and non-ECRS subtypes based on the presence of tissue eosinophilic infiltration or not. There are significant geographic and ethnic differences in the tissue eosinophilic infiltration, which is predominant in Western white patients and less common in East Asians, despite an increasing tendency for its prevalence in East Asia countries. ECRS differs significantly from non-ECRS in clinical characteristics, treatment outcomes and strategies, and underlying pathogenic mechanisms. ECRS commonly demonstrates more severe symptoms, polyp diseases with a higher incidence of bilateral polyps and sinonasal diseases on computed tomography, and the increase in blood eosinophils. ECRS is considered a special and recalcitrant subtype of CRS, commonly with poor treatment outcomes compared to non-ECRS. The differentiation of specific subtypes and clinical features of CRS will be important for developing novel treatment strategies and improving treatment outcomes for individual phenotypes of CRS. This review discusses clinical features, diagnosis, treatment and prognosis of ECRS in East Asians.

Current understanding of allergic fungal rhinosinusitis

Studying the pathophysiology of allergic fungal rhinosinusitis (AFRS) has proved challenging. While this clinical entity is easily distinguishable based on the clinical criteria set forth by Bent and Kuhn twenty-five years ago, studies examining type 2 inflammatory profiles in AFRS can make it seem more alike other CRS subtypes than it is different. Still, evolving research seems to clearly delineate this subtype from others in CRS. This review will critically evaluate the evolution of research examining the pathophysiology of AFRS and will conclude with a summary of the special considerations in the management of this fascinating disease.

Nasal Dermoid Cyst with Sinus Tract Intranasal Bone: A Case Report

Dermoid cysts are benign tumors originating from germ cells, which can form in various locations, including the nasal area in rare cases. They are of unknown exact etiology, but it is suggested that it is due to abnormal tissue migration during early embryonic development. Nasal dermoid cysts albeit rare, can present in various forms such as sinuses, fistulas, or intracranially extending tracts. They can be asymptomatic and incidentally discovered or present with a visible external mass or sinus that is either painful, infected or cosmetically concerning. If nasal dermoid cysts with an intra-nasal bone sinus tract are left untreated, they can lead to life-threatening complications. This report describes the case of a 6-year-old girl with a nasal dermoid cyst connected to a superficial punctum by an intra-nasal tract. She had undergone surgical excision of a nasal swelling previously diagnosed as a dermoid cyst. One year later, she returned to our clinic with a recurrence of the nasal swelling. Imaging tests revealed a nasal dermoid cyst with a tract extending to the nasal tip, without intracranial expansion. The cyst, along with the entire tract, was successfully removed surgically, and the postoperative follow-up indicated no complications. Histopathology confirmed the diagnosis of a dermoid cyst. This case underscores the significance of considering the dermoid tract in nasal cyst cases and the necessity of its complete removal to prevent recurrence.

Local tissue hypoxia and formation of nasal polyps

To explore the response of nasal mucosa epithelial cells to hypoxia in terms of formation of nasal polyps (NP) Methods Epithelial cells of NP and inferior turbinate (IT) were cultured serum fr ee under normal oxygen and hypoxic circumstances with stimulation of IL 1β and TNFα The vascular endothelial growth factor (VEGF)mRNA and VEGF protein leve ls of the cultured cells were detected using in situ hybridization and ELISA, re spectively Results The expression of VEGF mRNA was significantly higher in epithelial cells of NP t han in IT exposed to pro inflammatory cytokines or hypoxia ( P <0 01) VEGF levels were higher in NP epithelial cells than those of IT ( P <0 01) under hypoxia Conclusion VEGF induced by hypoxia is very important for the early stages of forming polyp s

Nasal cytology with emphasis on mast cells can improve the diagnosis and treatment of chronic rhinosinusitis

Objective:Chronic rhinosinusitis (CRS) involves inflammation of the nasal and para-nasal mucosa.Due to its heterogeneous nature,unknown pathogenesis,and high recurrence rate,effective treatment is difficult.Nasal cytology is presently not a part of the routine diagnosis or treatment decision for CRS.Data sources:A literature search was performed for published papers in English between January 1990 and June 2019 using MEDLINE.Study sdection:Terms used were chronic rhinosinusids,eosinophils,etiology,immunopathology,inflammation,mast cells,nasal cytology,polyps,and treatment.Both reviews and original articles were collected and studied.Results:There is no standard nasal fluid,mucus sampling,or staining techniques for identifying inflammatory cell types.Results were divergent from different countries.Moreover,the main focus of these papers on the cells in nasal washings was eosinophils,with infrequent mentioning of other cell types that may imply different etiology and pathology.The heterogeneous cell profile of CRS and the role of mast cells have been unappreciated due to the lack of specific immunohistochemical technique or study of its unique mediators.Conclusions:Nasal cytology could help distinguish the type and the activation state of inflammatory cells.Thus it can help in providing a clearer picture of CRS pathogenesis,identifying different patient groups,and developing effective treatments.

The serum squamous cell carcinoma antigen level in inverted sinonasal papilloma and nasal polyps patients

Objective:To clarify whether the serum squamous cell carcinoma antigen(SCCA)levels of patients with inverted papilloma(IP)are different from patients with nasal polyps(NP)and rhinitis.Materials and methods:Serum SCCA levels were measured in 30 patients with IP and 30 patients with NP at one day before surgery and seven days after surgery and measured in 28 patients with rhinitis.Results:Elevated serum SCCA levels(>1.5 ng/ml)were found in 80.0%of patients in the IP group,6.7%of patients in the NP group and 14.3%of patients in the rhinitis group,which was a significant difference.The medians of serum SCCA levels in the IP,NP and rhinitis groups were 3.9,0.8 and 1.1 ng/ml,respectively,which was a significant difference.The SCCA level in IP group was not significantly correlated according to Krouse Staging.There was a significant difference in serum SCCA levels between the pre-and postoperative stages in the IP group,at 3.9 and 0.8 ng/ml,respectively,while in the NP group the levels were 0.8 and 1.0 ng/ml,not significantly different.With regard to the IP diagnosis in the IP and NP group based on the SCCA level(>1.5 ng/ml),sensitivity and specificity was 80.0%and 93.3%,respectively.Conclusions:The serum SCCA level in patients with IP was elevated and then it decreased after surgery.This was different from NP and rhinitis patients who mostly had normal levels,which did not change.

Ethmoidal Polyposis, Adenoid Hypertrophy and Tympanic Membrane Perforation—A Case Report

Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition improved remarkably with subsequent medical treatment. She was followed up for 8 months and no recurrence was observed. Conclusion: Sinonasal polyposis can coexist with adenoid hypertrophy and middle ear disease as a single pathological condition. Hence, a high index of suspicion and thorough evaluation become necessary for making timely diagnoses and instituting effective management.

鼻腔局部类固醇药物治疗慢性鼻窦炎息肉和变应性鼻炎患者的临床效果

目的:分析鼻腔局部应用类固醇类药物在治疗鼻窦炎息肉、变应性鼻炎方面的有效性与安全性情况,为临床提供参考。方法:选择2021年3月—2022年3月河南科技大学第二附属医院收治的145例变应性鼻炎和慢性鼻窦炎鼻息肉患者作为研究对象。根据用药差异性划分为参照组与研究组。参照组予以安慰治疗,研究组予以鼻腔局部类固醇药物治疗。比较两组患者的治疗情况与使用安全性情况。结果:参照组采安慰剂治疗无法获得较好效果,仅可对患者的心理状态产生一定安慰作用。研究组各组患者治疗总有效率均明显高于参照组,差异有统计学意义(χ^(2)=50.516、54.133、54.133、50.516,P<0.05)。研究组各组间治疗总有效率比较,差异无统计学意义(χ^(2)=0.352、0.000、0.352、0.352、0.000、0.352,P>0.05)。研究组各组患者的不良反应发生率均较低,但各组间比较,差异无统计学意义(χ^(2)=1.681、1.097、0.420、0.090、0.892、0.132,P>0.05)。结论:将鼻腔局部类固醇药物应用于慢性鼻窦炎息肉和变应性鼻炎患者的治疗工作当中,不仅可以有效提升治疗有效率,同时可以保证患者的用药安全性。

鼻黏膜不同炎症的临床表现及客观炎症指标的异同性研究

目的比较慢性鼻炎(CR)、慢性鼻窦炎伴鼻息肉(CRSwNP)和慢性鼻窦炎不伴鼻息肉(CRSsNP)患者在鼻部症状、生活质量评估和临床炎症指标表达方面异同。方法研究共纳入2017年1月~2018年12月在北京同仁医院鼻科就诊的154例连续患者,年龄18~70岁,其中男性106例,女性48例。根据入选标准,纳入患者分为CR组、CRSsNP组和CRSwNP组。患者于就诊当天进行鼻内镜、鼻呼出NO(nasal exhaled nitric oxide,nNO)、皮肤点刺试验、鼻窦CT和血常规检查,并在医师指导下对自身鼻部症状进行视觉模拟量表(VAS)评分,填写鼻腔鼻窦结局测试22条(SNOT-22)问卷。共43例CR患者,58例CRSsNP患者及53例CRSwNP患者入选本研究。结果CRSsNP组SNOT-22总分显著低于CR和CRSwNP组(30.0±19.4 vs.41.1±21.9,30.0±19.4 vs.40.9±18.7,P<0.05),CR组和CRSwNP组的SNOT-22总评分无统计学差异。CRSwNP组鼻部症状及鼻外症状平均得分最高;CRSsNP组得分较低;CR患者对睡眠的损害影响显著高于CRSsNP患者(9.9±6.2 vs.5.1±5.3,P<0.05),与CRSwNP组睡眠评分无显著差异(9.9±6.2 vs.7.1±5.7,P>0.05)。当患者合并过敏原阳性时,CR、CRSsNP和CRSwNP之间症状评分及SNOT-22评分之间无统计学差异;当过敏原阴性时,无论症状评分还是SNOT-22评分,三者之间均表现出明显的统计学差异。结论CR、CRSsNP和CRSwNP三种鼻黏膜炎症类型都对患者生活质量产生明显影响。就症状评分及生活质量评分而言,CR组和CRSwNP组相近且较CRSsNP组损害更明显。客观评价指标与症状和生活质量评分的变化趋势并不一致。

短期口服糖皮质激素对慢性鼻窦炎伴鼻息肉上皮紧密连接的影响

目的观察短疗程口服糖皮质激素(glucocorticoids,GCs)对慢性鼻窦炎伴鼻息肉(CRSwNP)上皮中紧密连接(tight junctions,TJs)表达水平的影响。方法招募拟行鼻内镜手术治疗的CRSwNP患者,术前给予GCs口服连续7 d,分别留取治疗前、后的鼻息肉组织。选取因非炎性疾病而拟行相关鼻内镜手术的成年患者,留取术中所得到的钩突黏膜、中鼻甲黏膜或下鼻甲黏膜作为对照。应用实时荧光定量PCR和免疫荧光共聚焦显微镜检测TJs的表达情况。结果短疗程口服GCs治疗前,鼻息肉标本中claudin-3、claudin-4和occludin mRNA的表达水平显著低于正常鼻黏膜;治疗后,鼻息肉组织中TJs mRNA和蛋白的表达水平较治疗前显著升高。结论鼻息肉组织中多种TJs表达下降,短期口服GCs治疗可以显著上调TJs的表达。