Remodeling changes of the upper airway with chronic rhinosinusitis
Remodeling changes of the upper airway with chronic rhinosinusitis
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DOI：
10.1002/alr.21546
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发表时间：
2015-07-01
影响因子：
6.4
通讯作者：
Harvey, Richard J.
中科院分区：
文献类型：
--
作者：
Barham, Henry P.;Osborn, Jodi L.;Harvey, Richard J.
背景虽然下气道的重塑改变已被充分描述，但上气道的类似改变却鲜为人知。慢性鼻窦炎（CRS）相关的不同表型和内源性及其临床特点的上气道重塑的变化investigated.MethodsA横断面研究与CRS的成人患者进行。在内窥镜鼻窦手术（ESS）期间采集粘液样品。组织学分析包括嗜酸性粒细胞计数、嗜酸性粒细胞活化（嗜酸性粘蛋白）和重塑变化。粘膜损伤定义为溃疡、水肿和肥大性变化。使用鼻症状评分（NSS）和鼻-鼻窦结局测试（SNOT-22）评估患者报告结局（PROM）。根据息肉（CRSwNP/CRSsNP）或组织嗜酸性粒细胞增多（>10/高倍视野）的存在对患者进行亚组。当嗜酸性粒细胞慢性鼻窦炎（eCRS）和嗜酸性粒细胞活化（eCRSwEA）共存时进行亚组分析。亚组之间的分析，病理，和PROMs也performed.ResultsA共259例（年龄48.5 - 15.6岁，45%的女性）被招募; 53%CRSwNP，51%eCRS。85%的患者存在重塑变化，CRSwNP（90%，p = 0.006）和eCRS（91%，p = 0.004）均较高。粘液损伤变化在eCRS中常见（溃疡18%，p = 0.003;水肿98%，p < 0.001;肥大变化25%，p = 0.007）。与CRSsNP（2.84 +/- 1.1 vs 2.29 +/- 1.1，p < 0.001）和eCRSwEA（2.95 +/- 0.16 vs 2.51 +/- 0.11，p = 0.04）相比，CRSwNP的NSS更差。嗅觉或味觉的丧失是更糟的患者与证据的粘膜损伤（p = 0.006）。组织嗜酸性粒细胞增多和嗜酸性粒细胞活化的证据与CRS的重塑特征、相关粘膜损伤和临床症状密切相关。(C)2015 ARS-AAOA，LLC.
BackgroundAlthough remodeling changes of the lower airway are well described, similar changes in the upper airway are less well known. Remodeling changes of the upper airway in chronic rhinosinusitis (CRS) relevant to different phenotypes and endotypes and their clinical characteristics are investigated.MethodsA cross-sectional study of adult patients with CRS was performed. Mucosal samples were taken during endoscopic sinus surgery (ESS). Histopathological analysis included eosinophil count, eosinophil activation (eosinophilic mucin), and remodeling changes. Mucosal damage was defined as ulceration, edema, and hypertrophic changes. Patient-reported outcomes (PROMs) were assessed using a Nasal Symptom Score (NSS) and Sino-Nasal Outcome Test (SNOT-22). Patients were subgrouped by presence of polyps (CRSwNP/CRSsNP) or tissue eosinophilia (>10/high power field). Subgroup analysis was performed when both eosinophilic chronic rhinosinusitis (eCRS) and eosinophil activation (eCRSwEA) were coexistent. Analysis between subgroups, pathology, and PROMs was also performed.ResultsA total of 259 patients (age 48.5 15.6 years, 45% female) were recruited; 53% CRSwNP, 51% eCRS. Remodeling changes were present in 85%, higher in both CRSwNP (90%, p = 0.006) and eCRS (91%, p = 0.004). Mucosal damage changes were common in eCRS (ulceration 18%, p = 0.003; edema 98%, p < 0.001; hypertrophic changes 25%, p = 0.007). NSS was worse in CRSwNP compared to CRSsNP (2.84 +/- 1.1 vs 2.29 +/- 1.1, p < 0.001) and eCRSwEA (2.95 +/- 0.16 vs 2.51 +/- 0.11, p = 0.04). Loss of sense of smell or taste was worse in patients with evidence of mucosal damage (p = 0.006).ConclusionRemodeling features are present in CRS. Tissue eosinophilia and evidence of eosinophil activation is closely associated with remodeling features of CRS, associated mucosal damage and clinical symptoms. (C) 2015 ARS-AAOA, LLC.