Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy
Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy
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鼻息肉中中性粒细胞增多会降低对口服皮质类固醇治疗的反应
DOI：
10.1016/j.jaci.2012.01.079
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发表时间：
2012-06-01
影响因子：
14.2
通讯作者：
Xu, Geng
中科院分区：
文献类型：
--
作者：
Wen, Weiping;Liu, Wenlong;Xu, Geng
背景：鼻息肉（NPs）以嗜酸性粒细胞炎症为特征，通常被认为对皮质类固醇治疗敏感。目的：我们评估NPs中中性粒细胞的水平，并研究息肉组织中中性粒细胞的增加是否影响对皮质类固醇治疗的反应。方法：对NPs患者进行3组独立横断面研究。通过免疫组织化学分析确定不同类型炎症细胞的浸润水平，并与无NPs受试者的对照鼻组织进行比较。通过实时PCR、ELISA和流式细胞术分析检测炎症介质的水平。NPs患者接受口服皮质类固醇治疗（强的松30 mg，每日1次，连用7天）；疗效的临床参数与NP表型相关。结果：NPs患者中，76.5%为嗜酸性表型，46.0%为嗜中性表型，35.8%为混合型（双染显示）。总体而言，皮质类固醇治疗后患者症状有所改善；嗜酸性粒细胞数量及其介质（IL-4和IL-5）水平降低，中性粒细胞数量及其介质（IL-8和干扰素诱导蛋白10）水平未见降低（P < 0.05）。经皮质类固醇治疗后，非中性粒细胞表型（中性粒细胞阴性）患者在双侧息肉大小评分、鼻塞评分、鼻总症状评分和鼻阻力方面的下降明显大于中性粒细胞表型（中性粒细胞阳性，P < 0.05）患者。结论：NPs根据免疫细胞浸润的类型和产生的细胞因子（嗜酸性或嗜中性）有不同的表型。根据症状评分，嗜中性粒细胞表型的患者对皮质类固醇治疗反应较差。[J] .中华过敏杂志，2012;29(1):1 -8。
Background: Nasal polyps (NPs) are characterized by eosinophilic inflammation, which is generally considered sensitive to corticosteroid treatment.Objectives: We evaluated levels of neutrophilia in NPs and investigated whether increased neutrophilia in polyp tissue affected the response to corticosteroid treatment.Methods: We studied 3 independent cross-sectional groups of patients with NPs. Levels of infiltration by different types of inflammatory cells were determined by using immunohistochemical analyses and compared with those seen in control nasal tissues from subjects without NPs. Levels of inflammatory mediators were measured by using real-time PCR, ELISA, and FlowCytomix analyses. Patients with NPs received oral corticosteroid therapy (30 mg of prednisone once daily for 7 days); clinical parameters of efficacy were associated with NP phenotypes.Results: Among patients with NPs, 76.5% had an eosinophilic phenotype, 46.0% had a neutrophilic phenotype, and 35.8% had a mixed phenotype (indicated by double staining). Overall, patients' symptoms improved after corticosteroid treatment; numbers of eosinophils and levels of their mediators (IL-4 and IL-5), but not numbers of neutrophils or levels of their mediators (IL-8 and interferon-inducible protein 10), were reduced (P < .05). After corticosteroid treatment, patients with the nonneutrophilic phenotype (neutrophil negative) had significantly greater reductions in bilateral polyp size scores, nasal congestion scores, total nasal symptom scores, and nasal resistance than patients with the neutrophilic phenotype (neutrophil positive, P < .05).Conclusions: There are different phenotypes of NPs based on the type of immune cell infiltrate and cytokines produced (eosinophilic or neutrophilic). Patients with the neutrophilic phenotype have less response to treatment with corticosteroids based on symptom scores. (J Allergy Clin Immunol 2012;129:1522-8.)