Increased serum amyloid A in nasal polyps is associated with systemic corticosteroid insensitivity in patients with chronic rhinosinusitis with nasal polyps: a pilot study
Increased serum amyloid A in nasal polyps is associated with systemic corticosteroid insensitivity in patients with chronic rhinosinusitis with nasal polyps: a pilot study
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鼻息肉中血清淀粉样蛋白 A 的增加与患有鼻息肉的慢性鼻窦炎患者的全身皮质类固醇不敏感有关：一项初步研究。
DOI：
10.1007/s00405-017-4809-z
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发表时间：
2018-02-01
影响因子：
2.6
通讯作者：
Sun, Yue-Qi
中科院分区：
文献类型：
--
作者：
Lu, Hangui;Lin, Xin-Sheng;Sun, Yue-Qi
血清淀粉样蛋白A（SAA）参与了肺部疾病糖皮质激素抵抗的发病机制。本研究纳入32例慢性鼻窦炎鼻息肉（CRSwNP）患者，探讨SAA在NP中的表达与皮质激素不敏感性之间的关系，以及息肉SAA水平对CRSwNP患者口服皮质激素反应的预测价值。所有患者均口服泼尼松30 mg/d，疗程2周，并根据息肉大小评分的变化分为糖皮质激素（GC）敏感组和不敏感组。分别于激素治疗前后取息肉标本。采用酶联免疫吸附试验和定量逆转录聚合酶链反应检测息肉组织中SAA水平。回归分析SAA蛋白水平与激素不敏感性之间的关系。13/32例（40.62%）CRSwNP患者对口服激素治疗不敏感。SAA的mRNA和蛋白水平显着增加，在GC不敏感的NP相比，在GC敏感的NP。组织SAA蛋白水平与组织中性粒细胞数量呈正相关。回归分析显示，组织SAA水平与激素不敏感性显著相关（P < 0.01）。ROC曲线显示曲线下面积为0.87。当息肉SAA蛋白水平≥ 122.2ng/ml时，敏感性和特异性分别为76.92和73.68%，提示NP患者SAA升高与CRSwNP患者对口服激素的反应降低有关。SAA水平在预测CRSwNP患者皮质激素不敏感性方面可能具有潜在价值。
Serum amyloid A (SAA) was involved in the pathogenesis of glucocorticoid resistance in lung diseases. However, their association with systemic corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP) patients remains to be assessed.This study enrolled 32 CRSwNP patients to evaluate the association between SAA expression in NP and corticosteroid insensitivity, and the value of polyp SAA level for predicting the response to oral corticosteroids in CRSwNP patients. All patients were given a course of oral prednisone (30 mg daily for 2 weeks) and subdivided into glucocorticoid(GC)-sensitive and -insensitive subgroup according to the change in polyp size scores. The polyp specimens were obtained before and after corticosteroid treatment. SAA levels in polyp tissues were evaluated by enzyme-linked immunosorbent assay and quantitative reverse transcription polymerase chain reaction. Regression analysis was performed to analyze the association between SAA protein levels and corticosteroid insensitivity.13/32 (40.62%) CRSwNP patients were insensitive to the oral corticosteroid therapy. SAA mRNA and protein levels were significantly increased in GC-insensitive NP compared to those in GC-sensitive NP. Tissue SAA protein levels were positively correlated with tissue neutrophil numbers. Regression analysis revealed tissue SAA levels were significantly correlated with corticosteroid insensitivity (P < 0.01). ROC curves indicated that the area under the curve was 0.87. When the polyp SAA protein level was 122.2 ng/ml or higher, the sensitivity and specificity were 76.92 and 73.68%, respectively.Our findings suggest that increased SAA in NP is associated with reduced response to oral corticosteroids in CRSwNP. SAA levels in NP may have potential value in predicting corticosteroid insensitivity in CRSwNP patients.