Prognostic factors for recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps
Prognostic factors for recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps
复制标题
DOI：
10.1016/j.anl.2016.02.015
复制
发表时间：
2016-12-01
影响因子：
1.7
通讯作者：
Haruna, Shin-ichi
中科院分区：
文献类型：
--
作者：
Nakayama, Tsuguhisa;Asaka, Daiya;Haruna, Shin-ichi
目的：本研究旨在通过对慢性鼻窦炎合并鼻息肉（CRSwNP）患者进行鼻内镜手术后长期随访，明确影响筛窦状况的预后因素。方法：2008年12月至2012年2月期间，对36例CRSwNP患者进行了手术。所有手术均由一名外科医生完成，所有患者术后均随访至少2年。我们调查了鼻息肉术后内镜检查结果与临床参数、粘膜嗜酸性粒细胞计数以及 CCL11、IL-5 和 IFN-γ mRNA 表达的关系。结果：17 例患者 (47.2%) 出现严重粘膜水肿，并且在 2 年以上的随访期间未确认每个鼻窦是否通畅。严重粘膜水肿组的粘膜嗜酸性粒细胞计数和两种嗜酸性粒细胞相关因子，即CCL11和IL-5 mRNA水平高于对照组。严重粘膜水肿组分为两个亚组：类固醇反应组和抵抗组。 5 名患者（13.9%）由于口服类固醇效果较差而明显形成息肉。粘膜嗜酸性粒细胞计数在包括对照组在内的四组之间存在显着差异（p = 0.001）；然而，CCL11、11-5 和 LPN-gamma mRNA 水平没有显着差异。尽管四组之间IL-5 mRNA水平没有显着差异，但当鼻窦状况恶化时，IL-5 mRNA水平往往会增加。重度黏膜水肿组中，较高的IL-5 mRNA水平与筛窦腔重度黏膜水肿发生时间相关。结论：IL-5 mRNA水平与筛窦腔重度水肿形成时间相关。这一发现允许对术后病程进行早期干预，并防止息肉复发。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Objective: In this study, we aimed to clarify the prognostic factors affecting the ethmoid condition duHng a long-term follow-up after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods: Thirty-six patients with CRSwNP underwent surgery from December 2008 to February 2012. All surgeries were performed by one surgeon, and all patients were followed up for at least 2 years postoperatively. We investigated the association of postoperative endoscopic findings with clinical parameters, mucosal eosinophil count and mRNA expression of CCL11, IL-5, and IFN-gamma in nasal polyps.Results: Seventeen patients (47.2%) had severe mucosal edema, and the patency of each sinus was not confirmed during the >2-year follow-up. The mucosal eosinophil count and two eosinophil-associated factors, namely the CCL11 and IL-5 mRNA levels, were higher in the severe mucosal edema group than in the control group. The severe mucosal edema group was divided into two subgroups: the steroid-responsive and-resistant groups. Five patients (13.9%) had frank polyp formation because the oral steroids were less effective. The mucosal eosinophil count was significantly different among the four groups, including the control group (p = 0.001); however, the CCL11, 11-5, and LPN-gamma mRNA levels were not significantly different. Although the IL-5 mRNA level was not significantly different among the four groups, it tended to increase when the sinus condition worsened. In the severe mucosal edema group, a higher IL-5 mRNA level was associated with earlier severe mucosal edema in the ethmoid cavity.Conclusion: The IL-5 mRNA level is associated with the time of severe edema formation in the ethmoid cavity. This finding permits early intervention on the postoperative course and would prevent polyp recurrence. (C) 2016 Elsevier Ireland Ltd. All rights reserved.