The importance of local eosinophilia in the surgical outcome of chronic rhinosinusitis: A 3-year prospective observational study
The importance of local eosinophilia in the surgical outcome of chronic rhinosinusitis: A 3-year prospective observational study
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DOI：
10.2500/ajra.2014.28.4024
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发表时间：
2014-05-01
影响因子：
2.6
通讯作者：
Gevaert, Philippe
中科院分区：
文献类型：
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作者：
Vlaminck, Stephan;Vauterin, Tom;Gevaert, Philippe
背景：慢性鼻窦炎伴或不伴鼻息肉(CRSwNP/CRSsNP)患者可接受鼻内窥镜鼻窦手术(ESS)，手术成功率估计为80%。目前，ESS后分泌物中的嗜酸性粒细胞、嗜酸性粘蛋白(EM)和真菌菌丝(FH)对临床预后的影响尚不清楚。通过根据嗜酸性粒细胞、EM和FH的发现划分CRS组和亚组，研究ESS后复发的差异。方法：对221例接受ESS治疗无效的CRS患者进行前瞻性单中心研究。对所有组织和鼻腔分泌物进行显微镜检查，以确定是否存在嗜酸性粒细胞、EM和FH。术后随访3年。根据欧洲鼻窦炎和鼻息肉意见书定义复发。结果：共纳入96例CRSwNP和125例CRSsNP患者。CRSwNP患者中有78%的患者组织中有嗜酸性粒细胞，而CRSsNP患者中这一比例为42%。CRSwNP组的EM发生率为52%，CRSsNP组为20%。此外，分泌物分析显示，7%的CRS存在FH。全组3年复发率为22%。组织嗜酸性粒细胞受累的CRSwNP患者复发率为48%，伴有EM的患者复发率为56%。结论：CRSwNP患者组织或呼吸道分泌物中有嗜酸性粒细胞的存在，极大地增加了CRSwNP患者复发的风险。组织嗜酸性粒细胞增多症和EM的发现提供了有价值的信息，说明ESS后CRS复发的可能性增加，而FH的发现不能。
Background: Patients with chronic rhinosinusitis with/without nasal polyps (CRSwNP/CRSsNP) benefit from endoscopic sinus surgery (ESS), with an estimated success rate of 80%. At present, the influence on clinical outcome after ESS of eosinophils, eosinophilic mucin (EM), and fungal hyphae (FH) in secretions remains unclear. By delineating CRS groups and subgroups based on the finding of eosinophils, EM, and FH, differences in recurrence after ESS were investigated.Methods: A prospective monocenter study including 221 CRS patients who were unresponsive to medical treatment and underwent ESS was performed. All tissue and sinonasal secretions were microscopically examined for the presence of eosinophils, EM, and FH. Patients were followed for 3 years after surgery. Recurrence was defined according to the European position paper on rhinosinusitis and nasal polyps.Results: In total, 96 CRSwNP and 125 CRSsNP patients were included. Tissue eosinophils were found in 78% of CRSwNP patients compared with 42% in CRSsNP patients. EM was observed in 52% of the CRSwNP group versus 20% of the CRSsNP group. Furthermore, secretion analysis revealed FH in 7% of CRS. Recurrence in the total group was 22% over 3 years. CRSwNP patients with tissue eosinophilic involvement showed a recurrence rate of 48%, and those with additional EM showed recurrence in 56%.Conclusion: The presence of eosinophils in tissue or airway secretions greatly increases the risk of recurrent disease in CRSwNP patients. The finding of tissue eosinophilia and EM provides valuable information regarding the increased likelihood of CRS recurrence after ESS, whereas the finding of FH does not.