Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis
Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis
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DOI：
10.1016/j.jaip.2019.05.009
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发表时间：
2019-11-01
影响因子：
9.4
通讯作者：
Kato, Atsushi
中科院分区：
文献类型：
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作者：
Stevens, Whitney W.;Peters, Anju T.;Kato, Atsushi
背景：慢性鼻窦炎（CRS）是一种异质性疾病，其特征是鼻子和鼻窦粘膜炎症。 CRS 中的炎症也具有异质性，主要特征为 2 型 (T2) 炎症，但部分患者表现出 1 型 (T1) 和 3 型 (T3) 炎症。炎症内型是否与临床表型相关尚待详细探讨。 目的：确定炎症内型与 CRS 临床表现之间的关联。 方法：我们比较了 121 例非息肉样 CRS (CRSsNP) 患者和 134 例息肉样 CRS (CRSwNP) 患者，并使用 IFN-gamma (T1)、嗜酸性粒细胞阳离子蛋白等标志物鉴定了炎症内型。 (T2)、Charcot-Leyden 晶体半乳糖凝集素 (T2) 和 IL-17A (T3)。我们从医疗和手术记录中收集临床参数，并检查内型和临床特征之间是否存在任何关联。 结果：在所有 CRS 患者中，鼻息肉、哮喘合并症、嗅觉丧失和过敏性粘蛋白的存在与 T2 内型的存在显着相关。 T1 内型在女性中更为常见，并且所有 CRS 患者中脓的存在与 T3 内型显着相关。我们进一步分别分析了 CRSsNP 和 CRSwNP 中的这些关联，发现在 CRSsNP 和 CRSwNP 中，嗅觉丧失仍然与 T2 内型相关，而脓与 T3 内型相关。重要的是，具有 T2 和 T3 混合内型的 CRS 患者往往具有 T2 和 T3 内型共有的临床表现。结论：临床表现与 CRS 的炎症内型直接相关。炎症内型的识别可能有助于对 CRS 进行更精确和个性化的治疗。 (C) 2019 年美国过敏、哮喘和免疫学学会
BACKGROUND: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail.OBJECTIVE: To identify associations between inflammatory endotypes and clinical presentations in CRS.METHODS: We compared 121 patients with nonpolypoid CRS (CRSsNP) and 134 patients with polypoid CRS (CRSwNP) and identified inflammatory endotypes using markers including IFN-gamma (T1), eosinophil cationic protein (T2), Charcot-Leyden crystal galectin (T2), and IL-17A (T3). We collected clinical parameters from medical and surgical records and examined whether there were any associations between endotype and clinical features.RESULTS: The presence of nasal polyps, asthma comorbidity, smell loss, and allergic mucin was significantly associated with the presence of T2 endotype in all patients with CRS. The T1 endotype was significantly more common in females, and the presence of pus was significantly associated with T3 endotype in all patients with CRS. We further analyzed these associations in CRSsNP and CRSwNP separately and found that smell loss was still associated with T2 endotype and pus with the T3 endotype in both CRSsNP and CRSwNP. Importantly, patients with CRS with T2 and T3 mixed endotype tended to have clinical presentations shared by both T2 and T3 endotypes.CONCLUSIONS: Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS. (C) 2019 American Academy of Allergy, Asthma & Immunology