Nasal polyp eosinophilia and FeNO may predict asthma symptoms development after endoscopic sinus surgery in CRS patients without asthma
Nasal polyp eosinophilia and FeNO may predict asthma symptoms development after endoscopic sinus surgery in CRS patients without asthma
复制标题
DOI：
10.1080/02770903.2021.1897837
复制
发表时间：
2021-03-03
影响因子：
1.9
通讯作者：
Niimi, Akio
中科院分区：
文献类型：
--
作者：
Kurokawa, Ryota;Kanemitsu, Yoshihiro;Niimi, Akio
背景哮喘是嗜酸粒细胞性慢性鼻窦炎（CRS）的重要合并症。鼻窦组织嗜酸性粒细胞增多和一氧化氮分数（FeNO）等2型驱动的生物标志物可用于检测CRS患者内镜鼻窦手术（ESS）后出现哮喘症状的高危患者。 方法对2015年10月至2017年12月期间同意接受ESS的36名无哮喘CRS患者进行前瞻性观察，为期12个月。监测他们是否出现典型哮喘症状，包括呼吸困难、喘息和咳嗽，这些症状对抗哮喘药物有反应。对 ESS 后出现哮喘症状的患者（哮喘症状组）和未出现哮喘症状的患者（非哮喘组）之间的生物标志物进行了比较。还评估了 ESS 干预后生物标志物的变化。结果 6 名患者在 ESS 后失访。因此，我们对 30 名 CRS 患者[其中 16 名经手术证实患有鼻息肉 (NP)] 进行了随访。七名（23%）在随访期间新抱怨有哮喘症状。哮喘症状组的 FeNO 水平和嗜酸性 NP 患病率（嗜酸性粒细胞 >= 70/高倍视野）显着高于非哮喘组 [FeNO 水平分别为 50.7 ppb 和 22.4 ppb，嗜酸性 NP 患病率分别为 100% (n = 3) 和 23% (n = 3)，p < 0.05]。 ESS 在非哮喘组中显着降低了痰骨膜素水平。然而，ESS后生物标志物的变化在两组之间具有可比性。结论NPs中的嗜酸性粒细胞（≥70/高倍视野）和术前FeNO可能是预测ESS后哮喘症状发展的重要生物标志物。
BackgroundAsthma is a significant comorbidity of eosinophilic chronic rhinosinusitis (CRS). Type2-driven biomarkers such as sinus tissue eosinophilia and fractional nitric oxide (FeNO) may be utilized to detect high risk patients who develop asthma symptoms after endoscopic sinus surgery (ESS) in CRS patients.MethodsThirty-six CRS patients without asthma who agreed to undergo ESS between October 2015 and December 2017 were prospectively observed for 12 months following ESS. They were monitored for the development of typical asthma symptoms including dyspnea, wheezes, and cough which responded to anti-asthma medication. Biomarkers were compared between patients who developed asthma symptoms after ESS (asthma symptoms group) and those who did not (non-asthma group). Biomarker changes following ESS intervention were also evaluated.ResultsSix patients were lost to follow after ESS. Thus, 30 CRS patients [16 with nasal polyps (NPs) proved by surgery] were followed. Seven (23%) newly complained of asthma symptoms during follow-up. Levels of FeNO and the prevalence of eosinophilic NPs (eosinophils >= 70/high power fields) were significantly higher in the asthma symptom group than in non-asthma group [50.7 ppb vs 22.4 ppb for FeNO levels, and 100% (n = 3) vs 23% (n = 3) for eosinophilic NP prevalence, both p < 0.05]. Levels of sputum periostin decreased significantly by ESS in the non-asthma group. However, changes of biomarkers after ESS were comparable between the two groups.ConclusionsEosinophils in NPs (>= 70/high power fields) and preoperative FeNO may be significant biomarkers for predicting the development of asthma symptoms after ESS.