Changes in the clinical and histological characteristics of Chinese chronic rhinosinusitis with nasal polyps over 11 years
Changes in the clinical and histological characteristics of Chinese chronic rhinosinusitis with nasal polyps over 11 years
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DOI：
10.1002/alr.22234
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发表时间：
2019-02-01
影响因子：
6.4
通讯作者：
Lv, Wei
中科院分区：
文献类型：
--
作者：
Wang, Weiqing;Gao, Yali;Lv, Wei
传统上认为，与北美和欧洲相比，慢性鼻窦炎伴鼻息肉（CRSwNP）在中国表现出较少的嗜酸性粒细胞和更多的中性粒细胞炎症。然而，炎症模式可能会随着时间的推移而改变。本研究旨在分析中国CRSwNP临床和组织学特征随时间的变化趋势。方法回顾性研究2003 - 2005年连续115例CRSwNP患者和2014 - 2016年连续114例CRSwNP患者。比较两个时间段患者的临床和组织学资料。结果随着时间的推移，鼻息肉组织中嗜酸性粒细胞百分比增加，中性粒细胞百分比和总炎症细胞计数下降。11年间，嗜酸性CRSwNP的比例从59.1%显著增加到73.7%。鼻息肉中性粒细胞比例和总炎症细胞计数下降，术前1个月使用鼻皮质类固醇的嗜酸性CRSwNP患者比例在11年内显著增加。此外，嗜酸性CRSwNP患者鼻内使用皮质类固醇的依从性优于非嗜酸性CRSwNP患者，合并变应性鼻炎和哮喘的患者鼻内使用皮质类固醇的依从性优于无这些疾病的患者。结论嗜酸性CRSwNP以前在东亚地区是一个次要亚型，现在发病率显著增加，成为中国北京地区的主要CRSwNP亚型，提示鼻科医生应更加重视其诊断和治疗。
Background Traditionally, it was believed that chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrated less eosinophilic and more neutrophilic inflammation in China compared to North America and Europe. However, inflammatory patterns may change over time. The study aimed to analyze the changing trends in the clinical and histological characteristics of CRSwNP over time in China. Methods A total of 115 consecutive CRSwNP patients from 2003 to 2005 and 114 consecutive CRSwNP patients from 2014 to 2016 were enrolled in this retrospective study. The clinical and histological data were compared between patients from the 2 time periods. Results The percentage of eosinophils in nasal polyp tissue increased, and the percentage of neutrophils and total inflammatory cell count decreased, over 11 years. The proportion of eosinophilic CRSwNP significantly increased from 59.1% to 73.7% over 11 years. The proportion of neutrophils and the total inflammatory cell count in nasal polyps decreased, and the proportion of eosinophilic CRSwNP patients using intranasal corticosteroids 1 month before surgery increased remarkably over 11 years. Moreover, eosinophilic CRSwNP patients had better compliance with intranasal corticosteroid use than non-eosinophilic CRSwNP patients, and patients with comorbid allergic rhinitis and asthma had better compliance with intranasal corticosteroid use than patients without those conditions. Conclusion Eosinophilic CRSwNP, which was previously a minor subtype in East Asians, has increased remarkably in incidence to become the predominant CRSwNP subtype in Beijing, China, indicating that rhinologists should place greater emphasis on its diagnosis and treatment.