Abstract：
OBJECTIVE: Successful recovery from chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) can be characterized by minimal presence of symptoms and absence of disease on endoscopy. However, molecular markers of surgical success remain to be characterized. These could allow for better tailoring of perioperative therapy. This study aims to identify novel molecular markers associated with surgery responsive patient.
METHODS: Prospective cohort study.
METHODS: Single academic hospital center.
METHODS: One hundred eighteen consecutive patients with CRS at high risk of recurrence after surgery were followed prospectively following ESS in an academic medical center. Symptomatic and endoscopic outcomes were assessed at 4 months, with success rigorously defined subjectively as minimal or no symptoms (no symptom greater than 1 on an ordinal scale of 0-3) and objectively by the absence of nasal polyposis on sinus cavity endoscopy and Lund-Kennedy endoscopic edema score no greater than 1. Samples were obtained at the time of surgery and at 4-month postoperatively. Changes associated with surgery were determined by gene expression profiling using Affymetrix\'s Clariom S Human HT arrays.
RESULTS: Successful ESS was characterized by a mild upregulation in Type 1 inflammation, upregulation of cell cycle progression, and epithelial barrier and proliferation-associated genes and pathways. ESS failure was associated to very high levels of Type 1 inflammation along with downregulation of epithelial barrier function and regeneration genes and pathways.
CONCLUSIONS: Successful recovery from ESS involves restoration of epithelial function and regulated activation of Type 1 inflammation. Excessively elevated Type 1 inflammation is associated with epithelial barrier dysfunction.
METHODS: Prospective cohort study.
METHODS: Single academic hospital center.
METHODS: One hundred eighteen consecutive patients with CRS at high risk of recurrence after surgery were followed prospectively following ESS in an academic medical center. Symptomatic and endoscopic outcomes were assessed at 4 months, with success rigorously defined subjectively as minimal or no symptoms (no symptom greater than 1 on an ordinal scale of 0-3) and objectively by the absence of nasal polyposis on sinus cavity endoscopy and Lund-Kennedy endoscopic edema score no greater than 1. Samples were obtained at the time of surgery and at 4-month postoperatively. Changes associated with surgery were determined by gene expression profiling using Affymetrix\'s Clariom S Human HT arrays.
RESULTS: Successful ESS was characterized by a mild upregulation in Type 1 inflammation, upregulation of cell cycle progression, and epithelial barrier and proliferation-associated genes and pathways. ESS failure was associated to very high levels of Type 1 inflammation along with downregulation of epithelial barrier function and regeneration genes and pathways.
CONCLUSIONS: Successful recovery from ESS involves restoration of epithelial function and regulated activation of Type 1 inflammation. Excessively elevated Type 1 inflammation is associated with epithelial barrier dysfunction.
摘要：
目的：内窥镜鼻窦手术（ESS）后从慢性鼻-鼻窦炎（CRS）中成功恢复的特征是症状很少，内窥镜检查没有疾病。然而,手术成功的分子标志物仍有待表征。这些可以更好地定制围手术期治疗。本研究旨在鉴定与手术反应患者相关的新型分子标志物。
方法：前瞻性队列研究。
方法：单一学术医院中心。
方法：在一个学术医疗中心，在ESS之后，对118名连续的CRS患者进行了前瞻性随访。在4个月时评估症状和内镜结果，成功被严格定义为主观上最小或没有症状（在0-3的序数上没有大于1的症状），客观上通过鼻窦腔内窥镜检查没有鼻息肉病和Lund-Kennedy内窥镜下水肿评分不大于1。在手术时和术后4个月获得样品。通过使用Affymetrix的ClariomS人类HT阵列的基因表达谱分析确定与手术相关的变化。
结果：成功的ESS以1型炎症轻度上调为特征，细胞周期进程的上调，以及上皮屏障和增殖相关基因和途径。ESS失败与非常高水平的1型炎症以及上皮屏障功能和再生基因和途径的下调有关。
结论：从ESS中成功恢复涉及上皮功能的恢复和1型炎症的调节激活。过度升高的1型炎症与上皮屏障功能障碍有关。
方法：前瞻性队列研究。
方法：单一学术医院中心。
方法：在一个学术医疗中心，在ESS之后，对118名连续的CRS患者进行了前瞻性随访。在4个月时评估症状和内镜结果，成功被严格定义为主观上最小或没有症状（在0-3的序数上没有大于1的症状），客观上通过鼻窦腔内窥镜检查没有鼻息肉病和Lund-Kennedy内窥镜下水肿评分不大于1。在手术时和术后4个月获得样品。通过使用Affymetrix的ClariomS人类HT阵列的基因表达谱分析确定与手术相关的变化。
结果：成功的ESS以1型炎症轻度上调为特征，细胞周期进程的上调，以及上皮屏障和增殖相关基因和途径。ESS失败与非常高水平的1型炎症以及上皮屏障功能和再生基因和途径的下调有关。
结论：从ESS中成功恢复涉及上皮功能的恢复和1型炎症的调节激活。过度升高的1型炎症与上皮屏障功能障碍有关。
