■嗜酸性粒细胞慢性鼻-鼻窦炎(ECRS)是通过日本难治性嗜酸性粒细胞慢性鼻-鼻窦炎流行病学调查(JESREC)评分系统和解剖性鼻息肉的组织病理学嗜酸性粒细胞计数诊断的。具有低JESREC评分和少量组织嗜酸性粒细胞的患者被诊断为非ECRS(NECRS)。由于该诊断系统的2个参数,慢性鼻-鼻窦炎分为4组,部分患者分为ECRS和NECRS以外的2组:可能的ECRS(pECRS)和可能的非ECRS(pNECRS)。我们试图阐明临床和组织病理学的异同,特别是关于主要碱性蛋白(MBP),在这些群体中。
■纳入了128例接受内窥镜鼻窦手术治疗的患者。比较各组临床特点,对35例随机选择的患者进行了MBP的免疫组织学分析。通过半定量方法评估MBP在粘膜内上皮的沉积。
■ECRS患者与过敏性鼻炎的合并症发生率明显增高(36例,78.3%),哮喘(36例,78.3%)与其他组比较。此外,抱怨嗅觉功能障碍的患者百分比(42例,91.3%)显著高于(p<0.001)。隆德-麦凯得分(平均,14.5;6-24)和复发率(27例,61.4%)在ECRS患者中最高。关于pECRS,嗅觉功能障碍患者人数(5例,55.6%)高于pNECRS和NECRS组。此外,哮喘的合并症和血液嗜酸性粒细胞的百分比倾向于高于这两组。PECRS组MBP评分明显高于NECRS(p<0.05),尽管组织嗜酸性粒细胞计数较小。
■尽管与ECRS相比,组织嗜酸性粒细胞计数明显较少,但pECRS可能与ECRS具有一些共同特征。这项研究的结果表明,pECRS鼻息肉的MBP评分明显高于NECRS患者,接近ECRS。这可能表明在手术前的某个时候,pPECRS患者的鼻息肉中已经存在嗜酸性粒细胞。
UNASSIGNED: Eosinophilic chronic rhinosinusitis (ECRS) is diagnosed by Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scoring system and histopathological eosinophil counts of dissected nasal polyps. Patients with low JESREC score and small number of tissue eosinophils are diagnosed with non-ECRS (NECRS). Due to the 2 parameters of this diagnostic system, chronic rhinosinusitis is to be divided to 4 groups and some patients fall into the 2 groups other than ECRS and NECRS: probable ECRS (pECRS) and probable non-ECRS (pNECRS). We attempted to clarify clinical and histopathological similarities and differences, especially concerning major basic protein (MBP), among those groups.
UNASSIGNED: One hundred twenty-eight patients treated by endoscopic sinus surgery was included. Clinical characteristics were compared among each group, and immunohistological analysis for MBP was performed to 35 randomly selected patients. MBP deposition at intra mucosal epithelium was evaluated by semiquantificational approach.
UNASSIGNED: ECRS patients showed significantly higher comorbidity rate with allergic rhinitis (36 patients, 78.3%), asthma (36 patients, 78.3%) compared with other groups. Also, percentage of the patients complaining olfactory dysfunction (42 patients, 91.3%) was significantly higher (p < 0.001). Lund-Mackay score (mean, 14.5; 6-24) and recurrence rate (27 patients, 61.4%) was the highest in ECRS patients. Regarding pECRS, the number of patients with olfactory dysfunction (5 patients, 55.6%) was higher than pNECRS and NECRS groups. Also, comorbidity of asthma and percentage of blood eosinophils tended to be higher than those 2 groups. MBP score of pECRS group was significantly higher than NECRS (p < 0.05), despite of smaller tissue eosinophil counts.
UNASSIGNED: pECRS might share some characteristics with ECRS although tissue eosinophil count was significantly smaller compared with ECRS. The results of this study have shown that MBP score in pECRS nasal polyps was significantly higher than NECRS patients and close to ECRS. That might suggest that eosinophils have existed in the nasal polyps of pPECRS patients at some point before surgery.