鼻黏膜白细胞介素17、嗜酸性粒细胞水平与慢性鼻窦炎患者鼻内镜术后嗅觉功能转归的关系

Relationship between the levels of IL-17 and EOS in nasal mucosa and the outcome of olfactory function in patients with chronic sinusitis after endoscopic sinus surgery

摘要:

目的 探讨鼻黏膜白细胞介素17（IL-17）、嗜酸性粒细胞（EOS）水平与慢性鼻窦炎（CRS）患者鼻内镜术后嗅觉功能转归的关系。方法 选取2019年2月—2021年6月徐州医科大学附属宿迁医院收治的121例CRS患者为研究对象，所有患者行鼻内镜手术治疗，采用免疫组织化学法检测鼻黏膜组织IL-17、EOS。收集所有患者临床资料，术后随访3个月。比较术前不同嗅觉功能障碍程度患者的鼻黏膜IL-17、EOS表达，采用逐步多因素Logistic回归分析影响CRS患者术后嗅觉功能转归的因素，绘制受试者工作特征（ROC）曲线分析鼻黏膜IL-17、EOS对CRS患者术后嗅觉功能转归的预测价值。结果 嗅觉功能轻度障碍组IL-17、EOS表达低于嗅觉功能中、重度障碍组（P <0.05），嗅觉功能中度障碍组IL-17、EOS低于嗅觉功能重度障碍组（P <0.05）。逐步多因素Logistic回归分析结果显示：鼻窦CT评分［O^R=3.857（95% CI：1.587，9.375）］、Lund-Kennedy评分［O^R=3.827（95% CI：1.575，9.300）］、IL-17［O^R=3.367（95% CI：1.385，8.183）］、EOS［O^R=3.680（95% CI：1.514，8.944）］是CRS患者术后嗅觉功能转归的影响因素（P <0.05）。ROC曲线结果显示，鼻黏膜IL-17、EOS及两者联合预测CRS患者术后嗅觉功能转归的敏感性分别为78.26%、73.91%和73.91%，特异性分别为74.79%、79.83%和89.92%，AUC分别为0.754、0.772和0.879。结论 鼻黏膜IL-17、EOS表达与CRS患者鼻内镜术后嗅觉功能有关，两者联合预测CRS患者鼻内镜术后嗅觉功能转归效能较好。

Abstract:

Objective To explore the relationship between the levels of interleukin-17 (IL-17) and eosinophils (EOS) in the nasal mucosa and the outcome of olfactory function in patients with chronic sinusitis (CRS) after endoscopic sinus surgery.Methods A total of 121 CRS patients admitted to the hospital from February 2019 to June 2021 were selected. All patients underwent endoscopic sinus surgery, and the levels of IL-17 and EOS in the nasal mucosa were detected by immunohistochemistry. The clinical data of all patients were collected and the patients were followed up for 3 months after the operation. The levels of IL-17 and EOS in the nasal mucosa of CRS patients with different degrees of olfactory dysfunction were analyzed before the operation. Factors affecting the outcome of postoperative olfactory function in CRS patients were analyzed. The value of nasal mucosal IL-17 and EOS levels in predicting the outcome of postoperative olfactory function in CRS patients was also analyzed.Results The levels of IL-17 and EOS in the mild olfactory dysfunction group were lower than those in the moderate and severe olfactory dysfunction groups (P < 0.05), and the levels of IL-17 and EOS in the moderate olfactory dysfunction group were lower than those in the severe olfactory dysfunction group (P < 0.05). The multivariable Logistic regression analysis showed that the CT score of the sinuses [O^R =3.857 (95% CI: 1.587, 9.375) ], Lund-Kennedy endoscopic score [O^R = 3.827 (95% CI: 1.575, 9.300)], IL-17 level [O^R = 3.367 (95% CI: 1.385, 8.183) ], and EOS level [O^R = 3.680 (95% CI: 1.514, 8.944) ] were independent factors affecting the outcome of postoperative olfactory function in CRS patients (P < 0.05). The ROC curve analysis revealed that the sensitivities of the levels of nasal mucosal IL-17, EOS and their combination for predicting the outcome of postoperative olfactory function in CRS patients were 78.26% 73.91% and 73.91%, the specificities were 74.79%, 79.83% and 89.92%, and the AUCs were 0.754, 0.772 and 0.879, respectively.Conclusions The levels of IL-17 and EOS in the nasal mucosa are related to the olfactory function after endoscopic sinus surgery in CRS patients, and the combination of the two better predicts the postoperative outcome of the olfactory function in these patients.