嗜酸性粒细胞浸润与慢性鼻窦炎伴鼻息肉患者临床特征及IL-17表达变化的关系

Analysis of clinical characteristics and IL-17 expression changes in patients with eosinophilic granulocyte infiltration and chronic sinusitis with nasal polyps

摘要:

目的 探究嗜酸性粒细胞（EOS）浸润与慢性鼻窦炎伴鼻息肉患者临床特征及IL-17表达变化的关系。方法 选取2020年1月—2022年10月徐州医科大学附属宿迁医院收治的100例慢性鼻窦炎伴鼻息肉患者。根据患者是否发生EOS浸润将患者分为对照组（55例，未发生EOS浸润）和观察组（45例，发生EOS浸润）。患者均行鼻内镜检查，并留取鼻息肉组织待用。检测患者鼻息肉组织及外周静脉血血清白细胞介素-17（IL-17）水平；对患者行鼻内镜及CT检查，采用Lund-Kennedey及Lund-Mackey评分对患者病变程度及病变范围进行评估；收集患者临床资料，比较其差异，并对可能影响患者发生EOS浸润的因素进行分析，探究EOS浸润与病灶组织及IL-17表达变化的相关性。结果 两组患者的年龄、性别构成、病程、中性粒细胞百分比、淋巴细胞百分比及患者病灶分型比较，差异无统计学意义（P >0.05）；观察组鼻内镜检查息肉、水肿及鼻漏方面Lund-Kennedey评分与对照组比较，差异均无统计学意义（P >0.05）；观察组CT检查结合Lund-Mackey评分在后组筛窦、鼻道窦口复合体、蝶窦及蝶筛隐窝部位的评分均高于对照组，上颌窦评分低于对照组（P <0.05），前组筛窦及额窦评分比较，差异均无统计学意义（P >0.05）；观察组鼻息肉组织及血清IL-17水平高于对照组（P <0.05）。血清IL-17水平、鼻息肉组织IL-17水平、蝶筛隐窝、蝶窦病变、鼻道窦口复合体、后组筛窦与EOS浸润均呈正相关（r =0.859、0.904、0.955、0.680、0.281和0.421，均P =0.000）；上颌窦病变与EOS浸润呈负相关（r =-0.700，P =0.000）；鼻漏评分与EOS浸润无相关性（r =0.147，P =0.073）。结论 慢性鼻窦炎伴鼻息肉发生EOS浸润时，其病灶组织及血清IL-17水平异常改变，且血清IL-17水平、鼻息肉组织IL-17水平、鼻窦病变情况与EOS浸润相关，该研究有助于揭示慢性鼻窦炎伴鼻息肉的发病机制，并为治疗提供新思路，提高诊断和治疗效果，以改善患者生活质量。

Abstract:

Objective To investigate the relationship between eosinophil infiltration (EOS) and clinical characteristics, as well as changes in IL-17 expression in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods A total of 100 patients diagnosed with CRSwNP between January 2020 and October 2022 at Suqian Hospital Affiliated to Xuzhou Medical University were selected. Based on the occurrence of EOS infiltration, patients were divided into a control group (55 cases without EOS infiltration) and an observation group (45 cases with EOS infiltration). Nasal endoscopy was performed on all patients, and nasal polyp tissues were collected. IL-17 levels in nasal polyp tissues and peripheral venous blood were measured. Nasal endoscopy and CT scans were used for lesion assessment with Lund-Kennedey and Lund-Mackey scores. Clinical data were collected and compared to explore factors influencing EOS infiltration and the correlation between EOS infiltration, lesion tissues, and IL-17 expression.Results There were no statistically significant differences in age, gender composition, disease duration, neutrophil percentage, lymphocyte percentage, and lesion classification between the two groups (P > 0.05). The Lund-Kennedey scores for nasal polyps, edema, and nasal discharge in the observation group were comparable to the control group (P > 0.05). However, the CT scan combined with the Lund-Mackey scores for posterior ethmoidal sinus, ostiomeatal complex, sphenoid sinus, and sphenoid recess were higher in the observation group, while the maxillary sinus score was lower than the control group (P < 0.05). The scores for anterior ethmoidal sinus and frontal sinus showed no significant differences (P > 0.05). IL-17 levels in nasal polyp tissues and serum were higher in the observation group than in the control group (P < 0.05). Serum IL-17 levels, nasal polyp tissue IL-17 levels, sphenoid recess, sphenoid sinus lesions, ostiomeatal complex, posterior ethmoidal sinus, and EOS infiltration showed a positive correlation (r = 0.859, 0.904, 0.955, 0.680, 0.281, and 0.421, all P = 0.000). Maxillary sinus lesions were negatively correlated with EOS infiltration (r = -0.700, P = 0.000), while there was no correlation between nasal discharge scores and EOS infiltration (r = 0.147, P = 0.073).Conclusion In CRSwNP with EOS infiltration, abnormal changes in IL-17 levels were observed in lesion tissues and serum. Serum IL-17 levels, nasal polyp tissue IL-17 levels, and sinus lesion conditions were associated with EOS infiltration. This study contributes to understanding the pathogenesis of CRSwNP and provides new insights for treatment, aiming to enhance diagnostic and therapeutic efficacy to improve patients' quality of life.