苏州地区慢性鼻窦炎合并鼻息肉细胞表型分析  

Cellular phenotyping analysis of chronic rhinosinusitis with nasal polyps in Suzhou area

作　　者：李晶[1] 纪文君 惠奕 王鑫 LI Jing;JI Wenjun;HUI Yi;WANG Xin(Department of Otolaryngology Head and Neck Surgery,the People’s Hospital of SND,Suzhou,Jiangsu,215129,China;Department of Pathology,the People’s Hospital of SND,Suzhou,Jiangsu,215129,China)

机构地区：[1]苏州高新区人民医院耳鼻咽喉头颈外科,江苏苏州215129 [2]苏州高新区人民医院病理科,江苏苏州215129

出　　处：《中国耳鼻咽喉头颈外科》2020年第11期640-643,647,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：苏州高新区医疗卫生科技计划重点项目(2019Z001);苏州高新区人民医院面上项目(SGY2019B02);苏州高新区人民医院科学创新重点项目(SGY2019C01)。

摘　　要：目的分析苏州地区慢性鼻窦炎合并鼻息肉(CRSwNP)的细胞表型分布及其临床特征,并确定苏州地区鼻息肉组织嗜酸性粒细胞增多预测息肉复发的最佳分界点。方法选取74例就诊于苏州高新区人民医院的CRSwNP患者,术后随访12~24个月。鼻息肉组织标本HE染色,计数炎性反应细胞数量。依据嗜酸性粒细胞、中性粒细胞、淋巴细胞、浆细胞百分比,分为五种表型。分析五种细胞表型的分布比例,并比较不同表型间临床特征的差异。应用ROC曲线,确定苏州地区鼻息肉组织嗜酸性粒细胞增多预测息肉复发的最佳分界点。结果苏州地区CRSwNP患者嗜酸性粒细胞性鼻息肉占12.1%(9/74),远低于北京地区(37.2%)。该表型患者主观症状和客观CT评分与其他组相比均最差,复发率高达100%。浆细胞性鼻息肉和淋巴细胞性鼻息肉占总病例数的一半以上。与北京地区相仿,中性粒细胞性鼻息肉占比最少,为9.5%(7/74)。本研究中鼻息肉的术后复发率为32.4%(24/74)。组织嗜酸性粒细胞百分比>28.5%时,预测息肉复发的敏感度为95.8%,特异度为96%。结论苏州地区嗜酸性粒细胞性鼻息肉比例明显低于北京,嗜酸性粒细胞百分比>28.5%,是预测息肉复发的最佳分界点。OBJECTIVE To analyze the cellular phenotyping and its relationship with clinical characteristics of chronic rhinosinusitis with nasal polyps(CRSwNP)in Suzhou area.To identify the optimal cutoff point of tissue eosinophilia for predicting recurrence.METHODSSeventy-four CRSwNP patients were enrolled in the study.HE staining was used to count inflammatory cells.According to the percentage of the four types of inflammatory cells,the proportions of the five types of cell phenotypes were analyzed,and the differences of clinical characteristics were compared.The optimal cutoff point for predicting the recurrence was determined by ROC curve.RESULTS The proportion of eosinophil nasal polyps in patients with CRSwNP in Suzhou was much lower than that in Beijing.Subjective symptoms and objective CT scores of patients with this phenotype were the worst compared with other groups,and the recurrence rate was up to 100%.Plasma cell and lymphocytic nasal polyps accounted for more than half of the total cases.Similar to Beijing area,neutrophil nasal polyps accounted for the least.In this study,the recurrence rate was 32.4%.A cutoff value of 28.5%for tissue eosinophil percentage was able to predict recurrence with 95.8%sensitivity and 96%specificity.CONCLUSIONThe proportion of eosinophil nasal polyps in Suzhou area was significantly lower than that in Beijing.28.5%of tissue eosinophil percentage was the best cutoff point for predicting the recurrence.

关 键 词：鼻窦炎 鼻息肉 复发 细胞分型 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]