Department of Otorhinolaryngology-Head and Neck Surgery,Huashan Hospital North of Fudan University
目的 嗜中性粒细胞（neutrophils，Neu）性慢性鼻窦炎伴有鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）主要发生于东亚国家的患者，到目前为止尚未发现有效的治疗方法，本研究旨在评估局部用糖皮质激素布地奈德鼻喷剂对Neu 性CRSwNP的治疗作用。方法 15例CRSwNP患者受到招募，并接受布地奈德鼻喷剂治疗3个月。分别从正常鼻黏膜组织和CRSwNP患者的鼻息肉（nasal polyps，NP）组织中获取样本， 用免疫荧光染色方法确定NP的内表型，以免疫组织化学染色方法检测治疗前后NP组织中Neu的浸润情况，随后用苏木精-伊红和过碘酸-雪夫染色方法分别对治疗前后NP组织中杯状细胞和黏膜下腺体细胞进行检测，最后用酶联免疫吸附试验对治疗前后NP中炎症介质髓过氧化物酶（myeloperoxidase，MPO）和γ-干扰素（interferon-γ， IFN-γ）以及黏蛋白（mucin，MUC）5AC和MUC5B进行了检测。结果 15例CRSwNP患者的NP内表型均为Neu性，Neu在NP中浸润数目显著多于正常鼻黏膜，布地奈德治疗后NP组织中Neu计数没有显著降低，杯状细胞的计数和黏膜下腺体细胞的染色评分在NP中显著高于正常组织，但治疗后这些指标没有显著降低，NP中MPO、IFN-γ、MUC5AC和MUC5B的含量显著多于正常黏膜，但布地奈德治疗前后，NP组织中这些物质的含量差异没有统计学意义。结论 布地奈德对Neu性NP没有显著治疗作用。
Objective Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occur predominantly in Eastern Asian subjects. Appropriate treatments for this endotype have not been elucidated. This study aimed to evaluate the effect of local glucocorticoid budesonide nasal spray on neutrophilic CRSwNP. Methods Fifteen CRSwNP subjects were enrolled and received budesonide treatment for three months. Nasal samples were obtained from normal nasal mucosa and nasal polyps (NP) of CRSwNP patients, and their endotypes were identified using immunofluorescent staining. Then the infiltration of neutrophils (Neu) was examined with immunohistochemical staining before and after budesonide treatment. After that, we used Hematoxylin-Eosin and Periodic Acid–Schiff staining to assess goblet cells and submucosal gland cells before and after the therapy. Finally, we evaluated the effect of the treatment on inflammatory mediators including myeloperoxidase (MPO) and interferon-γ (IFN-γ) and mucin (MUC)5AC and MUC5B through enzyme linked immunosorbent assay. Results All the recruited patients (n = 15) belonged to the neutrophilic endotype. The number of Neu was increased in NP compared to normal nasal mucosa, and was not decreased significantly after budesonide treatment. Goblet cell numbers and submucosal gland cells scores were higher than normal tissues, and were not reduced significantly after the treatment. The contents of MPO, IFN-γ, MUC5AC and MUC5B were enhanced compared to normal mucosa. However, there were no statistical significances between pre and post treatments in above substances. Conclusion Budesonide can not treat neutrophilic NP effectively.