鼻喷激素对嗜中性粒细胞性慢性鼻窦炎伴鼻息肉的治疗作用

Treatment of neutrophilic nasal polys with steroid nasal spray

摘要:

目的 嗜中性粒细胞（Neu）性慢性鼻窦炎伴有鼻息肉（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，并接受局部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（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，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组织中炎症介质髓过氧化物酶（MPO）和γ-干扰素（IFN-γ）以及黏蛋白（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组织中浸润数目显著多于正常鼻黏膜，布地奈德鼻喷剂局部治疗后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组织中显著高于正常黏膜组织，治疗后这些指标无显著降低；NP组织中MPO、IFN-γ、MUC5AC和MUC5B的含量显著多于正常黏膜组织；布地奈德治疗前后，NP组织中这些物质的含量差异无统计学意义（P<0.05）。结论 布地奈德鼻喷剂对Neu性CRSwNP无显著治疗作用。

Abstract:

Objective Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occurs 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, Hematoxylin-Eosin and Periodic Acid-Schiff stainings were used to assess goblet cells and submucosal gland cells before and after the therapy. Finally, the effects of the treatment on inflammatory mediators including myeloperoxidase (MPO), interferon-γ (IFN-γ) and mucin (MUC)5AC as well as MUC5B were evaluated through enzyme linked immunosorbent assay.Results All the recruited patients 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 in NP were higher than those in the 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, the content differences of above substances in NP before and after treatment were statistically insignificant.Conclusion Budesonide can not treat neutrophilic NP effectively.