[Predictive diagnostic value of serum 25-hydroxyvitamin D3 in eosinophilic chronic rhinosinusitis with nasal polyps].

Objective: To compare the value of 25-hydroxyvitamin D3 (25-(OH)D3) with other clinical parameters in the prediction and diagnosis of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). Methods: Eligible chronic rhinosinusitis with nasal polyps (CRSwNP) patients and healthy subjects in the Affiliated Hospital of Guizhou Medical University from January to April of 2021 were included for this study. The age, gender, past history and other basic characteristics of all subjects were recorded. The CRSwNP patients were classified into ECRSwNP and non-eosinophilic chronic rhinosinusitis with nasal polyps (nECRSwNP) endotypes by the percentage of tissue eosinophils. Serum 25-(OH)D3 levels measurements were performed in all subjects. Paranasal sinus CT scans, blood eosinophil counts, and determination of total immunoglobulin E (total IgE), Th1/Th2 plasma cytokines and nasal nitric oxide (nNO) levels were performed before surgery. Logistic regression analysis was used to evaluate the related factors of ECRSwNP. Receiver operating characteristic (ROC) curves was used to evaluate the predictive potential of the clinical parameters. Results: One hundred and twenty-seven CRSwNP patients and 40 healthy subjects were recruited, including 74 males and 93 females of the patients, with the age of (38.73±13.05) years. In patients with ECRSwNP, serum 25-(OH)D3 levels were significantly lower than those in nECRSwNP patients ((26.14±4.58) ng/ml vs (35.71±7.86) ng/ml, t=-8.564, P<0.01). The prevalence of asthma, prevalence of allergic rhinitis, peripheral blood eosinophil counts, total IgE levels, nNO levels and CT scores ratio for ethmoid sinus and maxillary sinus (E/M ratio) of ECRSwNP patients were significantly higher than those in nECRSwNP patients (all P<0.05). However, there was no significant difference in Th1/Th2 cytokines levels between the histological types of CRSwNP (all P>0.05). Among the predictive indicators, 25-(OH)D3 had the highest predictive value, with ROC area under curve (AUC) value of 0.882. The best cut-off point of 28.5 ng/ml for 25-(OH)D3 demonstrated a sensitivity of 0.871 and a specificity of 0.762 for ECRSwNP. Conclusion: Measurement of serum 25-(OH)D3 level may be used as an effective method to distinguish between ECRSwNP and nECRSwNP.目的： 比较25羟基维生素D3［25-（OH）D3］与其他临床指标在预测诊断嗜酸粒细胞性慢性鼻窦炎伴鼻息肉（ECRSwNP）中的价值。 方法： 将2021年1—4月就诊于贵州医科大学附属医院符合条件的慢性鼻窦炎伴鼻息肉（CRSwNP）患者和健康受试者纳入本研究。记录所有受试者的年龄、性别、既往史等基本特征。根据组织嗜酸粒细胞百分比将CRSwNP患者分为ECRSwNP和非嗜酸性慢性鼻窦炎伴鼻息肉（nECRSwNP）亚型。所有受试者均进行了血清25-（OH）D3水平检测。所有患者于术前进行鼻窦CT扫描、外周血嗜酸粒细胞计数、总IgE、Th1/Th2细胞因子和鼻呼出气一氧化氮（nasal nitric oxide，nNO）水平检测。运用Logistic回归分析评估ECRSwNP的相关因素。采用受试者工作特征（receiver operating characteristic，ROC）曲线评价各项临床指标的预测潜力。 结果： 共纳入127例CRSwNP患者和40名健康受试者，患者中男性74例，女性93例，年龄（38.73±13.05）岁。ECRSwNP患者的血清25-（OH）D3水平显著低于nECRSwNP患者［（26.14±4.58）ng/ml比（35.71±7.86）ng/ml，t=-8.564，P<0.01］。ECRSwNP患者的哮喘患病率、变应性鼻炎患病率、外周血嗜酸粒细胞计数、总IgE水平、nNO水平、筛窦与上颌窦CT评分比值均高于nECRSwNP组（P值均<0.05）。然而，Th1/Th2细胞因子水平在不同CRSwNP组织类型间的差异均无统计学意义（P值均>0.05）。在各项预测指标中，25-（OH）D3具有最高的预测诊断价值，其ROC曲线下面积为0.882，最佳截断值为28.5 ng/ml，敏感度为0.871，特异度为0.762。 结论： 血清25-（OH）D3水平的测定可作为鉴别ECRSwNP和nECRSwNP的一种有效方法。.