[Expression of immunological and inflammatory biomarkers in chronic rhinosinusitis with nasal polyps and its predictive value for recurrence].

Objective: To evaluate the expression of immunological and inflammatory biomarkers as well as to analyze their predictive value for recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: Seventy-seven CRSwNP patients were enrolled in this survey from January 2011 to December 2012 in Beijing Tongren Hospital. There were 13 males and 64 females, with the range of age from 14 to 74 years old. The average follow-up period was more than 2 years. The demographic and clinical features of patients were compared between recurrence and non-recurrence groups, and 43 kinds of cytokines, chemokines and inflammatory mediators, tissue and serum total IgE, and morphological and cytology indexes were compared between the two groups. The receiver operating characteristic (ROC) curves were used to evaluate the predictive value of significant indicators for the postoperative recurrence of CRSwNP and to calculate the best diagnostic cut-off values. Results: The recurrence rate of CRSwNP was 44.2% (34/77). Compared with non-recurrence CRSwNP, there were higher risk of aspirin intolerance and asthma in the recurrence group, as well as higher CT and endoscopic polyp scores and lower olfactory sense (7/34 vs 0/43, 10/34 vs 4/43, 18.5[3.0, 24.0] vs 13.8[2.0, 24.0], 2.1[0.5, 3.0] vs 1.5[0.5, 3.0], 5.0[4.5, 5.0] vs 3.0[1.0, 5.0], χ(2) value was 9.738, 5.161, Z value was -3.267, -2.705, -3.213, respectively, all P<0.05). At the same time, the level of interleukin-5 (IL-5), eosinophilic cationic protein / myeloperoxidase (ECP/MPO), tissue inhibitor of metalloproteinase 1 (TIMP1), chemokine (C-C motif) ligand 2 (CCL2), CCL3, CCL4 and tissue and serum total IgE were higher in the recurrence group than those of the non-recurrence. Moreover, the oedema of the lamina propria were more severe. The total IgE, IL-5, ECP/MPO and CCL4 in the tissue had a acceptable discrimination value for the prediction of CRSwNP recurrence. The best diagnostic cut-off values and corresponding sensitivity and specificity were 124.85 pg/ml (82.4%, 60.5%), 6.22 pg/ml (76.5%, 58.1%), 0.61 (55.9%, 83.7%) and 2 456.96 pg/ml (61.8%, 79.1%), respectively. Conclusions: The profile of the immunological and inflammatory biomarkers was different between the non-recurrence CRSwNP and recurrence CRSwNP groups. And a variety of biomarkers can be considered as indicators of recurrence of CRSwNP with acceptable predictive value.目的： 研究慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）的免疫炎性因子表达特点，并探讨上述因子对患者术后复发的预测价值。 方法： 收集2011年1月至2012年12月就诊于北京同仁医院的77例CRSwNP患者，男性13例，女性64例，年龄14~74岁。随访2年以上，比较术后复发和未复发患者的人口学特征和临床特征，并比较其43种细胞因子、趋化因子、炎性介质、组织和血清中总IgE以及组织病理学差异。应用受试者工作特征（receiver operating characteristic，ROC）曲线评估差异有统计学意义的检测指标对CRSwNP术后复发的预测价值。 结果： CRSwNP患者术后复发率为44.2%（34/77）。复发与未复发的CRSwNP患者相比，伴发阿司匹林过敏和哮喘的比例、CT评分和内镜息肉评分均更高，嗅觉减退更明显[7/34比0/43，10/34比4/43，18.5[3.0，24.0]分（M[P(25)，P(75)]，下同）比13.8[2.0，24.0]分，2.1[0.5，3.0]分比1.5[0.5，3.0]分，5.0[4.5，5.0]分比3.0[1.0，5.0]分，χ(2)值分别为9.738、5.161，Z值分别为－3.267、-2.705、-3.213，P值均<0.05]。复发者组织中的白细胞介素5（IL-5）、嗜酸性阳离子蛋白/髓过氧化物酶（ECP/MPO）、基质金属蛋白酶抑制剂1（TIMP1）、趋化因子（CCL）2、CCL3、CCL4、组织和血清总IgE含量均高于未复发组，固有层水肿程度更重。组织中总IgE、IL-5、ECP/MPO和CCL4对CRSwNP复发具有可接受程度的预测价值，最佳诊断临界值和相应的敏感度、特异度分别为124.85 pg/ml（82.4%，60.5%）、6.22 pg/ml（76.5%，58.1%）、0.61（55.9%，83.7%）和2 456.96 pg/ml（61.8%，79.1%）。 结论： 复发和未复发CRSwNP术前鼻息肉组织的免疫炎性因子表达有不同特点，多种因子可作为预测CRSwNP术后复发与否的标志物。.