混合中性粒细胞-嗜酸性粒细胞内型的CRSwNP削弱术后改善：基于手术完整性指数的判定
The Mixed Neutrophilic-Eosinophilic Endotype of CRSwNP Blunts Postsurgical Improvement as Determined by the Completeness of Surgery Index.
文献信息
| PMID | 42931808 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Vidit M Talati |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. |
| 期刊 | International forum of allergy & rhinology |
| SCI 分区 | Q1 |
| IF | 4.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 手术完整性指数（CoSI）是评估慢性鼻窦炎伴鼻息肉（CRSwNP）手术质量的新指标。结构化组织病理学（SHP）有助于表征炎症驱动因素。整合这两种工具以识别手术难治性疾病风险较高的患者尚未被探索。
方法： 纳入2018年至2025年间术前CoSI < 70、接受初次或修正性功能性内镜鼻窦手术（FESS）并随后进行类固醇冲洗的CRSwNP患者。回顾性审查CT图像以及关于合并症、SHP、生物制剂使用和SNOT-22评分的数据。采用逻辑回归、Mann-Whitney U检验和卡方检验进行分析。
结果： 队列包括207例患者，在FESS后12个月实现显著的SNOT-22改善（-29.1 ± 22.1；p < 0.001）。平均年龄为48.4岁；53例（25.2%）患有阿司匹林加重性呼吸系统疾病（AERD），114例（54.3%）为修正性病例。修正性病例的术前平均CoSI为37.2。术后平均CoSI为80.0。在SHP变量中，仅中性粒细胞浸润与12个月时SNOT-22改善较少相关（中位数-22.4 vs. -33.8；p = 0.007）。中性粒细胞的作用仅在高组织嗜酸性粒细胞增多时出现，多变量模型中交互项具有统计学显著性。中性粒细胞浸润与术后生物制剂使用增加无关。
结论： 即使存在高组织嗜酸性粒细胞增多或异常组织结构，完整手术也能带来显著且持续的SNOT-22改善。合并组织中性粒细胞增多和嗜酸性粒细胞增多可能代表CRSwNP的一种混合内型，其在FESS后SNOT-22改善减少。将SHP与CoSI相结合可能有助于术后辅助药物治疗的决策，以优化患者结局。
英文摘要
BACKGROUND: The Completeness of Surgery Index (CoSI) is a novel metric for assessing surgical quality in chronic rhinosinusitis with nasal polyps (CRSwNP). Structured histopathology (SHP) is helpful for characterizing drivers of inflammation. Integrating these two tools to identify patients at higher risk for surgically recalcitrant disease has not been explored.
METHODS: CRSwNP patients with a preoperative CoSI < 70 undergoing primary or revision functional endoscopic sinus surgery (FESS) followed by steroid irrigations from 2018 to 2025 were included. CT images and data about comorbidities, SHP, biologic use, and SNOT-22 scores were retrospectively reviewed. Logistic regression, Mann-Whitney U, and Chi-squared tests were used for analysis.
RESULTS: The cohort comprised 207 patients achieving significant SNOT-22 improvement 12 months post-FESS (-29.1 ± 22.1; p < 0.001). Mean age was 48.4 years; 53 (25.2%) had aspirin-exacerbated respiratory disease (AERD), and 114 (54.3%) were revision cases. Mean preoperative CoSI was 37.2 among revisions. Mean postoperative CoSI was 80.0. Among SHP variables, only neutrophilic infiltrate correlated with less improvement in SNOT-22 at 12 months (median -22.4 vs. -33.8; p = 0.007). The effect of neutrophils was seen only with high tissue eosinophilia, with a statistically significant interaction term in the multivariable model. Neutrophil infiltrates were not associated with increased postoperative biologic use.
CONCLUSION: Complete surgery affords significant, sustained SNOT-22 improvement even with high tissue eosinophilia or abnormal tissue architecture. Comorbid tissue neutrophilia and eosinophilia may represent a mixed endotype of CRSwNP with reduced improvement in SNOT-22 after FESS. Combining SHP with CoSI may be helpful for decision-making regarding adjunct medical therapy postoperatively to optimize patient outcomes.