重度CRSwNP嗅觉恢复的无创预测：基于分泌型IL-17A的跨区室转化列线图
Non-invasive prediction of olfactory recovery in severe CRSwNP: a cross-compartment translational nomogram based on secretory IL-17A.
文献信息
| PMID | 42952741 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Hangtian Zhang |
| 作者单位 | Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. |
| 期刊 | Frontiers in allergy |
| SCI 分区 | Q2 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 预测重度慢性鼻窦炎伴鼻息肉（CRSwNP）术后嗅觉恢复仍具挑战性。为克服对侵入性组织活检的依赖，本研究旨在识别反映深部黏膜炎症微环境的无创液体活检生物标志物，最终开发一种即时检测的预后模型。
方法： 采用“组织到分泌物”的双队列验证策略。在一发现队列（N=67）中，随机森林（RF）算法筛选深部组织蛋白质组（Luminex）。在一验证队列（N=62）中，一个独立的RF模型评估无创鼻分泌物（Olink）。对双向汇聚的靶标评估其与6个月时绝对嗅觉改善[Δ（视觉模拟量表）VAS]评分的连续剂量-反应关系。开发了一个临床-分子列线图，并使用1,000次bootstrap重抽样进行内部验证。
结果： 基于组织的RF确定白细胞介素（IL）-17A为核心预后候选指标。独立的基于分泌物的RF模型也优先识别出分泌型IL-17A，实现双向汇聚。虽然经典2型细胞因子（IL-5、IL-13）在分泌物中失去预测意义（P>0.05），但分泌型IL-17A表现出稳健的剂量-反应相关性（r=0.334，P=0.0003），并成为嗅觉恢复的独立保护因素（[比值比]OR=1.408，95%[置信区间]CI：1.03-2.03）。联合列线图无缝整合基线VAS和分泌型IL-17A，产生经乐观校正的（受试者工作特征曲线下面积）AUC为0.793（95%CI：[0.6908-0.9079]），具有足够的校准度和显著的净临床获益。
结论： 通过跨区室转化，我们确定分泌型IL-17A是黏膜可塑性和嗅觉可逆性的稳健、无创指标。所衍生的联合列线图为重度CRSwNP的个性化术前咨询和风险分层提供了可操作的框架。
英文摘要
BACKGROUND: Predicting olfactory recovery after surgery for severe chronic rhinosinusitis with nasal polyps (CRSwNP) remains challenging. To overcome the reliance on invasive tissue biopsies, this study aimed to identify non-invasive liquid biopsy biomarkers reflecting the deep mucosal inflammatory microenvironment, ultimately developing a point-of-care prognostic model.
METHODS: A "tissue-to-secretion" dual-cohort validation strategy was employed. A Random Forest (RF) algorithm screened deep-tissue proteomes (Luminex) in a discovery cohort (N = 67). An independent RF model evaluated non-invasive nasal secretions (Olink) in a validation cohort (N = 62). Bidirectionally convergent targets were assessed for continuous dose-response relationships with absolute olfactory improvement [Δ(visual analog scale)VAS] score at 6 months. A clinical-molecular nomogram was developed and internally validated using 1,000 bootstrap resamples.
RESULTS: The tissue-based RF identified interleukin (IL)-17A as a core prognostic candidate. The independent secretion-based RF model also prioritized secretory IL-17A, achieving bidirectional convergence. While canonical Type 2 cytokines (IL-5, IL-13) lost predictive significance in secretions (P > 0.05), secretory IL-17A demonstrated a robust dose-response correlation (r = 0.334, P = 0.0003) and emerged as an independent protective factor for olfactory recovery ([odds ratio] OR = 1.408, 95% [confidence interval] CI: 1.03-2.03). The joint nomogram, seamlessly integrating baseline VAS and secretory IL-17A, yielded an optimism-corrected (area under the receiver operating characteristic curve) AUC of 0.793 (95% CI: [0.6908-0.9079]) with adequate calibration and substantial net clinical benefit.
CONCLUSIONS: Through cross-compartment translation, we identified secretory IL-17A as a robust, non-invasive indicator of mucosal plasticity and olfactory reversibility. The derived joint nomogram provides an actionable framework for personalized pre-operative counseling and risk stratification in severe CRSwNP.