The role of serum B cell activation factor in the diagnosis and phenotypes of chronic rhinosinusitis with nasal polyps
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摘要: 目的 探讨慢性鼻窦炎伴鼻息肉(CRSwNP)患者血清B细胞活化因子(BAFF)水平变化及在息肉组织分型中的应用价值。方法 选取40例健康志愿者(对照组)和77例CRSwNP患者作为研究对象, 并根据术后组织病理切片中嗜酸粒细胞浸润比例将CRSwNP分为非嗜酸性CRSwNP组(neCRSwNP组, n=40)和嗜酸性CRSwNP组(eCRSwNP组, n=37)。收集所有被纳入者的血清, 通过ELISA检测血清BAFF水平, 并探讨其与患者临床指标的联系。通过受试者工作曲线(ROC)和多因素Logistic回归评估血清BAFF在eCRSwNP判定中的应用价值。结果 CRSwNP组患者血清BAFF浓度为(1.2±0.4) ng/mL, 高于对照组的(0.8±0.3) ng/mL, 此外, eCRSwNP组血清BAFF浓度为(1.3±0.5) ng/mL, 高于neCRSwNP组的(1.1±0.2) ng/mL, 且两组均高于对照组水平, 差异均有统计学意义(P < 0.05)。CRSwNP患者血清BAFF浓度与组织嗜酸粒细胞浸润比例(r=0.629, P < 0.001)和数量(r=0.563, P < 0.001)、外周血嗜酸粒细胞比例(r=0.411, P=0.002)和数量(r=0.501, P < 0.001)以及血清总IgE均呈正相关(r=0.178, P=0.021)。多因素Logistic回归显示血清BAFF浓度是CRSwNP分型的相关因素(OR=3.652, P=0.001)。ROC分析结果显示, 血清BAFF浓度对eCRSwNP的判定具有较好的预测价值(AUC=0.885),结论 CRSwNP患者血清BAFF浓度升高且与组织嗜酸性炎症程度相关, 术前检测血清BAFF水平可能有助于早期判定CRSwNP组织亚型。Abstract: Objective To investigate the changes of serum B cell activating factor(BAFF) levels in chronic rhinosinusitis with nasal polyps(CRSwNP) patients and its predictive value in phenotypes.Methods Forty healthy volunteers(control group) and 77 patients with CRSwNP were recruited in the present study, all CRSwNP patients were divided into eosinophilic(neCRSwNP group, n=40) and non-eosinophilic(eCRSwNP group, n=37) according to the degree of eosinophil infiltration in postoperative histological sections. Serum samples were collected from all subjects, and serum BAFF levels were detected by ELISA, and the relationships between BAFF levels and clinical variables were evaluated. The predictive value of serum BAFF in distinguishing eCRSwNP was evaluated by receiver operating curve(ROC) and Logistic regression.Results BAFF concentrations in the serum of CRSwNP patients were(1.2±0.4) ng/mL, which were higher than control group([0.8±0.3]ng/mL). In addition, serum BAFF levels in eCRSwNP group were (1.3±0.5) ng/mL, which were higher than neCRSwNP group([1.1±0.2]ng/mL), and both groups were higher than control groupt(P < 0.05). The elevated serum BAFF levels in CRSwNP patients were positively correlated with the tissue eosinophil percentage(r=0.629, P < 0.001) and counts(r=0.563, P < 0.001), peripheral blood eosinophil percentage(r=0.411, P=0.002) and counts(r=0.501, P < 0.001), and serum total IgE(r=0.178, P=0.021). Multivariate Logistic regression showed that serum BAFF level was an independent factor associated with CRSwNP phenotypes(OR=3.652, P=0.001). ROC analysis suggested that serum BAFF exhibited a good predictive value for eCRSwNP(AUC=0.885).Conclusion Serum BAFF levels were increased in CRSwNP patients and associated with the degree of systemic and polyp eosinophilic inflammation. Preoperative evaluation of serum BAFF level maybe clinically meaningful for distinguishing CRSwNP phenotypes.
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Key words:
- sinusitis /
- nasal polyps /
- B cell activating factor /
- eosinophil
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图 3 CRSwNP患者血清BAFF浓度与组织嗜酸粒细胞比例(3a)和数量(3b)、外周血嗜酸粒细胞比例(3c)和数量(3d)、血清总IgE(3e)、Lund-Mackay评分(3f)、Lund-Kennedy评分(3g)和VAS评分(3h)的相关性
表 1 三组研究对象的临床资料比较
临床指标 对照组 neCRSwNP组 eCRSwNP组 P 例数 40 40 37 年龄/岁 39.0(29.0, 46.0) 41.0(32.0, 52.0) 43.0(35.0, 54.0) 0.358 男/女 23/17 25/15 21/16 0.854 变应性鼻炎/例(%) 0(0) 3(7.5) 7(18.9) 0.012 哮喘/例(%) 0(0) 3(7.5) 9(24.3) 0.002 外周血嗜酸粒细胞数量/(×106·L-1) 109.6(69.8, 193.3) 187.8(109.1, 266.7) 284.2(187.5, 368.0) 0.001 外周血嗜酸粒细胞比例/% 1.7(1.1, 2.5) 2.3(1.5, 2.8) 3.8(2.4, 5.0) 0.001 血清总IgE浓度/(IU·mL-1) - 74.0(42.1, 102.7) 133.2(79.8, 175.2) 0.001 病程/年 - 4.0(2.0, 5.0) 4.0(3.0, 5.0) 0.816 VAS评分 - 6.0(4.0, 8.0) 5.0(4.0, 7.0) 0.798 Lund-Mackay评分 - 18.0(13.0, 21.0) 19.0(14.0, 22.0) 0.519 Lund-Kennedy评分 - 9.0(7.0, 12.0) 9.0(7.0, 11.0) 0.902 
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表 2 与CRSwNP组织分型相关临床变量的多因素Logistic回归分析
临床变量 OR 95%CI P 变应性鼻炎 1.736 0.917~2.936 0.231 哮喘 2.469 0.938~4.032 0.086 外周血嗜酸粒细胞数量 1.989 1.145~3.077 0.036 外周血嗜酸粒细胞比例 2.415 1.327~3.698 0.010 血清总IgE浓度 1.386 1.084~2.358 0.049 血清BAFF浓度 3.652 1.732~5.944 0.001
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表 3 ROC曲线分析探讨诊断指标的诊断价值
诊断指标 AUC 95%CI P 临界值 灵敏度 特异度 外周血嗜酸粒细胞数/(×106·L-1) 0.669 0.549~0.789 0.003 208.5 0.811 0.570 外周血嗜酸粒细胞比例/% 0.747 0.639~0.855 0.001 2.8 0.919 0.474 血清总IgE浓度/(IU·mL-1) 0.536 0.417~0.663 0.432 123.5 0.405 0.825 血清BAFF浓度/(ng·mL-1) 0.885 0.828~0.963 0.001 1.1 0.973 0.725
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