Analysis And Clinical Significance Of Lung Function In Nasal Chronic Inflammatory Diseases

BackgroundNasal polyps(NP)is smooth,lychee-like new organism formed in the nasal cavity and sinuses.It occur more bilateral nasal cavity,can also be unilateral nasal cavity.Patients often accompanied by inflammation of the sinuses.The common clinical symptoms are nasal obstruction,runny nose,headache,dizziness and hyposmia,etc.According to the classification of the 2012 EPOS guidelines,chronic rhinosinusitis with nasal polyps(CRSwNP)is a subtype of chronic sinusitis(CRS).The pathogenesis of NP is complex and not fully understood.So far,there is no completely unified theory and mechanism.The possible pathogenesis includes disruption of the microenvironment of the middle meatus,allergic reaction of the nasal mucosa,genetic factors,bacterial superantigen theory,and Eosinophilic inflammation,etc.It has become a consensus that upper respiratory tract inflammatory diseases and lower respiratory tract inflammatory diseases are closely related.More and more studies have suggested that lower respiratory tract dysfunction exists in CRSwNP patients:there is a certain proportion of CRSwNP patients with asthma in clinical practice;some CRSwNP patients have small airway dysfunction without clinical symptoms,and some studies have found that CRSwNP patients with asthma have significantly improved asthma symptoms after endoscopic surgery.The purpose of this study is to detect and analyze the pulmonary function of NP patients in order to understand the changes of pulmonary function,analyze the correlation between the clinical characteristics and lesion scope of nasal polyps and the occurrence of lower respiratory tract,as well as the clinical significance.MethodsA total of 52 NP patients were enrolled in this study,who underwent endoscopic surgery at The Second Hospital of Shandong University were recruited between January 2016 to October 2016.After admission,the related clinical information was improved,including nasal sinus CT and Lund-Mackay CT grading,nasal endoscopy and nasal endoscopic grade,serum allergen determination and pulmonary function ventilation function examination,the clinical characteristics,lesion range and lung ventilation function indicators of the NP patients were analyzed.U test and Chi-square test was employed to assess for differences between groups.Correlations were analysedusing the Pearson correlation test.Values of p<0.05 were considered statistically significant.resultThe results of pulmonary ventilation function test in all patients showed:26 patients normal,10 patients with small airway dysfunction,16 patients with mild obstructive pulmonary ventilatory dysfunction,and 2 patients are positive of bronchial dilation test,accounting for 50%,19.2%,30.8%,3.8%of all patients respectively;significant differences are found between the pulmonary function of the single/bilateral nasal polyps patients(Z = 3.075,P = 0.0021);There was a significant difference between the pulmonary function of the serum allergen positive patients and the pulmonary function of the serum allergen negative patients(Z = 3.126,P ?0.0018);Patients with normal pulmonary function had a significantly lower nasal endoscopic grading than those with dysfunction,significant differences are found between the two groups(P<0.05);There was a significant difference between the CT grading of patients with normal pulmonary function and the CT grading of patients with abnormal pulmonary function(P<0.001).Moreover,there was a significant negative correlation between the CT grading of patients and FEV1/FVC also the small airway related parameters such as MEF75%,MEF50%,MEF25%,MEF25-75%(r =-0.5100,p<0.01;r =-0.4315,p<0.01;r =-0.3304,p<0.05;r =-0.4480,p<0.01;r =-0.4070,p<0.01).InconclusionCRSwNP patients,especially those with extensive lesions and allergen-positive patients,have worse lung function.the Lund-Mackay CT score of CRSwNP patients was significantly negatively correlated with FEV1/FVC and small airway function-related indicators,suggesting that lower respiratory tract lesions were closely related to the occurrence and development of CRSwNP,for CRSwNP patients,especially those who with extensive lesions and allergens positive,more attention should be paid to the combination of lower respiratory tract lesions.polypsBackgroundThe clinical symptoms of chronic rhinosinusitis with nasal polyps are nasal congestion,runny nose,forehead and/or facial pain,and at the same time,there will be decreased olfactory dysfunction and hearing,which seriously affects the social activities,life,work,study and mental health of patients.NP are characterized by inflammatory cell accumulation and marked tissue remodelling.However,nasal polyps have differrent performances in different regional,ethnic and environmental.Nasal polyps in patients from Western countries predominantly show T helper type 2(Th2)cytokine skewing and abundant Eosinophilic infiltration.Growing evidence suggests that nasal polyps in patients from china are relatively inclined to Neutrophilic inflammatory.The sub-classification of nasal polyps into Eosinophilic nasal polyps and Non-Eosinophilic nasal polyps according to the degree of Eosinophils infiltration in CRSwNP,and gradually gained widespread attention.Compared to Non-ECRSwNP,ECRSwNP patients often demonstrated significant increase in peripheral blood Eosinophils and more Eosinophilic infiltration in nasal polyps.Even so,nasal polyps from both Western and Asian countries show similar epithelial remodelling,including epithelial hyperplasia,goblet cells hyperplasia and squamous metaplasia.Under pathological conditions,polyps are characterized by marked edema and glandular hyperplasia.And infiltration of inflammatory cells such as plasma cells,Eosinophils,Neutrophils and lymphocytes in the lamina propria.Eosinophilic nasal polyps is often accompanied by thickening of the basement membrane and destruction of cilia,resulting in barrier dysfunction of the nasal mucosa epithelium,making it easier for pathogens to invade the body.It is well known that a close relationship exists between upper and lower respiratory tract diseases.However,the pulmonary function of patients with nasal polyps is not yet fully understood,and the relationship between histopathological features in tissue and lower airway disease manifestations remains largely unclear.Against this background,we conducted a comprehensive histological study of 99 Chinese nasal polyps patients,to determine:their demographic and clinical factors,the main features of inflammatory cellular infiltration,epithelial remodelling patterns,and their association with lung function parameters.MethodsA total of 99 patients with chronic rhinosinusitis with nasal polyps,who underwent endoscopic sinus surgery at The Second Hospital of Shandong University and the Jinan Central Hospital Affiliated to Shandong University,China,were recruited between 2014 and 2016,patients were inquired about the history of all asthma and disease in lower airway;each patient was examined as follows:(1)did sinus CT examination and Lund-Mackay CT grading;(2)Endoscopic examination and NP endoscopic score for each patient;(3)Blood samples were collected prior to all endoscopic sinus surgical procedures and the Eosinophil and Neutrophil count in peripheral blood was determined;(4)Pulmonary function test:the following parameters were measured or calculated:vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),force in 1 second Expiratory volume/forced vital capacity(FEV1/FVC),maximal expiratory flow rate at 25,50 and 75 per cent of vital capacity(FEF25%,FEF50%,FEF75%),maximal mid-expiratory flow(MMEF);(5)Haematoxylin and Eosin staining,Immunohistochemical staining,Immunofluorescence staining:evaluation of infiltration of Eosinophils and Neutrophils by HE and IHC staining;immunofluorescence staining to assess epithelial remodeling of NP;(6)Evaluation of Eosinophils and Neutrophils in polyp tissue,when the proportion of Eosinophils or Neutrophils in the specimen exceeds 10%of the total number of inflammatory cells,respectively,it is defined as an increase in Eosinophils or Neutrophils;(7)Evaluation of the epithelium.Where the presence of squamous metaplasia was uncertain;The Mann-Whitney U test was employed to assess for differences between groups.Correlations were analysed using the Pearson correlation test.Values of p<0.05 were considered statistically significant.ResultsEpithelial remodeling:the most common finding was epithelial hyperplasia(84.4 per cent),followed by goblet cell hyperplasia(61.5 per cent)and squamous metaplasia(26.0 per cent).All three types of epithelial remodelling were present in 18.8 per cent of the specimens.In 15.6 per cent of the samples,epithelial remodelling was not found;Eosinophilic infiltration and Neutrophilic infiltration:Eosinophilic infiltration in the tissue was the most common finding(n = 56,56.6 per cent).Up to 41.4 per cent of nasal polyps showed Neutrophilic infiltration.Of the study subjects,24.2 per cent showed peripheral blood Eosinophilia,while only 3.03 percent showed peripheral blood Neutrophilia.As shown in,Eosinophils in nasal polyps tissue revealed a significantly positive correlation with Eosinophils in peripheral blood in both Non-Eosinophilic and Eosinophilic nasal polyps patients(r = 0.2074,p =0.039);compared to the non-asthma group,the asthma group had significantly lower:FEV1(p<0.01),FEV1/FVC(p<0.001),FEF25%,FEF50%,FEF75%(p<0.001,p<0.001 and p<0.01,respectively),and MMEF(p<0.001);In regard to epithelial hyperplasia and goblet cell hyperplasia,no significant changes were found in the lung function parameters,except for reduced FEF25%(p<0.05)in nasal polyps patients with epithelial hyperplasia,and reduced FEF50%(p<0.05)in nasal polyps patients with goblet cell hyperplasia;Inflammatory cells and pulmonary function:when compared to the Non-Eosinophilic nasal polyps patients,the Eosinophilic nasal polyps patients demonstrated significant reductions in:FEV1(p<0.05),FEV1/FVC(p<0.001),FEF25%,FEF50%,FEF75%(p<0.05,p<0.05 and p<0.01,respectively),and MMEF(p<0.01).Compared to nasal polyps patients with a peripheral blood Eosinophil percentage of less than 5 per cent,nasal polyps patients with peripheral blood Eosinophilia showed significant reductions in:FEV1(p<0.05),FEV1/FVC(p<0.01),FEF25%,FEF50%,FEF75%(p<0.01,p<0.01 and p<0.05,respectively),and MMEF(p<0.01).However,no significant differences were found between Non-Neutrophilic and Neutrophilic nasal polyps patients.The Eosinophils in the peripheral blood showed significantly negative correlations with:FEF25%(r =-0.2443,p<0.05)and FEF50%(r =-0.2099,p<0.05),and MMEF(r =-0.2381,p<0.05).The Eosinophils in tissue demonstrated significantly negative correlations with:FEV1(r =-0.2322,p<0.05),FEV1/FVC(r =-0.4787,p<0.001),FEF25%(r =-0.3263,p<0.01),FEF50%(r =-0.3288,p<0.001),and FEF75%(r =-0.3439,p<0.001),and MMEF(r =-0.3588,p<0.001).No significant correlation was found between Neutrophils in tissue and the pulmonary function parameters.ConclusionA close relationship between upper and lower respiratory inflammatory diseases has been reported.Nasal polyps patients with peripheral blood Eosinophilia and tissue Eosinophilia showed poorer pulmonary functions in our study,it suggests that the potential risk of lower respiratory tract inflammatory disease in these patients is greater and should be given full attention.BackgroundAllergic rhinitis(AR)is a non-infectious nasal mucosal inflammation exhibited by IgE-mediated type I allergy in the nose.Common clinical symptoms include:stuffy nose,runny nose,sneezing,loss of olfaction and itchy eyes.There are many kinds of allergens causing AR,such as dust mites,pollen,mold,animal dander and the like.Non-allergic rhinitis is a non-infectious rhinitis with no allergic factors.Its clinical symptoms are similar to AR,but the serum-specific immunoglobulin E(IgE)test or the skin prick test(SPT)is negative.The serum IgE in normal people is very small,but when the patient is sensitized,the serum level will increase rapidly.Elevated serum IgE is one of the main clinical features of AR.The study found that IgE is closely related to the development of asthma.In recent years,a large number of research data show that AR is closely related to asthma,but it is still controversial whether the effects of different allergens on lung function are different.Recent studies have shown that NAR is also a factor in the pathogenesis of asthma,but the mechanism of NAR affecting the lower respiratory tract is unclear.Based on the above situation.This study was performed to observe the lung function of patients with AR and NAR,the lung function of mono-sensitized and poly-sensitized AR patients.Correlation between the level of the peripheral blood total IgE and specific IgE(sIgE)and the indicators of pulmonary function tests of AR patients were also observed.The lung function status of AR patients,NAR and different allergen patients has been evaluated,and the correlation between serum IgE and lung function of AR patients has been evaluated.MethodsA total of 174 patients who were treated in the outpatient department due to clearing,sneezing,nasal itching and nasal congestion in the ENT department of the Second Affiliated Hospital of Shandong University from March 2017 to June 2018;To improve the relevant information after admission to each study group,including history of asthma,history of allergic rhinitis,and acute and chronic respiratory inflammatory lesions.Check item serum allergen test:serum allergen test or SPT in each patient;lung function test contents:vital capacity(VC),forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),force in 1 second Expiratory volume/forced vital capacity(FEV1/FVC),maximum expiratory flow(PEF),maximal expiratory flow rate at 25,50 and 75 per cent of vital capacity(MEF75%,MEF50%,MEF25%or FEF25%,FEF50%,FEF75%),maximal mid-expiratory flow(MEF25-75%or MMEF);Patient grouping and content to be evaluated:? All patients were divided into two groups(AR and NAR)according to serum allergens and skin pricks.The pulmonary function tests were compared between the two groups;? Mono-sensitized patients(Patients allergic to an allergen)were divided into three groups of dust mite,pollen and mold based on serum IgE and Skin prick results,comparing lung function between the three groups;? All patients were divided into mono-sensitized patients and poly-sensitized patients(patients were allergic to more than two allergens)based on serum IgE and Skin prick results,comparing lung function between the two groups of patients;? All patients were divided into two groups according to whether the AR patients were allergic to mold,comparing lung function between the two groups of patients;? The correlation between the levels of total IgE and specific IgE in peripheral blood and the parameters of pulmonary function tests of patients;U test and Chi-square test was employed to assess for differences between groups.Correlations were analysedusing the Pearson correlation test.Values of p<0.05 were considered statistically significant.ResultsPulmonary function test results showed that 79 patients(61.24%)with normal pulmonary ventilation function and 27 patients(20.93%)with small airway dysfunction,mild obstruction there were 23 cases(17.83%)with ventilatory dysfunction in AR patients;25 cases(55.55%)with normal lung ventilation function,8 cases(17.78%)with small airway dysfunction,and 12 cases with mild obstructive ventilatory dysfunction(26.67%)in NAR patients.There were no significant differences in the classification of pulmonary function tests between the AR and NAR groups;There was no statistically significant difference in the distribution of lung function tests between mono-sensitized patients.FEV1/FVC,MEF50%,MEF25%,and MEF25-75%were significantly lower in single mold allergic patients than in single pollen allergic patients(p<0.05,p<0.05,p<0.05,and p<0.005);There was no significant difference in the distribution of pulmonary function tests between mono-sensitized patients and poly-sensitized patients.PEF and MEF75%of poly-sensitized patients were significantly lower than those of poly-sensitized patients(p<0.05 and p<0.05);There was a significant negative correlation between the peripheral total serum IgE and pulmonary ventilation function parameters FEV1,FEV1/FVC,PEF,MEF75%,MEF50%,MEF25%and MEF25-75%in AR patients(r =-0.3157,P<0.01;r =-0.2666,P<0.05;r =-0.2956,P<0.05;r =-0.3944,P<0.005;r =-0.3784,P<0.005;r =-0.2645,P<0.05 and r =-0.3781,P<0.005);The sIgE levels of the dl and d2 groups were significantly negatively correlated with the pulmonary ventilatory function parameter PEF(r =-0.2501,P<0.05).The sIgE levels of the mx2 group were significantly negatively correlated with the pulmonary ventilatory function parameters PEF,MEF50%and MEF25-75%(r =-0.3677,P<0.01;r =-0.3369,P<0.05 and r =-0.3566,P<0.01);There was no significant difference in the distribution of pulmonary function tests between the AR patients were/were't allergic to mold.PEF,MEF75%,MEF50%,and MEF25-75%of AR patients were allergic to mold were significantly lower than those of AR patients were't allergic to mold(p<0.05,p<0.05,p<0.05,and p<0.05).conclusion:? The pulmonary functionpatients parameters PEF and MEF75%of poly-sensitized patients were significantly lower than those of mono-sensitized patients;? The level of total serum IgE in peripheral blood of AR patients was significantly negatively correlated with the parameters of pulmonary function tests;? There was a significant negative correlation between the levels serum sIgE of dust mites and mold patients and the parameters related to lung function;PEF,MEF75%,MEF50%and MEF25-75%of the AR patients were allergic to mold were significantly lower than those of the AR patients were't allergic to mold.The results of the above studies suggest that clinicians should pay attention to the AR patient's lung function when they have the following conditions:poly-sensitized patients,patients with high serum total IgE level,and patients were allergic to mold.