Study On Classification And Clinical Features Of Eosinophilic Chronic Rhinosinusitis

Objective To verify the histological type of chronic rhinosinusitis(CRS)according to the degree of eosinophil infiltration in the tissue.Then,CRS can be devided into eosinophilic CRS(ECRS)and non-ECRS(NECRS).To observe the trend of ECRS composition ratio in recent 12 years.To analyze the clinical symptoms,the percentage of peripheral blood eosinophils,paranasal sinus computed tomography,prognosis,to find the reference index of CRS classification before operation,and to provide clinical basis for CRS classification therapy.Methods In accordance with CRS diagnostic criteria,three hundred and thirty patients were included.According to the histopathological type,the patients were divided into three groups: edema type,glandular hyperplasia type and fiber type.The differences of CRS in different EOS infiltration were compared.According to postoperative histopathological examination and percentage of nasal tissue eosinophils,ECRS was determined as the percentage of eosinophil was 15% or more and NECRS as the percentage was less than 15%,and depicted the change curve of ECRS composition ratio and the mean of tissue eosinophil percentage in the past 12 years,and observed the change trend.Evaluated all patients' clinical features by recording symptom scores and duration,testing peripheral blood EOS% level,doing nasal endoscopy and sinus CT to assess the severity of nasal cavity,comparing symptom scores before and after surgery.Compared these datas,and SPSS 22.0 was used for data processing.Results(1)There were no significant differences in the sex and age between the three groups of CRS cases with different histopathological type(P >0.05).But the difference of three groups according to the degree of eosinophil infiltration in the tissue was obvious(P =0.000409).(2)There was no regular trend in ECRS composition or percentage of nasal tissue eosinophils in the past 12 years.(3)There was no significant difference in sex and age between ECRS group and NECRS group(P>0.05).(4)The duration of ECRS was 12.00 [5.50;30.00] months,and the NECRS group was 9.00 [2.50;36.00] months,the difference was not statistically significant(P>0.05).(5)The peripheral blood eosinophil percent in the ECRS group was 5.10 [3.00;7.60],which was significantly higher than that of the NECRS group(1.90 [1.20;3.55]),and the difference was statistically significant(P = 6.14×10-10).The tissue eosinophil percent was associated with peripheral blood eosinophil percent in ECRS(r=0.49).When peripheral blood EOS% ?4.15%,the sensitivity of diagnosis of ECRS was 64%,and the specificity was 81.8%.(6)However,the result of endoscopic examination between two groups was no difference(P>0.05).(7)The total score of sinus CT in ECRS group was10.00 [7.00;16.00] and 8.00 [5.50;12.00] in NECRS group,the results were statistically significant(P = 0.041);the score of the anterior ethmoid sinus in the ECRS group(2.00 [2.00;3.00])was higher than the score of the NECRS group(2.00 [1.00;2.00]),the difference was statistically significant(P = 0.045);ECRS group's score of posterior ethmoid(2.00[2.00;3.00])was higher than NECRS group's(2.00 [1.00;2.00]),the results were statistically significant(P = 0.018);the score of frontal sinus,maxillary sinus,ethmoid / maxillary sinus values,sphenoid sinus and OMC in ECRS group and NECRS group were not statistically significant(P> 0.05).(8)The prevalence of pansinusitis in the ECRS group(22.88%)was significantly higher than that in the NECRS group(11.86%),the results were statistically significant(P = 0.008);the rate of posterior ethmoid sinus in the group of ECRS group(96.08%)was significantly higher than that in NECRS group(81.92%)(P = 0.00006);the rate of maxillary sinus was 98.04% in ECRS group and 88.14% in NECRS group,and there was significant difference between the two groups(P = 0.001).There was no difference in the prevalence of frontal sinus,anterior ethmoid sinus,sphenoid sinus and OMC on CT between two groups(P>0.05).(9)One year after FESS evaluation showed the postoperative symptoms of ECRS group were significantly reduced(P <0.01).The results were same to the NECRS group but aside from head and face pain(P>0.05).But there was no significant difference in the postoperativesymptom scores between the two groups(P>0.05).Conclusions CRS in the northeastern region of China can be classified according to the degree of eosinophil infiltration in the tissue.In the past 12 years,the trend of ECRS composition ratio has no significant characteristics.Compared with NECRS,ECRS had heavier sinus lesion range and extent,in which the ethmoid sinus was the most serious and the posterior ethmoid sinus and maxillary sinus were most vulnerable,and ECRS is more susceptible to the pansinusitis.Increased percentage of peripheral blood eosinophils can be used as a reference index for preoperative CRS typing.Making a classification of CRS at early stages will contribute to precise clinical treatment.