Clinical Features Of Chronic Sinusitis With Bilateral Nasal Polyps And Analysis Of Its Single Nucleotide Polymorphisms

Chapter 1 Clinical features of different phenotypes in patients with chronic sinusitis with bilateral nasal polypBackground and Objective:To investigate the clinical features of different phenotypes in patients with chronic sinusitis with bilateral nasal polyps,and the correlation between clinical data.Methods :We retrospectively studied 134 patients with chronic sinusitis with bilateral nasal polyps.According to histopathological HE staining,the lamina propria and infiltrating inflammatory cells were observed by light microscopy(×400)magnification,and the number of eosinophils was recorded.According to whether the total number of eosinophils per high power field is greater than 20,The patients were divided into(eosinophilic chronic sinusitis with bilateral nasal polyps,ECRSwBNP)group and(noneosinophilic chronic sinusitis with bilateral nasal polyps,non-ECRSwBNP)group.The clinical features between the two phenotypes were analyzed and compared by medical history collection,skin prick test,nasal secretion examination,serum total IgE level,peripheral blood test,nasal endoscopy,and sinus CT examination.Results :ECRSwBNP group and non-ECRSwBNP group with asthma(19.0%,0),atopy(26.6%,9.1%),recurrence rate(54.4%,30.9%),the ratio of EOS in peripheral blood(4.8%,1.9%),the ratio of EOS in nasal secretions(10.0%,2.0%)and total serum IgE levels(82.15 IU/L,25.80 IU/L)were statistically significant(P<0.05).In the sinus CT score,posterior ethmoid sinus(2.0,1.0),total ethmoid sinus(5.0,4.0),sphenoid sinus(3.0,2.0),Olfactory cleft(OC)(4.0,2.0),the ratio of thee thmoid sinus/maxillary sinus(2.0,1.0)was statistically significant(P<0.05),while the rest were not statistically significant.The OC score,the ratio of peripheral blood EOS,the ratio of the posterior ethmoid sinus/ anterior ethmoid sinus,and the ratio of the ethmoid sinus/maxillary sinus can be used as a diagnosis for whether the CRSwBNP patient is an eosinophilic type(AUC>0.5),but the OC score under the ROC curve is the largest area with the highest diagnostic value.When the OC score is 3 or higher,the predicted value specificity is 80.9% and the sensitivity is 52.1%.Conclusion: Patients with chronic sinusitis with bilateral nasal polyps have a certain proportion of asthma and atopy,that these patients are prone to recurrence.Among them,nasal polyps mainly characterized by eosinophil infiltration in tissues are more likely to occur.Targeted treatment based on phenotype should be considered in the clinic.Chapter 2 Analysis of multiple candidate loci and chronic rhinosinusitis with bilateral nasal polypsBackground and purpose: To investigate the susceptibility of single nucleotide polymorphisms(SNPs)of IL-4,FCεR1α,DCBLD2,FADS1 and RANTES genes to chronic sinusitis with bilateral nasal polyps in Jiangsu and Anhui populations.Methods: Case-control method,249 cases were collected samples,including chronic sinusitis with bilateral nasal polyps patients of 141 cases as cases,108 cases of healthy physical examination as a control.Relevant clinical data were collected,physical examination,medical history consultation and related auxiliary examinations were conducted,and 3m L of peripheral anticoagulation blood was extracted at the same time.The genotyping of IL-4 rs2243250,FCεR1α rs2427827,FADS1 rs174556,DCBLD2(the human discoidin,CUB and LCCL domain containg2)rs828618,RANTES(rs2107538 and rs2280788),5 genes and 6 loci was performed by using Mass ARRAY i PLEX GOLD typing technique.Results: Compared with the clinical data,there was no statistical difference in age and gender distribution between chronic sinusitis with bilateral nasal polyps and the control group(P>0.05).Logistic regression analysis results showed that IL-4 genes rs2243250,FCεR1α gene rs2427827,RANTES gene rs2280788,FADS1 rs174556 polymorphism loci of chronic sinusitis with bilateral nasal polyps on both sides there is no correlation,while the rs828618 polymorphism of the DCBLD2 gene,the mutation allele A and the wild type allele G were found to significantly increase the risk of CRSw BNP,and the difference was statistically significant(P=0.021,OR=1.53,95% CI=1.07-2.21).The mutation allele T in the rs2107538 polymorphism of the RANTES gene was significantly increased in the risk of CRSw BNP compared with the wild type allele C(P=0.037,OR=0.68,95%).CI=0.47-0.98),and we found that the sum of heterozygous mutant gene CT and homozygous mutant gene TT was statistically significant in CRSw BNP compared with the control group(P=0.031,OR=0.57,95%CI= 0.34-0.95),however,the homozygous mutant gene TT was not statistically different between the two groups.In the linkage disequilibrium analysis,we found(RANTES rs2107538/rs2280788)CG-type gene combination(P=0.037,OR=0.68,95% CI=0.47-0.98)to protect against chronic sinusitis with bilateral nasal polyps.Conclusion: The rs2243250 of IL-4 gene,rs2427827 of FCεR1α gene,rs2280788 of RANTES gene and rs174556 of FADS1 gene are not associated with chronic sinusitis with bilateral nasal polyps.The polymorphism site of DCBLD2 gene rs828618 and RANTES gene rs2107538 is associated with susceptibility to chronic sinusitis with bilateral nasal polyps.