Effect Of Specific Immunotherapy Combined With Nasal Irrigation In Postoperative Patients With Chronic Rhinosinusitis With Comorbid Allergic Rhinitis

Background: There is a close relationship between chronic rhinosinusitis(CRS)and allergic rhinitis(AR).CRS patients have a higher incidence of AR.And chronic rhinosinusitis with AR(CRSwAR)patients have more severe condition,AR is more difficult to control,and endoscopic sinus surgery(ESS)is less effective,with a higher rate of recurrence after surgery.Therefore,for the treatment of CRSwAR,in addition to nasal endoscopic surgery,the establishment of an effective comprehensive respiratory tract treatment strategy is of great significance not only to improve patients' symptoms and quality of life,but also one of the key factors to prevent AR progression and improve efficacy.Objectives: To explore whether specific immunotherapy(SIT)supplemented with nasal irrigation can treat inflammatory diseases of respiratory tract and improve the prognosis of CRS with AR synergistically after performing ESS.Methods: Patients who were diagnosed as CRS with AR and receivedESS were enrolled.According to the postoperative treatment strategies of patients(conventional drug treatment,drug treatment and nasal irrigation,and drug treatment with nasal irrigation and SIT),they were divided into three groups: group A,B,and C.Patients with preoperative nasal symptoms(nasal congestion,purulent discharge,etc)or polyps found by endoscopy one year after the surgery were recorded as recurrence.Visual analog score(VAS),nasal sinus outcome test-22(SNOT-22)scale score and total nasal symptom score(TNSS)were collected before ESS,3months,6 months and 1 year after surgery,calculate the difference between the postoperative score and the baseline score.The nasal mucosa of the patients was obtained before operation and 1 year after surgery,a part of that for transmission electron microscopy(TEM)and scanning electron microscopy(SEM),and a part of the nasal mucosa was detected by ELISA for the expression levels of related inflammatory factors(ECP,IL-8,IFN-?,IL-25,IL-33 and IL17)in nasal mucosa tissue homogenate.Compare the difference between patients who relapsed and non-relapsed before the treatment,and the difference between different treatment groups after treatment.The differences were tested by one-way ANOVA analysis,and differences were considered significant when p<0.05.Results: One year after surgery,the recurrence rate in group A was22.2%,that in group B was 10%,and no one in group C had relapse symptoms.In the third month after surgery,there was no significantdifference in the scores from baseline of the three treatment groups.At 6months,the VAS score and SNOT-22 score from baseline were significantly different among the three groups,while TNSS was not significantly different.One year after surgery,there were significant differences among the three scores from baseline in each group.One year after surgery,the epithelium arrangement,cilia morphology and inflammation of nasal mucosa in each group were better than those in the preoperative state;and the nasal mucosa in group C was better than groups A and B,and group B was better than group A.The expression levels of ECP and IL-17 in the nasal mucosa of the relapsed patients group were higher than that of the non-relapsed group,and the difference was statistically significant(P <0.05).There was no significant difference in the expression levels of IL-8,IFN-?,IL-25 and IL-33 between the two groups(P> 0.05).There was no significant difference in the expression levels of inflammatory mediators between groups before operation(P> 0.05).One year after operation,the expression levels of ECP,IL-8 and IL-17 in the nasal mucosa of group B were lower than those of group A(P <0.05);The expression level of ECP,IL-8,IL-25,IL-33,IL-17 in group C was lower than that in group A(P <0.05);and the expression levels of ECP,IL-25 and IL-17 in group C were lower than those in group B(P<0.05).Conclusion: Specific immunotherapy combined with nasal irrigation can reduce the recurrence rate of patients with CRSwAR after ESS,improve patients' symptoms and improve their qualities of life;promote the epithelialization of the mucosa in the surgical cavity;regulate the local immune response of the nasal cavity and improve the inflammatory response;thus improve the prognosis of patients with ESS after 1 year.