Analysis Of Factors Related To Eosinophilic Nasal Polyps And Construction Of Predictive Models

Objective: Eosinophilic Chronic Rhinosinusitis with Nasal Polyps(e CRSw NP)is a type of nasal polyp characterized by eosinophilic infiltration.Compared with non-eosinophilic chronic Rhinosinusitis with Nasal Polyps(ne CRSw NP),e CRSw NP has high expression of Ig E and IL-5 in tissue,severe type 2 inflammatory response,extensive lesion coverage,and severe symptoms,the postoperative recurrence rate is high,the drug treatment effect is poor,often accompanied by rhinitis and asthma,and is sensitive to glucocorticoid treatment.At present,the diagnosis of e CRSw NP relies on histopathology examination.It is difficult to make a clear diagnosis and effective treatment before operation due to the trauma and poor acceptance of patients.This article analyzes the clinical data of peripheral blood composite inflammatory markers,JESREC score,Lund Mackay score,and other clinical data of e CRSw NP and ne CRSw NP patients,and establishes a joint prediction model.It is hoped to provide a simple,accurate,and fast method for the diagnosis of e CRSw NP;By analyzing the correlation between peripheral blood composite inflammation indicators and Ig E/IL-5in nasal polyp tissue,it is hoped to provide scientific reference for the application of Ig E and IL-5 monoclonal antibodies.Methods: Select 100 CRSw NP patients who underwent functional endoscopic surgery at the Otolaryngology Department of Qingdao University Affiliated Hospital from January2019 to December 2022.Collect clinical data such as preoperative sinus CT examination,fiberoptic laryngoscopy,Self-reporting Inventory,and CBC results from patients.Perform HE and Ig E/IL-5 immunohistochemical staining on polyp tissue sections,analyze and calculate Lund Mackay imaging score,Lund Kennedy nasal endoscopy score,JESREC score,SNOT22 symptom score,NLR and other composite inflammatory indicators,as well as immunohistochemical positive cell count and sum IOD.According to the infiltration of eosinophils in HE staining,patients with nasal polyps were divided into e CRSw NP and ne CRSw NP groups.Statistical methods such as Mann Whitney U test,Student’s t-test,and Chi-square test were used to analyze the differences in clinical data,various scores,peripheral blood composite inflammation indicators,immunohistochemistry positive cell count,and sum IOD between the two groups of patients.Single factor binary logistic and multi factor binary logistic regression analysis were used to determine the independent risk factors for e CRSw NP.A predictive model for e CRSw NP was established and a column chart was drawn.The predictive value was evaluated using the receiver operator characteristic curve.Use Spearman correlation analysis to evaluate immunohistochemical positive cell count,sum IOD,and peripheral blood composite inflammation indicators.Results:(1)Age,gender,BMI,smoking history,nasal septum deviation history,medical history(month),Lund Kennedy score had no statistical difference between the two groups(p>0.05).Compared with ne CRSw NP patients,e CRSw NP patients have higher peripheral blood EOS(%),ELR(%),ENR(%)values,and lower PLR,SII,and SIRI,with statistical differences(p<0.05);At the same time,the CT score,JESREC score,and subjective symptom SNOT22 score of e CRSw NP group patients were significantly higher than those of ne CRSw NP group patients;Moreover,the e CRSw NP group had a higher incidence of concomitant asthma and decreased olfactory symptoms.(2)Olfactory decline,Lund Mackay score,SNOT22 subjective score,JESREC score,as well as EOS(%),NLR,ELR(%),ENR(%),SII in peripheral blood inflammation indicators,were all correlated with e CRSw NP,and the results were statistically significant(p<0.05).(3)The JESREC score,concomitant olfactory dysfunction symptoms,and peripheral blood composite inflammatory index ENR(%)are associated with e CRSw NP and are independent risk factors for e CRSw NP(p<0.05).Establishing a joint prediction model for independent risk factors of e CRSw NP,with a C-index value of 0.918 and a 95% CI of 0.862-0.974.This model has high predictive value.(4)The use of ROC curves to evaluate the joint prediction model has the highest predictive value(AUC=0.918),with a sensitivity of 0.822 and a specificity of 0.927,both of which are better than single indicator predictions and can be used as the best predictive indicator.(5)The number of IL-5 histochemical staining positive cells and sum IOD in the e CRSw NP group were significantly higher than those in the ne CRSw NP group,with statistical significance(p<0.05);The positive cell count and sum IOD of Ig E histochemical staining were significantly higher than those of the ne CRSw NP group,with statistical significance(p<0.05).(6)EOS(%),ELR(%),ENR(%)were moderately positively correlated with tissue Ig E histochemical staining positive cell count and sum IOD,IL-5 histochemical staining sum IOD(0.5 ≤ r ≤ 0.7,p<0.05);NLR,SIRI showed a low degree of negative correlation with Ig E and IL-5 histochemical staining positive cell counts(0.2 ≤ r<0.5,p<0.05),while there was no linear correlation with Ig E positive cell counts,sum IOD,and IL-5 sum IOD(p>0.05).There was no linear correlation(p>0.05)between peripheral blood composite inflammatory markers(LMR,SII,PLR)and the positive cell count of Ig E and IL-5 in tissues,as well as sum IOD.Conclusion: The joint prediction model established by integrating independent risk factors can accurately distinguish e CRSw NP and ne CRSw NP patients,providing a safer,more reliable,and simpler diagnostic method for e CRSw NP patients,and providing reference for personalized and precise treatment.EOS(%),ELR(%),and ENR(%)can to some extent reflect the concentration of Ig E and IL-5 in polyp tissue,and have the potential to be used as indicators to evaluate the concentration of Ig E and IL-5 in tissue and guide clinical monoclonal antibody therapy.