Highlights of eosinophilic chronic rhinosinusitis with nasal polyps in definition, prognosis, and advancement

• Published in: International forum of allergy & rhinology Vol. 8; no. 11; pp. 1218 - 1225
• Main Authors: Lou, Hongfei, Zhang, Nan, Bachert, Claus, Zhang, Luo
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2018; John Wiley and Sons Inc
• Subjects: Biomarkers; Chronic Disease; chronic rhinosinusitis; classification; cluster analysis; Cultural differences; diagnosis; endotype; Eosinophilia; eosinophils; Humans; Interleukin 5; Leukocytes (eosinophilic); Literature reviews; Mucosa; Nasal Polyps; pathology; Patients; phenotype; Polyps; Precision medicine; Prognosis; Review; Rhinitis; Rhinosinusitis; Sinusitis; phenotype; pathology; endotype; chronic rhinosinusitis; nasal polyps; diagnosis; eosinophils; classification; cluster analysis; prognosis
• ISSN: 2042-6976; 2042-6984; 2042-6984
• DOI: 10.1002/alr.22214

Background Tissue eosinophils are characteristic of inflammation in most but not all patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and may be useful for defining subgroups and making treatment choices. However, no consistent diagnostic criteria for CRSwNP with eosinophilic inflammation have been established. Methods Related literature review was performed and current developments in the diagnosis of eosinophilic CRSwNP were summarized. Details in histopathology, definition of tissue eosinophilia, eosinophil as an indicator of disease recurrence, eosinophilic shift, and related biomarkers in CRSwNP are included in this review article. Results Mucosal eosinophilia exhibits significant geographic and ethnic differences and may increase over time. Tissue eosinophilia can be defined using a cutoff value based on reference values from healthy mucosa, but typical disease‐specific values should also be employed to increase sensitivity and specificity for clinical use. Recent developments highlight the diagnostic criteria for eosinophilic CRSwNP based on cluster analysis, which were also associated with clinical outcomes. Additionally, some promising eosinophil‐relevant biomarkers, such as eosinophilic cation protein and interleukin 5 (IL‐5), may be clinically applied as diagnostic or predictive tools for CRSwNP in the future. Conclusion Sinonasal tissue eosinophilia is present in a majority of CRSwNP patients but is currently more common in the West than in the East. Cutoff values of eosinophils as the diagnostic criteria of eosinophilic CRSwNP are subject to change with geographic and ethnic differences over time. It will be important to identify validated eosinophil‐related biomarkers in different continents/countries for future research and for the introduction of precision medicine. 背景 绝大部分慢性鼻窦炎伴鼻息肉 (CRSwNP) 患者存在组织炎性嗜酸性粒细胞浸润的特点。这一表现可能对疾病亚群的明确及治疗策略的选择有所裨益。然而, 迄今为止尚未有关于CRSwNP嗜酸性粒细胞炎症浸润的统一诊断标准。 方法 通过对相关文献进行回顾, 我们对目前有关嗜酸性粒细胞浸润型CRSwNP的诊断最新进展进行总结。本篇综述性文章中涵盖了其病理学特点、组织嗜酸性粒细胞浸润的定义、嗜酸性粒细胞作为疾病复发、嗜酸性转换及相关的生物学标记物的指标等问题的总结和讨论。 结果 黏膜嗜酸性粒细胞浸润呈现显著的地理学及种族差异特点, 并且随着时间推移有逐渐增加的趋势。组织嗜酸性粒细胞浸润可以通过临界值进行定义, 临界值的确定基于来之正常黏膜的参考值, 但是典型的疾病‐特异值也应该明确以提升其在临床应用中的敏感性及特异性。新近研究基于聚类分析结果明确嗜酸型CRSwNP的诊断标准, 且与临床预后相关联。此外, 有一些富有前景的嗜酸性粒细胞‐相关生物标记物, 比如嗜酸性粒细胞阳离子蛋白、白介素5 (IL‐5) , 或可作为将来CRSwNP临床诊断或预后评估的辅助工具。 结论 鼻窦组织嗜酸性粒细胞浸润存在于大部分CRSwNP患者中, 西方CRSwNP患者相较东方患者这一特点更为明显。诊断嗜酸性粒细胞型CRSwNP的嗜酸性粒细胞浸润临界值受地域、种族乃至时间推移的变化所影响。明确针对不同大洲/国家的嗜酸性粒细胞‐相关生物标志将对未来研究有所裨益, 利于精准医学的应用推广。