以肥大细胞为靶细胞探索慢性鼻窦炎伴鼻息肉内在型的初步研究

A Preliminary Exploration of Chronic Rhinosinusitis with Nasal Polyps Endotypes Based on Mast Cells as Target Cells

摘要: 目的：通过高倍镜下计数鼻息肉组织中的肥大细胞数目，分析其与患者临床特征的相关性，评估肥大细胞能否作为CRSwNP内在型分型的靶细胞。方法：回顾性纳入2021年3月至2024年6月于青岛大学附属医院就诊的361例CRSwNP患者，收集人口学、合并症及检验检查资料。鼻息肉组织行HE和CD117染色，计数肥大细胞与嗜酸性粒细胞。以肥大细胞计数中位数为界，分为肥大细胞型与非肥大细胞型组；依据JESREC标准，分为嗜酸性组与非嗜酸性组。采用t检验、χ²检验比较组间基线差异，分析两种细胞计数与临床指标的相关性，并通过单因素及多因素Logistic回归分析筛选肥大细胞型及嗜酸性鼻息肉分型的独立预测因素。结果：肥大细胞型与嗜酸性型CRSwNP均与外周血嗜酸性粒细胞百分比、Lund-Mackay评分及过敏状态呈正相关。多因素分析显示，组织嗜酸性粒细胞计数和Lund-Mackay评分是肥大细胞型的独立危险因素，外周血嗜酸性粒细胞百分比和Lund-Mackay评分是嗜酸性型的独立危险因素。结论：肥大细胞型与嗜酸性粒细胞型CRSwNP对疾病严重程度和临床特征的指示作用相近。但肥大细胞分型更依赖于局部组织2型炎症的严重程度，能识别出外周血嗜酸性粒细胞正常而组织嗜酸性粒细胞增高的隐匿性2型炎症，弥补JESREC标准对局部病理重视不足的局限。对肥大细胞增多的患者，可考虑靶向肥大细胞的治疗策略(如奥马珠单抗)，为临床提供更全面的治疗选择。

Abstract: Objective: To quantify mast cells in nasal polyp tissue under high-power field, analyze their correlation with clinical characteristics, and evaluate whether mast cells can serve as target cells for the endotyping of chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: A total of 361 patients with CRSwNP treated at the Affiliated Hospital of Qingdao University from March 2021 to June 2024 were retrospectively enrolled. Demographic data, comorbidities, and laboratory and imaging findings were collected. Nasal polyp tissues were stained with hematoxylin and eosin (HE) and CD117 for mast cell and eosinophil counting. Patients were classified into mast cell-high and mast cell-low groups based on the median mast cell count, and into eosinophilic and non-eosinophilic groups according to the JESREC criteria. Intergroup differences in baseline characteristics were compared using the t-test or χ² test. Correlations between the two cell counts and clinical parameters were analyzed, and univariate and multivariate logistic regression analyses were performed to identify independent predictors for the mast cell-high and eosinophilic endotypes. Results: Both mast cell-high and eosinophilic CRSwNP were positively associated with blood eosinophil percentage, Lund-Mackay score, and atopic status. Multivariate analysis revealed that tissue eosinophil count and Lund-Mackay score were independent risk factors for the mast cell-high endotype, while blood eosinophil percentage and Lund-Mackay score were independent risk factors for the eosinophilic endotype. Conclusion: The mast cell-high and eosinophilic endotypes of CRSwNP exhibit comparable indicative value for disease severity and clinical features. However, mast cell-based endotyping is more dependent on the severity of local type 2 inflammation and may identify occult type 2 inflammation in patients with normal blood eosinophil percentages but high tissue eosinophil counts, thereby compensating for the insufficient emphasis on local histopathology in the JESREC criteria. In patients with elevated mast cell counts, mast cell-targeted therapies, such as omalizumab, may be considered, offering a more comprehensive treatment approach.