Comparison of subjective and objective assessment of glucocorticoid response in nasal polyps: a preliminary study

Abstract

Background: Glucocorticoids (GC) therapeutic response in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) varies markedly.

Aims/Objectives: To compare the utility between subjective and objective assessment of GC sensitivity in reflecting the impact of GC on systemic and local eosinophilia in CRSwNP patients.

Material and methods: Twenty-six patients with CRSwNP were enrolled. All patients were given 30 mg of prednisone once daily for 7 days and subsequently classified into subjectively GC-sensitive and -insensitive subgroup or objectively GC-sensitive and -insensitive subgroup. The numbers of eosinophils and neutrophils in blood and polyp tissues were compared between GC-sensitive and GC-insensitive subgroup.

Results: 17/26 (65.4%) patients were subjectively and 8/26 (30.8%) patients objectively sensitive to GC treatment. The absolute number and percentage of eosinophils in blood were decreased both in GC-sensitive and -insensitive subjects after GC treatment. In addition, a significant reduction in tissue eosinophil percentage was only observed in objectively GC-sensitive subjects after GC treatment. Furthermore, the change of tissue eosinophil percentage in objectively GC-sensitive subjects was significantly higher than that in objectively GC-insensitive subjects.

Conclusions and significance: Objective assessment may better reflect oral GC response in tissue eosinophilic inflammation than subjective assessment in patients with CRSwNP.

Chinese abstract

背景：糖皮质激素（GC）治疗伴鼻息肉的慢性鼻窦炎（CRSwNP）的疗效之间有明显差异。

目的：比较主观和客观评估GC敏感性的效用, 该敏感性反映在GC对CRSwNP患者全身和局部嗜酸性粒细胞增多的影响。

材料与方法：26例CRSwNP患者入选。所有患者每天服用一次30毫克强的松, 持续7天, 随后分为主观GC敏感和不敏感亚组或客观GC敏感和不敏感亚组。比较GC敏感亚组和GC不敏感亚组的血液和息肉组织中嗜酸性粒细胞和中性粒细胞的数量。

结果：26名患者中有17例（65.4%）对GC治疗有主观敏感性, 8例（30.8%）对GC治疗有客观敏感性。GC治疗后, 血液中嗜酸性粒细胞的绝对数和百分比在GC敏感和不敏感受试者中均下降。另外, 只有在客观GC敏感受试者接受GC治疗后, 组织嗜酸性粒细胞百分比才会显著降低。此外, 客观GC敏感受试者的组织嗜酸性粒细胞百分比的变化明显高于客观GC不敏感受试者。

结论与意义：客观评价比主观评价更能反映CRSwNP患者的组织嗜酸性粒细胞性炎症对口服GC的反应。

Keywords:

• Chronic rhinosinusitis
• Nasal polyps
• Glucocorticoid
• Total nasal symptom score
• Nasal polyp size score

Acknowledgements

We thank the nurses of Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University for collecting the study samples.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Natural Science Foundation of China [81873691, 81500768 and 81770975]; Science and Technology Program of Guangzhou [201803010110 and 201605030003]; China Postdoctoral Science Foundation Grant [2018T110914 and 2018M633245]