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Effect of budesonide transnasal nebulization in patients with eosinophilic chronic rhinosinusitis with nasal polyps

机译：布地奈德经鼻雾化吸入对嗜酸性粒细胞性慢性鼻 - 鼻窦炎鼻息肉的影响

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Background: There is little evidence on the efficacy of glucocorticoid transnasal nebulization therapy in patients with eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP). Objective: We sought to evaluate the immunologic and remodeling effects of budesonide transnasal nebulization in patients with eosinophilic CRSwNP. Methods: Sixty patients with eosinophilic CRSwNP were randomized to receive budesonide or placebo treatment for 14 days by means of transnasal nebulization in a double-blind manner. Endoscopic polyp size scores (maximum 5 6 points, Kennedy score) and visual analog scale scores for nasal symptoms were assessed before and after treatment. Similarly, polyp samples were evaluated for inflammatory cytokines, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) by using an immunoassay; collagen by using histochemistry; eosinophils by using hematoxylin and eosin stain; and T-cell subsets by using flow cytometry. Results: Budesonide transnasal nebulization significantly reduced polyp size compared with placebo (mean difference between groups, 20.73 units; 95% CI, -1.15 to -0.32 units; P = .002) and improved symptoms. Polyp IL-5 and eotaxin expression decreased significantly, whereas TGF-beta and IL-10 expression increased. Expression of IFN-gamma and IL-17 was not altered. Budesonide transnasal nebulization consistently reduced eosinophil infiltration and T(H)2 cell frequency and increased natural regulatory T-cell and type 1 regulatory T-cell frequencies. Indices of remodeling, including albumin, MMP-2, MMP-7, MMP-8, and MMP-9, were significantly decreased, whereas collagen deposition and TIMP-1, TIMP-2, and TIMP-4 levels were significantly increased. Budesonide transnasal nebulization did not suppress the hypothalamicpituitary-adrenal axis or cause any serious side effects. Conclusion: Short-term budesonide transnasal nebulization is an effective and safe treatment option in patients with eosinophilic CRSwNP, achieving clinical improvement by regulating remodeling, cytokine expression, and T-cell subset distribution.
机译：背景：糖皮质激素经鼻雾化治疗对嗜酸性粒细胞增多性慢性鼻鼻窦炎伴鼻息肉（CRSwNP）的疗效尚无证据。目的：我们试图评估布地奈德经鼻雾化对嗜酸性CRSwNP患者的免疫学和重塑作用。方法：将60例嗜酸性CRSwNP患者随机分为双盲经鼻雾化接受布地奈德或安慰剂治疗14天。在治疗前后分别评估鼻内窥镜检查息肉大小评分（最高5 6分，肯尼迪评分）和视觉类似物评分评分。同样，通过免疫分析评估息肉样品的炎性细胞因子，基质金属蛋白酶（MMP）和金属蛋白酶组织抑制剂（TIMP）。使用组织化学的胶原蛋白；使用苏木精和曙红染色的嗜酸性粒细胞；流式细胞仪检测T细胞和T细胞亚群结果：与安慰剂相比，布地奈德经鼻雾化术可显着降低息肉大小（组间平均差为20.73单位； 95％CI为-1.15至-0.32单位； P = 0.002），且症状得到改善。息肉IL-5和嗜酸性粒细胞趋化因子的表达明显降低，而TGF-β和IL-10表达增加。 IFN-γ和IL-17的表达未改变。布地奈德经鼻雾化持续减少嗜酸性粒细胞浸润和T（H）2细胞频率，并增加自然调节性T细胞和1型调节性T细胞频率。重塑的指标（包括白蛋白，MMP-2，MMP-7，MMP-8和MMP-9）显着降低，而胶原蛋白沉积和TIMP-1，TIMP-2和TIMP-4水平显着提高。布地奈德经鼻雾化不能抑制下丘脑-垂体-肾上腺轴或引起任何严重的副作用。结论：短期布地奈德鼻腔雾化是嗜酸性CRSwNP患者的一种安全有效的治疗选择，可通过调节重塑，细胞因子表达和T细胞亚群分布实现临床改善。

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