Savlevich E.L., Gaganov L.E., Gerasimov A.N., Kurbacheva O.M., Egorov V.I., urochka A.V. Analysis of clinical course of chronic rhinosinusitis with nasal polyp (CRSWNP) and pathomorphological composition of nasal polyp tissue in patients living in different regions of the Russian Federation. Head and neck. Russian Journal. 2021;9(3):15–24 (In Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex pathologic process. It is regulated by different cytokines and biologically active molecules produced by various cells that are participating in inflammatory response. The study objective was to conduct analysis of the clinical data and the nasal polyp pathomorphological data in CRSwNP patients living in 29 regions of the Russian Federation geographically distant from each other.
Material and methods. The authors assessed the questionnaire results filled in by attending physicians, and the nasal polyp tissue of 512 patients of 27 nationalities from 29 regions of the Russian Federation referred for surgical treatment with a diagnosis of bilateral CRSwNP. Histological types of nasal polyps and eosinophil-neutrophil index (ENI) — the ratio of mean number of eosinophils to mean number of neutrophils — were assessed by microscope with magnification of 400x in ten fields of view. According to the questionnaire, following information was compared: heredity, nationality, comorbidities (asthma, respiratory allergy, NSAID intolerance), duration of CRSwNP, number of surgeries for CRSwNP and time window between them, conservative treatment in every region. Results and conclusions. Across the 29 analyzed regions of the Russian Federation, the eosinophil type of CRSwNP inflammation is predominant accounting for 81.69%, regardless of nationality, gender, climatic conditions, and region of residence of patients. Mixed type of nasal polyps was recorded in 5.71% of cases, and neutrophilic type – in 12.6% of cases. Maximum intensity of eosinophilic infiltration defined by ENI was revealed in people of Asian nationalities (Me = 10.5 [3; 16] vs 7 [3; 18] in the group of European nationalities and 6.5 [3.75-60.25] in a separate group of Caucasian peoples. Correlation analysis in patients with CRSwNP (gender, presence of comorbidities and respiratory allergy) did not show significant difference depending on patients’ nationality. The frequency of the neutrophilic type of inflammation in nasal polyps ranges from 0 to 40% in regions located at a considerable distance from each other. Comorbid pathology in the form of respiratory allergy, bronchial asthma and intolerance to non-steroidal anti-inflammatory drugs increases the intensity of eosinophilic inflammation in nasal polyps compared to isolated CRSwNP. All patients with CRSwNP have recommendation to be supervised by an allergologist-immunologist with assessment for asthma and respiratory allergy. All the patients with CRSwNP should be followed and treated by a multidisciplinary team.
Key words: chronic rhinosinusitis with nasal polyps, endotypes, eosinophils, neutrophils, asthma, respiratory allergy, NSAIDs-intolerance, eosinophil-neutrophil index
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. The work was carried out with the financial support of the Russian Foundation for Basic Research (project No. 17-04-01750 “a”).