Nazal polipozisli hastalarda eozinofil/nötrofil oranları ile klinik bulguların korelasyonu
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Date
2014
Authors
Tecimer, Sevilay H.
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Publisher
Uludağ Üniversitesi
Abstract
Nazal polipozis gelişimi ile ilgili olarak günümüze kadar ortaya atılan pek çok teori arasında, henüz kesinlik kazanan bir teori bulunmamaktadır. Nazal polip dokuları histolojik olarak nötrofil ve eozinofil gibi inflamatuar hücrelerin infiltrasyonu ile karakterizedir. Nazal poliplerin, eozinofilik ve nötrofilik olarak ayrımının yapılmasının klinik önemini, bölgesel hakimiyetini ve nazal polipli hastaların takibinde, tedavi aşamasında bu bulguların önemini göstermeyi amaçladık. Geriye yönelik yapılan klinik bulgu taramasında, nazal polip tanısı ile tedavi edilen 40 hasta dosyası değerlendirildi. Hastaların şikayetleri ve hastalık hikayesi, endoskopi ve BT sonuçları, prick testi sonuçları, polip dokusunun biyopsi sonuçları ve tedavi sonrası değerlendirme kayıtları incelendi. Eozinofilik nazal polipli kronik rinosinüzit (E-NP'li KRS) ve nötrofilik nazal polipli kronik rinosinüzit (N-NP'li KRS) gruplar belirlendi. İki grup arasındaki veriler karşılaştırılarak, hastalardaki klinik bulgular, ayrıca diğer olası etyolojik nedenler ve alerji, astım gibi komorbid hastalıklarla ilişkisi gösterildi. Bursa ve çevresinde, nazal polipozisli hastalarda, histolojik olarak eozinofilik polip (%77,5), nötrofilik polibe (%22,5) göre daha fazla olarak tespit edildi. Klinik bulgular iki grup arasında karşılaştırıldığında, istatistiksel olarak anlamlı farklılık saptanmadı. Tedavi öncesi ve tedavi sonrası 6.ay semptom ve endoskopi skorları, E-NP'li KRS ve N-NP'li KRS hastalarında karşılaştırıldı, istatistiksel anlamlı farklılık olduğu izlendi (p<0,001-p=0,035, p<0,001-p=0,007). Tedavi sonrası iki grupta da semptom, endoskopi ve BT skorunda gerileme olduğu görüldü. NP'li KRS, histolojik özelliğine göre alt gruplara ayrılabilir. E-NP'li KRS ve N-NP'li KRS sınıflaması, eozinofil/nötrofil hücre oranına göre yapılabilir. Klinik seyir konusunda bizim çalışmamızda, gruplar arasında anlamlı bir farklılık izlenmemiştir. Ancak daha geniş hasta grubu ile yapılacak çalışmalarda, daha anlamlı sonuçlar çıkabileceğini düşünmekteyiz.
Nasal polyposis formation is associated with many theories that have been raised, but there is no theory that is gained certainity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent disease which can be classified as eosinophilic or neutrophilic inflammatory cell type infiltration in nasal tissue. The aim of this study was to evaluate the clinical relevance of classifying nasal polyps as eosinophilic or neutrophilic on treatment outcomes and to show the district prevelance. This retrospective study was conducted with forty patients who treated with the diagnosis of CRSwNP. All patients were examined by nasal endoscopy and paranasal computed tomography (CT), prick test results, subjective symptom scores, nasal endoscopy scores and CT scores, nasal biopsies and post-teatment symptoms and endoscopic outcoomes were measured. The patients were classified into two groups for further assessment up to eosinophil or netrophilic dominance at polyp tissue. Comparing data between the two groups, patients' clinical findings, also relations with other possible etiologies and co-morbid diseases like allergy and asthma has been evaluated. Histologic findings in Bursa and district, eosinophilic nasal polyps (77.5%) were found to be higher than neutrophilic polyps (22.5%). Clinical findings compared between the two groups, statistically significant differences were not detected. Initial findings and post-treatment 6 months, symptoms and endoscopy scores were compared between eosinophilic and neutrophilic polpy groups, statistically significant differences were found (p<0,001-p=0,035, p<0,001-p=0,007). Post-treatment in both groups, symptom scores, endoscopy and CT scores significantly decreased. v Chronic rhinosinusitis with nasal polyps (CRSwNP) can be divided into subgroups according to the histological features. CRSwE-NP and CRSwN-NP classification can be based on the ratio of eosinophil/ neutrophil cells. In this study, the comparative analysis between two subgroups showed no difference according to clinical findings. Whereas conducting studies with more patients we should get more significant results.
Nasal polyposis formation is associated with many theories that have been raised, but there is no theory that is gained certainity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent disease which can be classified as eosinophilic or neutrophilic inflammatory cell type infiltration in nasal tissue. The aim of this study was to evaluate the clinical relevance of classifying nasal polyps as eosinophilic or neutrophilic on treatment outcomes and to show the district prevelance. This retrospective study was conducted with forty patients who treated with the diagnosis of CRSwNP. All patients were examined by nasal endoscopy and paranasal computed tomography (CT), prick test results, subjective symptom scores, nasal endoscopy scores and CT scores, nasal biopsies and post-teatment symptoms and endoscopic outcoomes were measured. The patients were classified into two groups for further assessment up to eosinophil or netrophilic dominance at polyp tissue. Comparing data between the two groups, patients' clinical findings, also relations with other possible etiologies and co-morbid diseases like allergy and asthma has been evaluated. Histologic findings in Bursa and district, eosinophilic nasal polyps (77.5%) were found to be higher than neutrophilic polyps (22.5%). Clinical findings compared between the two groups, statistically significant differences were not detected. Initial findings and post-treatment 6 months, symptoms and endoscopy scores were compared between eosinophilic and neutrophilic polpy groups, statistically significant differences were found (p<0,001-p=0,035, p<0,001-p=0,007). Post-treatment in both groups, symptom scores, endoscopy and CT scores significantly decreased. v Chronic rhinosinusitis with nasal polyps (CRSwNP) can be divided into subgroups according to the histological features. CRSwE-NP and CRSwN-NP classification can be based on the ratio of eosinophil/ neutrophil cells. In this study, the comparative analysis between two subgroups showed no difference according to clinical findings. Whereas conducting studies with more patients we should get more significant results.
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Keywords
Nazal polip, Kronik rinosinüzit, Eozinofil, Nötrofil, Klinik bulgular, Nasal polyp, Chronic rhinosinusitis, Eosinophil, Neutrophil, Clinical characteristics
Citation
Tecimer, S. H. (2014). Nazal polipozisli hastalarda eozinofil/nötrofil oranları ile klinik bulguların korelasyonu. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.