Objective:To investigate the roles of nasal nitric oxide（nNO） in diagnosis and endotypes of CRSwNP. Methods:Eighty-two CRSwNP patients and thirty healthy volunteers were recruited for this study. The patients were classified into eosinophilic CRSwNP （Eos CRSwNP） and non-eosinophilic CRSwNP （non-Eos CRSwNP） endotypes by tissue eosinophil percentage. nNO levels were measured with an electrochemical sensor-based device. nNO levels and clinical factors were compared among the groups. Receiver-operating characteristic （ROC） curve and logistic regression analyses were performed to evaluate the predictive ability of the nNO for diagnosis and endotypes of CRSwNP. Results:Eos CRSwNP patients（143.9±106.2） ×10-9 had lower nNO levels than non-Eos CRSwNP[（228.3±109.2） ×10-9, P=0.000 9） and healthy subjects（366.5±88.0） ×10-9, P<0.000 1）. Patients with atopy exhibited significantly higher levers of nNO compared with patients without atopy（P<0.05）. For Eos CRSwNP diagnosis, nNO had the highest predictive value（AUC: 0.939; sensitivity: 76.74%; specificity: 96.67%; cut-off value: 231×10-9, P<0.001）. Furthermore, nNO levels were associated with CRSwNP endotypes（odds ratio: 1.010; 95% confidence interval: 1.003%, 1.016%; P=0.002）. When the nNO concentration was 158 ×10-9, we could discriminate Eos CRSwNP from non-Eos CRSwNP（AUC=0.710, sensitivity: 76.92%; specificity, 60.47%, P=0.001）. After it was combinated by nNO, periphera blood eosinophil count（PEAC） and VAS score, the AUC was increased to 0.894（95%CI=0.807 to 0.951, P<0.000 1, sensitivity: 76.74%, specificity: 89.74%）. Conclusion:nNO may has potential for non-invasive diagnosis and endotype of CRSwNP. nNO combined with PEAC and VAS score may be an ideal diagnostic tool for endotyps of Eos CRSwNP. However, the atopic status of the patients influenced the levels of nNO.
目的：探讨鼻呼出气一氧化氮（nNO）无创检测在慢性鼻窦炎伴鼻息肉（CRSwNP）诊断及分型中的临床应用价值。 方法：采用病例对照设计，共纳入82例CRSwNP患者（病例组）和30例健康志愿者（对照组）。根据组织病理中嗜酸粒细胞浸润程度将病例组分为嗜酸粒细胞性CRSwNP（Eos CRSwNP）组和非嗜酸粒细胞性CRSwNP（non-Eos CRSwNP）组。使用瑞典NIOX MINO仪器检测nNO水平。用t检验、χ²检验和Mann-Whitney U分析比较临床症状主客观评分差异，受试者工作特征曲线（ROC）及Logistic回归模型评估nNO测定在CRSwNP诊断和分型中的应用价值。 结果：①Eos CRSwNP组患者的nNO水平明显低于Non-Eos CRSwNP组患者[（143.9±106.2）×10-9 vs（228.3±109.2）×10-9，P=0.000 9]和对照组[（143.9±106.2）× 10-9 vs（366.5±88.0）×10-9，P<0.000 1]。②与非特应性患者相比，特应性患者表现出更高的nNO水平（P<0.05）。③ROC分析表明nNO对Eos CRSwNP的诊断具有较高的预测价值（AUC=0.939），对non-Eos CRSwNP的诊断具有中等的预测价值（AUC=0.83）。而nNO对CRSwNP分型的鉴别有中度的预测价值（AUC=0.710）。④单因素、多因素Logistic回归分析均表明nNO与CRSwNP的分型存在相关性，OR及其95%CI分别为1.007（1.003～1.011），P=0.001；1.010（1.003～1.016），P=0.002。nNO联合外周血嗜酸粒细胞计数、VAS评分对CRSwNP分型的诊断价值高于单一指标（AUC=0.894，95%CI=0.807～0.951，P<0.000 1，敏感度76.74%，特异度89.74%）。 结论：nNO检测有助于早期预测及区分CRSwNP亚型。将nNO、外周血嗜酸粒细胞计数和VAS评分三者结合可以更好地在临床上预测CRSwNP分型。CRSwNP患者的特应性状况影响nNO的水平。.
Keywords: eosinophil; nasal polyps; nitric oxide; sinusitis.
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