| Background:The widely used current international clinical divides the chronic sinusitis into without nasal polyps?chronic rhinosinusitis without nasal polyps,CRSsNP?and with nasal polyps?chronic rhinosinusitis with nasal polyps,CRSwNP?[1],Its classification can also be according to the pathology,among which the nasal polyp with eosinophilic infiltration is the hot focus.Up to now,the pathophysiology of the disease has not been clearly defined.Previous studies have shown that at the initial molecular level of CRSsNP and CRSwNP,the former is dominated by Th1 cells,while the latter is dominated by Th2 cells and eosinophil infiltration[2].However,subsequent studies have reported a broader immunospectrum,reflecting a type of neutrophilic inflammation.Other T cell subsets are involved,such as Th1 and Th17cells.Other studies have found that the expression of Th22 cells in nasal polyp tissues is significantly increased,which may play an important role in local chronic inflammatory mucosal immunity[3].In addition,the synchronous expression of different Th cell types in the same tissue has also been confirmed[4].Therefore,the clinical types of chronic sinusitis?CRS?alone may not fully reflect the pathophysiological diversity[5].Previous simple differentiation of Th1 and Th2diseases did not reflect the molecular diversity of patients with CRS.The roles and mechanisms of cytokines in Th1/Th2/Th17/Th2 and even various Th pathways have become the main research direction.Th9 cell subsets are characterized by high expression of interleukin 9?IL-9?,which plays an important role in many diseases.Studies have shown it can induce CRS mucosal epithelial cell growth,glandular epithelial cell proliferation,and provides a proinflammatory effect after tissue infiltration[6].It was also found that IL-9 was more highly expressed in nasal polyps than non-nasal polyps and promotes the development of airway hyperresponsiveness.Therefore,we speculate that IL-9has a causal relationship with the occurrence and development of eosinophilic bronchial asthma.Thymic stromal lymphogenin?TSLP?is a cytokine derived from epithelial cells,which are produced by epithelial cells and keratinocytes in skin,intestines,lungs,eye tissues and thymus[7].After triggering dendritic cell-mediated Th2 inflammatory response,TSLP enhances the production of IL-1-dependent Th2cytokines in mast cells.Although TSLP mRNA has been found to be elevated in nasal polyps?NPs?,the expression and function of TSLP protein in patients with chronic sinusitis?CRS?have not been fully explored[8].In summary,most of the current studies mainly reflect the mechanism of IL-9,TSLP and allergy,but there are few studies on their relationship with chronic sinusitis,nasal polyps and eosinophils,and the mechanism of action is still unclear.Objective:The purpose of this study was to observe the expression of TSLP,IL-9 in chronic sinusitis with nasal polyps.By analyzing the relationship between the two factors and Th2 inflammatory factor IL-5,or the degree of infiltration of eosinophil in nasal polyps,the possible mechanism of IL-9 and TSLP in the development of chronic sinusitis was further explored.Methods:1.Compared with the CRSsNP group and the control group,the ratio of eosinophil in the tissues of the CRSwNP group was significantly higher,but there was no statistical difference in the ratio of eosinophil in the nasal secretions,and no statistical difference in the ratio of eosinophil in the peripheral blood.2.IL-5 was significantly correlated with il-9 and TSLP,and il-9 was highly linearly correlated with TSLP.3.When the cutoff point of infiltration degree of eosinophils in tissues was 10%,<10%was the non-eosinophilic infiltration group,and>was 10%was the eosinophilic infiltration group.The expressions of ILl-5,IL-9 and TSLP in the non-eosinophilic infiltration group and the eosinophilic infiltration group were increased compared with the control group,and the preoperative CT and endoscopic scores were increased.The expression of IL-5 was increased in the eosinophilic infiltration group compared with the non-eosinophilic infiltration group,but IL-9 and TSLP were not increased,and CT and endoscopic scores were not increased.4.When the cutoff point of infiltration degree of eosinophils in tissues was 30%,<30%was the non-eosinophilic infiltration group,and 30%was the>eosinophilic infiltration group,the expression of IL-5,IL-9 and TSLP in the non-eosinophilic infiltration group and the eosinophilic infiltration group were increased compared with the control group,and the preoperative CT and endoscopic scores were increased.The expression of il-5 was increased in the eosinophilic infiltration group compared with the non-eosinophilic infiltration group,but IL-9 and TSLP were not increased,and CT and endoscopic scores were not increased.5.When the cutoff point of infiltration degree of eosinophils in tissues was 50%,<50%was the non-eosinophilic infiltration group,and 50%was the>non-eosinophilic infiltration group,the non-eosinophilic infiltration group and the eosinophilic infiltration group had increased expression of IL-5,IL-9,TSLP,and CT and endoscopic scores,compared with the control group.The expression of IL-5,IL-9and TSLP were increased in the eosinophilic infiltration group,and the CT and endoscopic scores were increased in the non-eosinophilic infiltration group.Results:1.Compared with the CRSsNP group and the control group,the ratio of eosinophil in the tissues of the CRSwNP group was significantly increased,but there was no statistical difference in the ratio of eosinophil in the nasal secretion,nor in the ratio of eosinophil in the peripheral blood.2.There was a significant correlation between IL-5,IL-9 and TSLP,and a highly linear correlation between IL-9 and TSLP.3.When the cut-off point of eosinophil infiltration degree in the tissues was 10%,<10%was in the non-eosinophil infiltration group,and>10%was in the eosinophil infiltration group,the expressions of IL-5,IL-9 and TSLP in the non-eosinophil infiltration group and the eosinophil infiltration group were increased compared with the control group,and the preoperative CT and endoscopic scores were increased.Compared with the non-eosinophilic infiltration group,IL-5 expression increased in the eosinophilic infiltration group,but IL-9 and TSLP did not increase,and preoperative CT and endoscopic scores did not increase.4.When the cut-off point of eosinophil infiltration degree in the tissues was 30%,<30%was in the non-eosinophil infiltration group,and>30%was in the eosinophil infiltration group,the expression levels of IL-5,IL-9 and TSLP in the non-eosinophil infiltration group and the eosinophil infiltration group were increased compared with the control group,and the preoperative CT and endoscopic scores were increased.Compared with the non-eosinophilic infiltration group,IL-5 expression increased in the eosinophilic infiltration group,but IL-9 and TSLP did not increase,and preoperative CT and endoscopic scores did not increase.5.When the cut-off point of eosinophil infiltration degree in the tissues was 50%,<50%was in the non-eosinophil infiltration group,and>50%was in the eosinophil infiltration group,the expressions of IL-5,IL-9 and TSLP in the non-eosinophil infiltration group and the eosinophil infiltration group were increased compared with the control group,and the preoperative CT and endoscopic scores were increased.Compared with the non-eosinophilic infiltration group,IL-5,IL-9 and TSLP expressions were increased in the eosinophilic infiltration group,and preoperative CT and endoscopic scores were increased.Conclusion:1.There is a certain relationship between the infiltration of eosinophils in nasal polyps and the incidence of nasal polyps in chronic sinusitis.2.The expression levels of IL-5,IL-9 and TSLP in the nasal polyp group were strongly correlated,which may trigger and enhance the accumulation of eosinophils and play the role of Th2 pathway in chronic sinusitis.3.When the degree of eosinophil infusion in nasal polyp tissues was heavy??50%?,IL-9,TSLP were significantly increased and corresponding to CT and endoscopic scores.IL-9 and TSLP may have certain significance in the pathogenesis and prognosis of refractory sinusitis. |
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