[Different phenotypes in patients with chronic sinusitis with bilateral nasal polyps]

Objective: To investigate the clinical features of patients with chronic sinusitis with bilateral nasal polyps. Method: The data of 134 patients with chronic sinusitis with bilateral nasal polyps were analyzed, retrospectively. Based on the results of the histopathological examination, patients were divided into eosinophilic chronic sinusitis with bilateral nasal polyps(ECRSwBNP) group and noneosinophilic chronic sinusitis with bilateral nasal polyps(nonECRSwBNP) group. The clinical data including medical history collection, skin prick test, nasal secretion examination, serum total IgE level, peripheral blood test, nasal endoscopy, and sinus CT examination were analyzed and compared. Result: The rate of concomitant with asthma(19.0%, 0), atopy(26.6%, 9.1%), NP recurrence rate(54.4%, 30.9%), the ratio of EOS in peripheral blood(4.8%, 1.9%), the ratio of EOS in nasal secretions(10.0%, 2.0%) and total serum IgE levels(82.15 IU/L, 25.80 IU/L) were significantly(P<0.05 ) different between two groups. In the sinus CT score, posterior ethmoid sinus(2.0, 1.0), total ethmoid sinus(5.0, 4.0), sphenoid sinus(3.0, 2.0), Olfactory cleft(OC)(4.0, 2.0), the ratio of thee thmoid sinus/maxillary sinus(2.0, 1.0) was statistically significant(P<0.05), while the rest were not statistically significant. The OC score, the ratio of EOS in peripheral blood, the ratio of the posterior ethmoid sinus/ anterior ethmoid sinus, and the ratio of the ethmoid sinus/maxillary sinus can be used for subtype in CRSwBNP patients (AUC> 0.5), while the OC score under the ROC curve is the largest area with the highest diagnostic value. When the OC score is 3 or higher, the predicted value specificity is 80.9% and the sensitivity is 52.1%. Conclusion: Patients with chronic sinusitis with bilateral nasal polyps often comorbid asthma and atopy, while these patients are trend to recurrence. The patients with ECRSwBNP comorbid asthma mainly characterized by eosinophil infiltration in tissues are more likely to recurrence. Targeted treatment based on phenotype should be considered in the clinic.