Prediktori učinkovitosti kirurškog liječenja polipoznog sinuitisa

Grgić, Marko Velimir (2009) Prediktori učinkovitosti kirurškog liječenja polipoznog sinuitisa. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The etiology of nasal polyposis and sinusitis is not entirely clear. The therapy of advanced disease is surgical removal. Since this therapy does not deal with the cause of the disease, reccurence occurs in about one third of the patients. Many factors are known to be involved in the development of nasal polyps. This study investigated the predictive value of the following parameters: preoperative extent of disease measured by CT scan, immunohistochemical score of Interlekin-5 (IL-5), Vascular endothelial growth factor (VEGF), Immunoglobulin-E (IgE) and eosinophylic infiltration. The study included 30 patients operated between 2004. and 2006. Minimal follow-up was one year. The level of IL-5, VEGF and IgE was determined by immunohistochemical analysis, using appropriate monoclonal antibodies on fixed specimens. The level of eosinophilic infiltration was determined by means of histomorphometric analysis. The outcome of the treatment was measured by clinical (endoscopical) assesment and by subjective outcome tests. Statistical analysis was performed by calculating coefitient of correlation, and by the use of X-square test and logistic regression. The preoperative extent of disease and eosinophylic infiltration were found to be statistically significant predictors of the outcome of the surgical treatment. IL-5, VEGF and IgE were not found to be statistically significant predictors. Patients with greater involvement of paranasal sinuses and greater eosinophylic infiltration had more reccurences and worse outcome measured by subjective tests. These results may help the clinician in informing the patients before the operation and in planning postoperative follow up and treatment.

Abstract in Croatian

Etiologija nosne polipoze i polipoznog sinuitisa nije sasvim razjašnjena. Temelj liječenja uznapredovale bolesti je kirurško liječenje, no kako ono ne rješava uzrok, u oko trećine pacijenata javljaju se recidivi. Poznato je više čimbenika koji imaju ulogu u nastanku nosne polipoze. U ovom istraživanju su ispitivani preoperativni opseg bolesti objektiviziran CT pretragom i endoskopski, te razina Interleukina-5 (IL-5), vaskularnog endotelnog čimbenika rasta (VEGF), Imunoglobulina-E (IgE) i eozinofilna infiltracija u tkivu polipa. Istraživanje je obuhvatilo 30 bolesnika s polipoznim sinuitisom operiranih u razdoblju od 2004. do 2006. godine. Svi bolesnici praćeni su godinu dana. Razina IL-5, VEGF i IgE određena je imunohistokemijskom analizom primjenom odgovarajućih monoklonalnih protutijela na fiksiranim preparatima. Razina eozinofilne infiltracije određena je histomorfometrijskom analizom. Ishod liječenja mjeren je kliničkom (endoskopskom) procjenom i upotrebom testova subjektivne procjene simptoma i funkcija bolesnika. Statistička analiza rezultata učinjena je računanjem koeficijenta korelacije, X2 testa i logističke regresije. Statistički značajnim prediktorima pokazali su se jedino preoperativni opseg bolesti i eozinofilna inflitracija odstranjenih polipa. IL-5, VEGF i IgE nisu se pokazali statistički značajnim prediktorima ishoda kirurškog liječenja. Bolesnici s većom zahvaćenosti paranazalnih sinusa i jačom eozinofilnom infiltracijom imali su češće recidive i lošiji ishod bolesti nakon godinu dana mjeren testovima subjektivne procjene. Rezultati ovog istraživanja mogu pomoći kliničaru pri informiranju bolesnika prije operacije, kao i pri planiranju postoperativnog praćenja i liječenja.

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