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Title: [Study on the relationship between 11β-hydroxysteroid dehydrogenase and glucocorticoid response in nasal polyps].
Author: Jiang LJ, Zhou M, Deng J, Zuo KJ, Shi JB, Lai YY.
Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2019 Mar 07; 54(3):198-202. PubMed ID: 30909340.
Abstract:
Objective: To investigate the expression of 11β-hydroxysteroid dehydrogenase (11β-HSD) in polyps of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and its correlation with glucocorticoid sensitivity. Methods: The prospective study method was applied. Forty-three adult CRSwNP patients from Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University between April 2016 and June 2017 were enrolled in this study. There were 19 males and 24 females with the age of (37.44±7.42) years old. The endoscopic scores by nasal Polyps Grading System before and after one-week prednisone treatment (0.5 mg/(kg·d)) were evaluated. The response of glucocorticoid by the total endoscopic scores was estimated. According to the patient's reduced nasal polyp endoscopic score, patients were devided into nasal polyps insensitive to glucocorticoids treatment group (insensitive group) and nasal polyp sensitive to glucocorticoids treatment group (sensitive group). The expression of 11β-HSD1, 11β-HSD2 in nasal polyps were measured by Real-time PCR (RT-PCR), Western Blot and immunohistochemisty. According to the clinical data, the Logistic regression models and receiver operation characteristics (ROC) curves were used to explore the predictor for glucocorticoid response in CRSwNP. Results: The expression of 11β-HSD1 and 11β-HSD1/11β-HSD2 was higher in sensitive group than that of insensitive group, while the expression of 11β-HSD2 was lower (rank average was 26.08 vs 16.33, 27.24 vs 14.72, 18.66 vs 26.64, Z value was -2.511, 0.323, -2.059, respectively, all P<0.05). The endoscopic scores in CRSwNP group declined whereas the expression of 11β-HSD1/11β-HSD2 increased (r=0.528, P=0.001), while the cutoff value of the ratio of 11β-HSD1/11β-HSD2 was 2.290 (sensitivity was 79.17%, specificity was 88.89%). Conclusions: There is a positive correlation between the response of glucocorticoid and the ratio of 11β-HSD1/11β-HSD2, which could be used as a marker in predicting the level of tissue response to glucocorticoid therapy in CRSwNP. 目的： 探讨慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）患者鼻息肉组织中11β-羟基类固醇脱氢酶（11β-hydroxysteroid dehydrogenase，11β-HSD）的表达及与糖皮质激素敏感性的相关性。 方法： 采用前瞻性研究方法，收集2016年4月至2017年6月期间就诊于中山大学附属第一医院耳鼻咽喉医院的43例CRSwNP患者，男19例，女24例，年龄（37.44±7.42）岁，给予口服泼尼松[（0.5 mg/（kg·d）]1周。采用鼻息肉内镜评分系统对入组患者用药前后的鼻息肉大小进行内镜评分，根据下降分值将患者分为激素敏感组和激素不敏感组。采用实时定量聚合酶链反应（Real-time PCR，RT-PCR）、Western Blot及免疫组织化学等实验方法观察11β-HSD1、11β-HSD2在鼻息肉组织中的表达。结合临床病例资料，采用单因素Logistic回归分析息肉内镜评分下降的分值与11β-HSD1/11β-HSD2比值的统计学关联；并制作受试者工作特征曲线预测模型。 结果： 激素敏感组中11β-HSD1的表达及11β-HSD1/11β-HSD2比值明显高于不敏感组，11β-HSD2的表达明显低于不敏感组（秩平均值26.08比16.33，27.24比14.72，18.66比26.64，Z值分别为－2.511、0.323、-2.059，P值均<0.05）。息肉内镜评分下降的分值与11β-HSD1/11β-HSD2比值呈正相关（r=0.528，P=0.001）。同时，11β-HSD1/11β-HSD2比值的最佳截断点为2.290，对应的敏感度为79.17%，特异度为88.89%。 结论： 11β-HSD1/11β-HSD2比值与糖皮质激素敏感性存在正相关性，可作为预测糖皮质激素治疗鼻息肉效果的指标。.

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