BACKGROUND Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occur predominantly in Asian subjects. Appropriate treatments for this endotype have not been elucidated. This study aimed to evaluate the efficacy of budesonide nasal spray on neutrophilic CRSwNP. MATERIALS AND METHODS Fifteen neutrophilic CRSwNP patients were included, and then they received budesonide nasal spray treatment for 3 months. Biopsies of nasal polyps (NPs) were obtained from these subjects. Their clinical indexes were scored using Visual Analog Scale (VAS), Sino-Nasal Outcome Test (SNOT)-22, and Endoscopic Appearances (EAs). Histological analyses were used to assess numbers of neutrophils, goblet cells, and submucosal gland cells in NPs. Percentages of CD8+ T cells and CD4+CD25+Foxp3+ regulatory T cells (Tregs) were evaluated using flow cytometry. Mucin 5AC (MUC5AC), MUC5B, myeloperoxidase (MPO), interferon (IFN)-γ, and interleukin (IL)-1β and their mRNAs were also examined. After that, we cultured NP tissues in vitro and evaluated the abovementioned inflammatory parameters before and after the administration of budesonide. RESULTS Budesonide nasal spray did not improve clinical evaluations including VAS, SNOT-22, and EA scores. Numbers of neutrophils and goblet cells, the score of submucosal gland cells, percentages of CD8+ T cells and Tregs, MUC5AC, MUC5B, MPO, IFN-γ, and IL-1β and their mRNAs were not decreased in NPs after the budesonide treatment. Furthermore, the administration of budesonide into NP cultures also did not reduce their levels in comparison with those before the treatment. CONCLUSION These findings demonstrate that budesonide treatment may not alleviate the inflammatory condition in neutrophilic CRSwNP.

中文翻译：

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布地奈德鼻喷雾剂对中性慢性鼻鼻窦炎伴鼻息肉的疗效：结合临床和实验研究。

背景技术带有鼻息肉（CRSwNP）的嗜中性慢性鼻鼻窦炎主要发生在亚洲受试者中。尚未阐明对该内型的适当治疗。这项研究旨在评估布地奈德鼻喷雾剂对嗜中性CRSwNP的疗效。材料与方法纳入15例嗜中性CRSwNP患者，然后接受布地奈德鼻喷剂治疗3个月。从这些受试者获得了鼻息肉（NPs）的活检。他们的临床指标使用视觉模拟量表（VAS），鼻腔结果测试（SNOT）-22和内窥镜外观（EAs）进行评分。使用组织学分析来评估NP中的中性粒细胞，杯状细胞和粘膜下腺细胞的数量。使用流式细胞仪评估CD8 + T细胞和CD4 + CD25 + Foxp3 +调节性T细胞（Tregs）的百分比。还检查了粘蛋白5AC（MUC5AC），MUC5B，髓过氧化物酶（MPO），干扰素（IFN）-γ和白介素（IL）-1β及其mRNA。之后，我们在体外培养NP组织并评估布地奈德给药前后的上述炎症参数。结果布地奈德鼻喷雾剂不能改善包括VAS，SNOT-22和EA评分在内的临床评估。布地奈德治疗后NPs的中性粒细胞和杯状细胞数目，粘膜下腺细胞分数，CD8 + T细胞和Tregs的百分比，MUC5AC，MUC5B，MPO，IFN-γ和IL-1β及其mRNA均未降低。此外，与治疗前相比，将布地奈德施用于NP培养物中也没有降低其水平。