Escalation in mucus cystatin 2, pappalysin‐A, and periostin levels over time predict need for recurrent surgery in chronic rhinosinusitis with nasal polyps

摘要: BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is treated using oral/topical steroids and surgery. Despite maximal medical therapy, some patients remain recalcitrant. Mucus cystatin 2, pappalysin-A, periostin can predict the presence of CRSwNP correlate disease severity. This study was designed to determine whether prospective sampling these mucus proteins could failure need for revision METHODS investigation an institutional review board-approved, 66 CRSwNP. All underwent surgery, administration topical/oral steroids, outpatient at 10 time-points over 2 years. Five proteins, including (CST2), pappalysin-A (PAPP-A), (PST), were analyzed correlated subjective parameters (including scores on 22-item Sino-Nasal Outcomes Test [SNOT-22]). Variables then compared between those requiring surgery within years (n = 5) stable 61). RESULTS demonstrated a significant decline in CST2, PAPP-A, after their initial The recalcitrant group escalations all despite levels higher than 1 year (CST2: 258.1 ± 205.2 pg/mL vs 235.3 275.7 pg/mL, p 0.86; PAPP-A: 170.3 150.4 74.6 106.7 < 0.05; periostin: 188.8 192.4 ng/mL 54.5 47.6 ng/mL, 0.001). Escalation significantly worsening SNOT-22 score each time-point (domain 1: 8.2 1.3 5.5 1.1; 0.05). CONCLUSION Early recurrences recalcitrance may be predicted noninvasively through serial, levels. These biosignatures help course guide individualized therapy.