Prognostic Value of IL-5 in Sinus Lavage in Patients with Chronic Maxillary Sinusitis

• Main Authors: Drviš, Petar, Kalogjera, Livije, Baudoin, Tomislav
• Format: Text
• Language: English
• Published: Sestre Milosrdnice University hospital and Institute of Clinical Medical Research; [e-mail] 2003
• Subjects: Maxillary sinusitis - drug therapy; Chronic disease; Sinusitis - complications; Cytokines - metabolism; Maksilarni sinusitis - medikamentno liječenje; Kronična bolest; Sinusitis - komplikacije; Citokini - metabolizam; sami
• Online Access: http://hrcak.srce.hr/14694; http://hrcak.srce.hr/file/22453

The aim of the study was to evaluate subjective outcomes in patients with chronic rhinosinusitis after steroid/antibiotic endosinusal treatment and to test the hypothesis that pretreatment levels of the cytokine interleukin-5 in sinus fluid could predict response to endosinusal steroid/antibiotic treatment. Twenty-four patients with symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than three months and maxillary sinus mucosa thickening by >6 mm, considered as maxillary sinusitis. Patients with asthma, polyposis, recent infection, systemic steroid therapy or previous sinus surgery were excluded. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamicin per maxillary sinus daily for 5 days. Patients rated nasal/chronic rhinosinusitis disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage collected at inclusion was analyzed for interleukin-5 concentration. Endonasal treatment led to improvement with symptom alleviation in ten (52.6%) patients (responders), whereas unchanged or worsened condition was recorded in nine (47.4%) patients (nonresponders). Significant improvement was noted for overall sinusitis symptom score (p=0.02), and for obstruction, postnasal drip, headache, sneezing and cough (p<0.05) in the study group as a whole. There was a positive correlation of baseline interleukin-5 level in sinus lavage with the improvement rate of overall sinusitis symptom score (p<0.01) and improvement rate of nasal secretion score (p<0.01). Results indicated the increased interleukin-5 levels in sinus fluid to predict good response to endosinusal steroid/antibiotic treatment. Cilj studije bio je procijeniti subjektivne ishode u bolesnika s kroničnim rinosinusitisom nakon endosinusne steroidne/ antibiotske terapije, te ispitati pretpostavku prema kojoj bi se iz prijeterapijske razine citokina interleukina-5 u sinusnoj tekućini mogao predvidjeti odgovor na ovu vrst liječenja. U studiju je bilo uključeno 24 bolesnika sa simptomima kroničnog rinosinusitisa. Kriteriji za uključivanje u studiju bili su trajanje simptoma sinusitisa duže od tri mjeseca i zadebljanje sluznice maksilarnih sinusa za više od 6 mm, tj. maksilarni sinusitis. Bolesnici s astmom, polipozom, nedavnom infekcijom, sistemskom uporabom steroida ili prethodnom operacijom sinusa bili su isključeni. Bolesnici su endosinusno primali 2 mg deksametazona i 40 mg gentamicina po maksilarnom sinusu kroz 5 dana. Bolesnici su ocjenjivali nosne simptome i simptome specifične za kronični rinosinusitis, i sami ispunili anketni obrazac o simptomima sinusitisa na početku i 30 dana nakon ispitivanja. Koncentracija interleukina-5 analizirana je u sinusnom ispirku uzetom na početku studije. U desetoro (52,6%) bolesnika je nakon endonazalne terapije nastupilo poboljšanje s ublaženjem simptoma (bolesnici s terapijskim odgovorom), dok je u devetoro (47,4%) bolesnika stanje ostalo nepromijenjeno ili se je pogoršalo (bolesnici bez terapijskog odgovora). Značajno je poboljšanje zabilježeno za ukupni zbroj simptoma sinusitisa (p=0,02), te za opstrukciju, postnazalni drip, glavobolju, kihanje i kašalj (p<0,05) u cijeloj skupini. Nađena je pozitivna korelacija između bazalne razine interleukina-5 u sinusnom ispirku i stope poboljšanja sveukupnog zbroja simptoma sinusitisa (p<0,01), kao i stope poboljšanja zbroja za nazalnu sekreciju (p<0,01). Rezultati su pokazali kako povišene razine interleukina-5 u sinusnoj tekućini predskazuju dobar odgovor na endosinusnu steroidnu/antibiotsku terapiju.