[The role of nasal nitric oxide in diagnosis and endotypes of chronic rhinosinusitis with nasal polyp].

Objective

To investigate the roles of nasal nitric oxide（nNO） in diagnosis and endotypes of CRSwNP.

Methods

Eighty-two CRSwNP patients and thirty healthy volunteers were recruited for this study. The patients were classified into eosinophilic CRSwNP （Eos CRSwNP） and non-eosinophilic CRSwNP （non-Eos CRSwNP） endotypes by tissue eosinophil percentage. nNO levels were measured with an electrochemical sensor-based device. nNO levels and clinical factors were compared among the groups. Receiver-operating characteristic （ROC） curve and logistic regression analyses were performed to evaluate the predictive ability of the nNO for diagnosis and endotypes of CRSwNP.

Results

Eos CRSwNP patients（143.9±106.2） ×10-9 had lower nNO levels than non-Eos CRSwNP[（228.3±109.2） ×10-9, P=0.000 9） and healthy subjects（366.5±88.0） ×10-9, P<0.000 1）. Patients with atopy exhibited significantly higher levers of nNO compared with patients without atopy（P<0.05）. For Eos CRSwNP diagnosis, nNO had the highest predictive value（AUC: 0.939; sensitivity: 76.74%; specificity: 96.67%; cut-off value: 231×10-9, P<0.001）. Furthermore, nNO levels were associated with CRSwNP endotypes（odds ratio: 1.010; 95% confidence interval: 1.003%, 1.016%; P=0.002）. When the nNO concentration was 158 ×10-9, we could discriminate Eos CRSwNP from non-Eos CRSwNP（AUC=0.710, sensitivity: 76.92%; specificity, 60.47%, P=0.001）. After it was combinated by nNO, periphera blood eosinophil count（PEAC） and VAS score, the AUC was increased to 0.894（95%CI=0.807 to 0.951, P<0.000 1, sensitivity: 76.74%, specificity: 89.74%）.

Conclusion

nNO may has potential for non-invasive diagnosis and endotype of CRSwNP. nNO combined with PEAC and VAS score may be an ideal diagnostic tool for endotyps of Eos CRSwNP. However, the atopic status of the patients influenced the levels of nNO.