[The impact of endoscopic sinus surgery on sinonasal microbiome of chronic rhinosinusitis with nasal polyps].

Objective

To compare the sinonasal microbiome of patients with chronic rhinosinusitis with nasal polyps （CRSwNP） and healthy subjects, and to prospectively observe the effect of surgery-centered comprehensive treatment on microbiome. Method:A case-control and prospective self-controlled study was conducted, recruiting the CRSwNP patients who were surgically treated, and collecting swab samples from the middle meatus. They were followed up for three months at an interval of one month. And we recruited healthy volunteers' samples as well. All specimens were analyzed by the second-generation high-throughput sequencing, collecting subjective and objective data, and analyzed the relationship between them. Result:①There was no significant difference of α diversity between the two groups（Shannon index were 4.41 vs. 3.89）. However, there was a dynamic change of the α diversity in the CRSwNP group, and the Shannon index for 1, 2, 3 months follow-up were 2.33, 2.89, 4.24 respectively, which showed an increase followed a descend. The β diversity showed that the MRA of cyanobacteria was higher in the CRSwNP group than the control group before the operation（P<0.05）, but significantly decreased（P<0.05） to be close to the control group at 3 months postoperatively. ②Comparing the microbiome with clinical factors and prognosis, we found that both the Lund-Kennedy scores and the history of asthma were positively correlated with the MRA of pseudomonas（r=0.397, P=0.012; r=0.420, P=0.008）. Campylobacter was negatively correlated with improvement of SNOT-22 scores（r=-0.63, P=0.038）, and enterococcus was negatively correlated with improvement of Lund-Kennedy scores（r=-0.77, P=0.005）.

Conclusion

The surgery-centered comprehensive treatment played an important role in the reconstruction of sinonasal microbiome. Pseudomonas may aggravate sinusitis and increase the risk of combined asthma. Campylobacter and enterococcus may affect the prognosis of surgery.