74 / 236
and NAScA had statistically higher plasma cells than
the control group (
P
<
.05). Cystic fibrosis also had statis-
tically higher plasma cells than AERD, AScA, and each
nonasthmatic sinusitis (
P
<
.01).
For the lymphocyte analysis, the control group had
the highest ratios of lymphocytes, but no statistical dif-
ference was achieved between the control group and any
of the CRS subclasses. In general, eosinophilic CRS sub-
classes (AFS, AERD, AScA, ASsA) had lower lymphocyte
ratios.
For mast cell analysis, cystic fibrosis had the high-
est mast cell ratio, being statistically higher than the
control group and all the CRS subtypes other than
NAScA (
P
<
.01). Both allergic-based CRS (AScA, NAScA),
AERD, and AFS were higher than the control group
(
P
<
.01) for mast cells. NAScA had higher mast cells
than each asthmatic sinusitis (AScA, ASsA) and NASsA
(
P
<
.01). Allergic fungal sinusitis was statistically higher
than NASsA (
P
<
.05) for mast cells.
Eosinophilic CRS subclasses (AScA, ASsA, AFS,
AERD) had statistically higher cellularity than the con-
trol group (
P
<
.05). Aspirin triad and AFS had higher
cellularity than NASsA (
P
<
.05). There was no statistical
difference in the amount of fibrosis between the CRS
and the control group.
Goblet cell counts ranged from an average eight/
HPF in CF samples to 89/HPF in NASsA (Table IV).
Cystic fibrosis had significantly lower number of goblet
cells than AERD, AScA, NASsA, and the control group
(
P
<
.05). AFS also had lower goblet cells than AScA,
NASsA, and the control group (
P
<
.05). Eosinophilic CRS
subclasses (AFS, AERD, AScA, ASsA) demonstrated the
most metaplasia of the surface epithelium but did not
reach statistical difference. Aspirin triad and each asth-
matic sinusitis had significantly more transitional
epithelium when compared to controls, nonasthmatic si-
nusitis, and CF (
P
<
.05).
Cell distribution data showed that CF samples had
a predominantly subepithelial cell distribution and was
statistically higher than the control group (
P
<
.01).
Eosinophilic CRS subclasses (AScA, ASsA, AERD, AFS)
were more likely to have a stromal cell distribution but
did not reach statistical difference.
Flow Cytometry
Fresh mucosal and polyp samples were analyzed
for CD3, CD4, CD8, CD19, and CD56 cells (Table V). In
regard to the T cells, there was no difference seen for
CD3 marker between the control group and CRS groups
or among the CRS subclasses. There were higher CD4
cells in both AScA and ASsA, both NAScA and NASsA,
and AERD than the control group (
P
<
.05). The two
allergy-based CRS subclasses (AScA, NAScA) had more
CD4 cells than CF (
P
<
.05). For the CD8 cells, the con-
trol group had a significantly higher amount of CD8
cells than each nonasthmatic group (NAScA, NASsA)
(
P
<
.05).
For the CD19 or B cells, both AFS (
P
<
.05) and CF
(
P
<
.01) were significantly higher than the control group.
Also, CF had significantly more CD19 cells than NASsA
and AScA (
P
<
.05). For the CD56 or natural killer cells,
there was no statistical difference between the control
group and CRS study groups. Also, there was no differ-
ence among the CRS subclasses.
We examined several intracellular cytokines: IFN-
c
,
IL4, IL5, IL13, and IL17 (Table VI) in CD45
1
,
CD45
1
CD4
1
and CD45
1
Cd4
2
cells. For IL5, IL13, and
IL17, only five samples in each CRS subclass and control
group were measured. When examining the CD45
1
cells, there was statistical difference for IFN, IL4, and
IL5. Nonasthmatic sinusitis without allergy had higher
IFN than AFS (
P
5
.03). For IL4, ASsA was statistically
higher than the control group (
P
5
.03) and all the CRS
subclasses (
P
<
.05) other than AERD. For IL5, AFS was
statistically higher than AERD, both ASsA and AScA,
and NASsA. Allergic fungal sinusitis was almost statisti-
cally higher for IL5 compared to the control group but
did not reach significance (
P
5
.06).
There was statistical
difference among
CD45
1
CD4
1
cells for IFN-
c
, IL4, IL5, and IL13. Both
NAScA, NASsA had statistically elevated IFN-
c
than the
control group (
P
<
.01) and eosinophilic CRS subclasses
(AFS, AERD, AScA) (
P
<
.05). For IL4 in CD45
1
CD4
1
,
ASsA had elevated levels compared to CF (
P
5
.05). For
IL5, AFS was statistically higher than the control group
(
P
<
.01). Allergic fungal sinusitis also had higher IL5
than eosinophilic sinusitis (AERD, AScA, ASsA), NASsA,
and CF (
P
<
.05). Allergic fungal sinusitis also had ele-
vated IL13 compared to CF (
P
<
.05).
There was statistical
difference among
CD45
1
CD4
2
cells for IL4 and IL13. For IL4, ASsA had
elevated levels of IL4 compared to CF and NAScA
(
P
<
.05). Aspirin-exacerbated respiratory disease was the
second highest in the study, but did not reach statistical
significance with any of the other groups. For IL13, CF
did have higher IL13 than the control group (
P
5
.05).
Cystic fibrosis also had higher IL13 compared to both
AScA and ASsA (
P
<
.03) and was close to significance to
AERD (
P
5
.06). There were no statistical differences
found for IL17 between CRS subclasses and control
group or among the CRS subclasses.
TABLE V.
The Average Percentage of Cells for CRS Subclasses.
CRS Subclass % CD3 % CD4 % CD8 % CD19 % CD56
AERD
79
36
42
9
6
AFS
67
28
33
15
6
CF
71
26
38
21
5
AScA
76
36
37
9
6
ASsA
74
32
34
14
6
NAScA
68
37
33
18
7
NASsA
72
30
36
11
9
Control
76
21
53
3
12
Total
73
31
39
12
7
AERD
5
aspirin exacerbated respiratory disease also known as aspirin
triad; AFS
5
allergic fungal sinusitis; AScA
5
asthmatic sinusitis with allergy;
ASsA
5
asthmatic sinusitis without allergy; CF
5
cystic fibrosis; CRS
5
chronic
rhinosinusitis; NAScA
5
nonasthmatic sinusitis with allergy; NASsA
5
nonasthmatic sinusitis without allergy.
Han: Subclassification of Chronic Sinusitis
Laryngoscope
123: March
2013
52