Purpose: The objective of this study was to elucidate the relationship between adenoid hypertrophy (AH) and glucocorticoid resistance, and to investigate the potential reasons for the suboptimal therapeutic response to intranasal glucocorticoids (INS) in pediatric patients with AH.
Methods: The present study enrolled a cohort of 110 patients diagnosed with AH, all of whom underwent adenoidectomy at Renmin Hospital of Wuhan University between June 2023 and September 2023. Immunohistochemistry and real-time quantitative polymerase chain reaction (RT-qPCR) were employed to assess the levels of inflammatory cytokines, and glucocorticoid receptors (GR, including GRα and GRβ) in adenoidal tissues. The Pearson correlation analysis was employed to ascertain the relationship between the levels of GR and inflammatory cytokines. The receiver operating characteristic (ROC) curve to evaluate the predictive efficacy of inflammatory cytokines in serum in assessing the glucocorticoid sensitivity and the expression of GR.
Results: Compared with the AH not associated with allergic rhinitis (AH-nAR) group, patients with AH-AR exhibit heightened eosinophilic inflammation and comorbid symptoms of AR. In patients with AH-nAR and those with poor glucocorticoid response, adenoidal tissues showed lower GRα expression and higher GRβ expression. Furthermore, IL-1β, CXCL-1, and CXCL-2 were simultaneously associated with a negative correlation with GRα, and a positive correlation with GRβ. Compared with IL-1β and CXCL-2, CXCL-1 in serum demonstrated a more significant predictive accuracy in discerning glucocorticoid sensitivity and evaluating the expression of GRα and GRβ.
Conclusion: In patients with AH-nAR and those with poor glucocorticoid response, evidence of glucocorticoid resistance is observed within adenoidal tissues. Serum CXCL-1 may serve as a potential predictive biomarker for glucocorticoid resistance in AH patients, suggesting that surgical intervention should be more heavily considered for this cohort of patients.
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