發(fā)布時(shí)間：2019-05-27 11:46

【摘要】：目的:本文通過觀察鼻息肉組織內(nèi)的炎性細(xì)胞的浸潤(rùn)特點(diǎn),分析以中性粒細(xì)胞的浸潤(rùn)為主的鼻息肉患者的臨床特點(diǎn),及IL-17、IL-8在其組織中的表達(dá),從而為鼻息肉的臨床分類和治療策略提供依據(jù)。方法:收集我科行鼻內(nèi)鏡手術(shù)的患者鼻息肉組織,時(shí)間為2016年3月至2016年10月。根據(jù)病理特點(diǎn),經(jīng)HE染色觀察后,采用Wenzel SE等[1]以炎性細(xì)胞的百分比例正常對(duì)照組的均數(shù)+2倍的標(biāo)準(zhǔn)差定義為該炎性細(xì)胞為主型的,區(qū)分出以中性粒細(xì)胞浸潤(rùn)為主的鼻息肉,并與嗜酸性粒細(xì)胞浸潤(rùn)為主的鼻息肉作比較,各收集40例,收集鼻中隔偏曲需要行矯正術(shù)的患者部分下鼻甲粘膜20例。常規(guī)檢查鼻息肉患者的外周血中性粒細(xì)胞百分比、嗜酸性粒細(xì)胞百分比,通過鼻息肉患者的術(shù)前鼻竇CT、模擬視覺量表(VAS)及鼻內(nèi)鏡下觀察的臨床數(shù)據(jù),分析其臨床特點(diǎn),并通過免疫組化檢查IL-17和IL-8在組織中的。結(jié)果:本實(shí)驗(yàn)中性粒細(xì)胞4%(1.25%+2×1.37%=3.96)定義為中性粒細(xì)胞型鼻息肉;嗜酸性粒細(xì)胞大于8%(4.4%+2×1.7%=7.9%)定義為嗜酸性粒細(xì)胞型鼻息肉。中性粒細(xì)胞浸潤(rùn)為主的鼻息肉組患者與嗜酸性粒細(xì)胞型鼻息肉組患者相比較,在性別、年齡、中性粒細(xì)胞百分比無(wú)顯著差別(p05.0);NEUNP與ENP患者流粘膿涕程度分別為6.35±1.20和5.69±1.31(p05.0),存在顯著的差異;而兩組患者的VAS整體主觀癥狀、鼻內(nèi)鏡下鼻息肉病變程度均無(wú)顯著差別(p05.0);NEUNP 患者和EOSNP患者的鼻竇CT影像學(xué)整體得分分別為9.59±3.35和14.43±3.81(p05.0),上頜竇評(píng)分分別為3.14±1.21和2.05±1.02(p05.0),均有顯著的差異,即NEUNP患者的整體病變較輕,但上頜竇病變較嚴(yán)重。IL-17、IL-8在NEUNP中的表達(dá)均明顯高于在EOSNP、正常下鼻甲粘膜中的表達(dá)(p05.0)。結(jié)論:中性粒細(xì)胞型鼻息肉患者的分泌物為粘膿性分泌物,其主觀癥狀的評(píng)分明顯高于嗜酸性粒細(xì)胞鼻型的鼻息肉患者;中性粒細(xì)型鼻息肉患者上頜竇的病變程度同樣明顯高于嗜酸性粒細(xì)胞鼻息肉患者,整體上鼻竇的病變程度相對(duì)嗜酸性粒細(xì)胞型鼻息肉較輕。IL-17、IL-8在中性粒細(xì)型鼻息肉組織中的表達(dá)均高于嗜酸性粒細(xì)胞型鼻息肉和正常對(duì)照組,提示IL-17、IL-8趨化中性粒細(xì)胞作用于鼻息肉,對(duì)中性粒細(xì)胞型鼻息肉的發(fā)病機(jī)制發(fā)揮重要作用。因此,以中性粒細(xì)胞浸潤(rùn)為主的鼻息肉,有明顯的臨床和病理特點(diǎn),為鼻息肉的發(fā)病機(jī)制提供了新的認(rèn)識(shí)。
[Abstract]:Objective: to observe the infiltration characteristics of inflammatory cells in nasal polyps, to analyze the clinical characteristics of patients with nasal polyps dominated by neutrophil infiltration, and to analyze the expression of IL-17,IL-8 in nasal polyps. So as to provide the basis for the clinical classification and treatment strategy of nasal polyps. Methods: the nasal polyp tissues of patients undergoing endoscopic sinus surgery were collected from March 2016 to October 2016. According to the pathological characteristics, after HE staining, Wenzel SE et al. [1] were defined as the main type of inflammatory cells by using Wenzel SE et al. [1] the standard deviation of the percentage of inflammatory cells in the normal control group was 2 times that of the normal control group. Nasal polyps with neutrophil infiltration were distinguished and compared with eosinophils infiltrating nasal polyposis. 40 cases were collected and 20 cases of inferior turbinate mucosa needed correction in patients with deviation of nasal septum. The percentage of neutrophils and eosinophils in peripheral blood of patients with nasal polyposis were examined by routine examination, and the clinical characteristics were analyzed by CT, simulated visual scale (VAS) and endoscopic observation in patients with nasal polyps. The expression of IL-17 and IL-8 in the tissue was examined by immunohistochemistry. Results: neutrophil 4% (1.25% 2 脳 1.37% = 3.96) was defined as neutrophil nasal polyp, and eosinophils more than 8% (4.4% 2 脳 1.7% = 7.9%) were defined as eosinophilic nasal polyp. There was no significant difference in sex, age and percentage of neutrophils between the patients with nasal polyposis with neutrophil infiltration and those with eosinophilic nasal polyposis (p05.0). The degree of runny nose in patients with NEUNP and ENP was 6.35 鹵1.20 and 5.69 鹵1.31 (p05.0), respectively, but there was no significant difference between the two groups in the overall subjective symptoms of VAS and the degree of nasal polyps under nasal endoscope (p05.0). The overall scores of CT and maxillary sinus in NEUNP patients and EOSNP patients were 9.59 鹵3.35 and 14.43 鹵3.81 (p05.0), respectively, and the maxillary sinus scores were 3.14 鹵1.21 and 2.05 鹵1.02 (p05.0), respectively. That is to say, the overall lesions of NEUNP patients were mild, but the maxillary sinus lesions were more serious. The expression of IL-17 and IL 鈮，

本文編號(hào)：2486122