本文選題：上頜竇后鼻孔息肉 + 鼻息肉��； 參考：《瀘州醫(yī)學院》2014年碩士論文

【摘要】：目的：目前關(guān)于鼻息肉(Nasal polyps,NP)的組織病理學特征有很多研究報道，較為公認的共性特征是組織水腫和炎性細胞的浸潤。上頜竇后鼻孔息肉（Antrochoanal polyp,ACP）作為鼻息肉的一種特殊類型，卻有其不同于普通鼻息肉的好發(fā)部位和預后，這些不同的臨床特征可能暗示兩組疾病的組織結(jié)構(gòu)有差異。但有關(guān)ACP和普通NP組織病理學差異的研究甚少，本研究旨在觀察ACP與普通NP的組織病理學特征，重點觀察兩者的黏膜下腺體分布，嗜酸性粒細胞、中性粒細胞、漿細胞及淋巴細胞的浸潤分布與計數(shù)，微血管的計數(shù)，并對各類炎細胞、微血管之間的相關(guān)關(guān)系進行分析，探討兩組疾病的組織病理學差異，以及這種差異在臨床上的可能意義。方法：選擇2011年10月至2013年07月雅安市人民醫(yī)院耳鼻咽喉科的住院病例，確定納入與排除標準，對符合標準的病例進行收集。將收集的病例資料分為ACP組與普通NP組，其中ACP組有24例，普通NP組40例。將納入病例術(shù)中取出的病變標本進行組織病理學研究。研究采用的主要方法有：①采用HE染色，觀察ACP組和普通NP組的黏膜下腺體分布，炎性細胞（嗜酸性粒細胞、中性粒細胞、漿細胞、淋巴細胞）的分布與計數(shù)，并對結(jié)果進行統(tǒng)計學分析；②采用免疫組化EnVision法分別計數(shù)ACP組和普通NP組中CD34標記陽性的微血管密度，并對結(jié)果進行統(tǒng)計學分析。結(jié)果：（1）在ACP組中，黏膜下出現(xiàn)腺體例數(shù)2例，腺體出現(xiàn)率為8.33%；普通NP組中黏膜下出現(xiàn)腺體例數(shù)為38例，腺體出現(xiàn)率為95%，兩組疾病粘膜下腺體出現(xiàn)率進行卡方檢驗，χ2=48.071，P＜0.05，粘膜下腺體出現(xiàn)率差異有統(tǒng)計學意義。（2）ACP組與普通NP組中嗜酸性粒細胞數(shù)、中性粒細胞數(shù)、漿細胞數(shù)、淋巴細胞數(shù)以及微血管密度進行兩獨立樣本t檢驗，t值分別為18.423，9.564，4.823，2.100，2.930，P值均＜0.05，差異均有統(tǒng)計學意義。（3）在ACP組中，，嗜酸性粒細胞同中性粒細胞、淋巴細胞、漿細胞兩兩間呈正相關(guān)（相關(guān)系數(shù)r分別為0.943，0.751，0.630，且P＜0.01）；微血管密度與嗜酸性粒細胞、中性粒細胞之間呈正相關(guān)（相關(guān)系數(shù)r分別為0.528，0.521，P＜0.01）。（4）普通NP組中，嗜酸性粒細胞同淋巴細胞、漿細胞兩兩間呈負相關(guān)（相關(guān)系數(shù)r分別為-0.686，-0.713,且P＜0.01）；嗜酸性粒細胞與微血管密度呈正相關(guān)（r=0.756，P＜0.01）。結(jié)論：(1)ACP組黏膜下腺體出現(xiàn)率顯著低于普通NP組；黏膜下浸潤細胞類型不同，普通NP組中以嗜酸性粒細胞浸潤為主，ACP組中以中性粒細胞及淋巴細胞浸潤為主。⑵微血管的增生同鼻息肉的發(fā)生、發(fā)展關(guān)系密切。微血管增生程度不同是導致ACP的結(jié)構(gòu)和預后不同于普通NP的因素之一。⑶通過相關(guān)性分析，嗜酸性粒細胞的浸潤同微血管增生在兩組疾病中均呈正相關(guān)，考慮嗜酸性粒細胞可能促進微血管增生。
[Abstract]:Objective: there are many reports on histopathological features of nasal polyp Nasal polypsNPs. The common characteristics are tissue edema and inflammatory cell infiltration. As a special type of nasal polyps, the posterior maxillary sinus polyp Antrochoanal polypypanus (ACPP) is different from the common nasal polyps in its location and prognosis. These different clinical features may indicate that there are differences in the tissue structure between the two groups. However, there are few studies on histopathological differences between ACP and NP. The aim of this study was to observe the histopathological characteristics of ACP and NP, and to observe the distribution of submucosal glands, eosinophils, neutrophils, and neutrophils. The infiltration, distribution and count of plasma cells and lymphocytes, the count of microvessels, and the correlation between inflammatory cells and microvessels were analyzed, and the histopathological differences between the two groups were discussed. And the possible clinical significance of this difference. Methods: the inpatients of Otolaryngology Department of Ya'an people's Hospital from October 2011 to July 2013 were selected, the inclusion and exclusion criteria were determined, and the cases that met the criteria were collected. The data were divided into ACP group and NP group, including 24 cases in ACP group and 40 cases in NP group. Histopathological study was performed on the pathological specimens taken out during the operation. The main methods used in the study were to observe the distribution of submucosal glands, the distribution and count of inflammatory cells (eosinophils, neutrophils, plasma cells, lymphocytes) in ACP group and NP group with HE staining. The results were statistically analyzed and the CD34 positive microvessel density in ACP group and NP group were counted by immunohistochemical EnVision method, and the results were analyzed statistically. Results in ACP group, there were 2 cases of submucosal glands and 8.33 cases of glands, and 38 cases of submucosal glands in NP group. The incidence of submucosal glands in the two groups was tested by chi-square test (蠂 ~ 2 + 48.071) (P < 0.05). There was significant difference in the occurrence rate of submucosal glands between the ACP group and the NP group. The number of eosinophils, neutrophils and plasma cells in the ACP group was significantly different from that in the normal NP group, and there was no significant difference in the number of eosinophils, neutrophils and plasma cells between the two groups. The t values of two independent samples were 18.4239.564 (4.8232.100) 2.930 (P < 0.05). The difference was statistically significant (P < 0.05). In ACP group, eosinophils were the same as neutrophils and lymphocytes. There was a positive correlation between plasma cells (r = 0.943) and eosinophils and neutrophils (r = 0.943, 0.751n, 0.630, P < 0.01), and a positive correlation between microvessel density and eosinophil and neutrophils (r = 0.528, 0.521, P < 0.01, P < 0.01, respectively) in NP group, eosinophil was the same lymphocyte in normal NP group. There was a negative correlation between plasma cells (r = -0.686- 0.713, P < 0.01), and a positive correlation between eosinophil and microvessel density (P < 0.01). Conclusion the incidence of submucosal glands in the ACP group was significantly lower than that in the NP group, and the submucosal infiltrating cells were different in the ACP group. In normal NP group, eosinophilic granulocytes infiltrate mainly. 2 in ACP group, neutrophils and lymphocytes infiltrate mainly. 2 the microvascular hyperplasia is closely related to the occurrence and development of nasal polyps. The degree of microvascular hyperplasia is one of the factors leading to the structure and prognosis of ACP being different from that of NP. 3 through correlation analysis, the infiltration of eosinophils is positively correlated with microvascular hyperplasia in both groups. Consider that eosinophil may promote microvascular proliferation.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R765.25

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