本文選題：慢性鼻竇炎伴鼻息肉 + 白細(xì)胞介素-17��； 參考：《河北醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:慢性鼻竇炎伴鼻息肉(chronic rhinosinusitis with nasal polyps, CRSwNP)是上呼吸道炎癥性疾病,其病理過程是復(fù)雜的,表現(xiàn)為上皮細(xì)胞分泌增強和鱗狀上皮化,黏膜固有層基底膜增厚,細(xì)胞外基質(zhì)積聚和膠原沉積,這種結(jié)構(gòu)的改變與炎癥細(xì)胞浸潤相關(guān)。但其發(fā)病機理尚不是很明確。IL-17被認(rèn)為在下呼吸道重建和慢性炎癥的形成中起著關(guān)鍵的作用。盡管IL-17細(xì)胞因子家族是近些年新發(fā)現(xiàn)的,但最近研究認(rèn)為它是引起自身免疫性疾病和炎性疾病的關(guān)鍵因素。細(xì)胞因子IL-17在促進(jìn)炎癥的過程中起著重要的作用[1]。眾所周知,IL-6是能夠誘導(dǎo)分化Th17細(xì)胞的細(xì)胞因子[2],而Th17細(xì)胞以分泌IL-17為主,IL-17的主要功能是刺激間質(zhì)細(xì)胞分泌IL-6、IL-8、GM-CSF、前列腺素E2和NO[3-7],同時,IL-17還促進(jìn)支氣管纖維細(xì)胞合成IL-6和IL-8。曾有學(xué)者報道IL-17在哮喘中表達(dá)增強,嗜酸性粒細(xì)胞是IL-17主要來源之一,證明了IL-17在氣道重構(gòu)中的作用[8]。目前已知,IL-6在細(xì)胞因子IL-17產(chǎn)生過程中起著重要的作用,它也是在各種炎癥性疾病發(fā)病機制中起作用的細(xì)胞因子,在目前的研究中,已經(jīng)證明了IL-6在慢性鼻竇炎中起作用。雖然IL-6已經(jīng)被認(rèn)為是慢性鼻竇炎中炎癥發(fā)生的標(biāo)志,但是其在慢性鼻竇炎伴鼻息肉發(fā)病機理中的作用尚未見報道。而IL-17作為最近較新的細(xì)胞因子,對于其在鼻息肉發(fā)病機制中的作用還需進(jìn)一步研究,本文旨在于通過研究慢性鼻竇炎伴鼻息肉中IL-17和IL-6的表達(dá)情況,來進(jìn)一步探討IL-17及IL-6在鼻息肉發(fā)病過程中的可能作用機理。 方法:病例選擇、實驗分組及取材。本實驗分為慢性鼻竇炎伴鼻息肉組和正常下鼻甲粘膜對照組兩組。鼻息肉組織、下鼻甲粘膜組織均來自于2009年10月～2010年8月在我科住院者中需行鼻內(nèi)鏡手術(shù)的患者。23例鼻息肉標(biāo)本來自我科行鼻內(nèi)窺鏡鼻竇手術(shù)的患者,其中男13例,女10例,年齡在20-65歲,平均年齡在48.5歲,19例正常下鼻甲粘膜來自我科鼻中隔偏曲伴下鼻甲肥大的患者,其中男10例,女9例,年齡在25-63歲,平均年齡在45歲。全部病例均無變應(yīng)性鼻炎、哮喘等變態(tài)反應(yīng)史,排除其他全身疾病,并術(shù)前4周未使用抗生素、皮質(zhì)類固醇激素及抗組胺藥等藥物治療。標(biāo)本經(jīng)10%多聚甲醛固定,常規(guī)脫水,石蠟包埋,組織切片,HE染色用于觀察炎性細(xì)胞浸潤情況,并在高倍視野觀察嗜酸性粒細(xì)胞。免疫組織化學(xué)染色用于觀察IL-17,IL-6的表達(dá)部位及表達(dá)情況。所有資料均運用SPSS13.0進(jìn)行統(tǒng)計分析,采用Wilcoxon秩和檢驗,卡方檢驗和相關(guān)分析處理數(shù)據(jù),以α=0.05作為檢驗標(biāo)準(zhǔn)。P0.05有統(tǒng)計學(xué)意義。 結(jié)果: 1 HE染色:在鼻息肉組織中可見假復(fù)層柱狀纖毛上皮覆蓋,上皮下為水腫的疏松結(jié)締組織,還可見有不規(guī)則的囊性擴張的腺體,并有不同程度的炎性細(xì)胞浸潤。其中存在著大量的嗜酸性粒細(xì)胞的浸潤明顯高于下鼻甲組織(P0.01)。 2免疫組化染色可見IL-17主要在鼻息肉組織中嗜酸性粒細(xì)胞,漿細(xì)胞和中性粒細(xì)胞胞質(zhì)中,少量的在漿液腺泡也有陽性表達(dá)。IL-17在鼻息肉組中的表達(dá)顯著高于對照組(P0.01)。 3 IL-6的陽性表達(dá)在鼻息肉黏膜下浸潤的炎性細(xì)胞、成纖維細(xì)胞、少量血管內(nèi)皮細(xì)胞的胞質(zhì)或胞膜上,間質(zhì)也偶有表達(dá)。IL-6在兩組間差異有顯著性意義(P0.01)。 4 IL-17和IL-6兩者在鼻息肉中表達(dá)存在著明顯的相關(guān)性,相關(guān)系數(shù)r=0.77(P0.01)。 結(jié)論: 1鼻黏膜中大量嗜酸性粒細(xì)胞浸潤是慢性鼻竇炎伴鼻息肉的一個重要病理學(xué)特征。 2慢性鼻竇炎伴鼻息肉患者中Th17細(xì)胞高表達(dá)可能是一個重要原因。 3 IL-6可能協(xié)同Th17細(xì)胞參與慢性鼻竇伴鼻息肉的發(fā)生發(fā)展。 4在慢性鼻竇炎伴鼻息肉中,IL-17及IL-6之間密切相關(guān),或許可以為慢性鼻竇炎伴鼻息肉的治療提供一條新思路。
[Abstract]:Objective: chronic nasosinusitis with nasal polyps (chronic rhinosinusitis with nasal polyps, CRSwNP) is an inflammatory disease of the upper respiratory tract. Its pathological process is complex, characterized by enhanced secretion and squamous epithelialization of epithelial cells, thickening of the basilar membrane of the lamina propria, accumulation of extracellular matrix and deposition of collagen, such structural changes and inflammatory cells The pathogenesis is not yet very clear that.IL-17 is considered to play a key role in the reconstruction of the lower respiratory tract and the formation of chronic inflammation. Although the IL-17 cytokine family is newly discovered in recent years, the recent study suggests that it is a key factor in the cause of autoimmune diseases and inflammatory diseases. Cytokine IL-17 is promoting. [1]. is known to play an important role in the process of inflammation, as is known to all, IL-6 is the cytokine [2] that can induce the differentiation of Th17 cells, while Th17 cells secrete IL-17, and the main function of IL-17 is to stimulate interstitial cells to secrete IL-6, IL-8, GM-CSF, prostaglandin E2 and NO[3-7]. Scholars have reported that the expression of IL-17 in asthma is enhanced. Eosinophils are one of the main sources of IL-17. The role of IL-17 in airway remodeling is now known. [8]. is known to play an important role in the production of cytokine IL-17. It is also a cytokine that plays a role in the pathogenesis of various inflammatory diseases. IL-6 has been shown to play a role in chronic nasosinusitis. Although IL-6 has been identified as a marker of inflammation in chronic sinusitis, its role in the pathogenesis of chronic sinusitis with nasal polyps has not yet been reported. And the role of IL-17 as a recent more new cytokine in the pathogenesis of nasal polyps is still needed. One step is to investigate the possible mechanism of IL-17 and IL-6 in the pathogenesis of nasal polyps by studying the expression of IL-17 and IL-6 in chronic rhinosinusitis with nasal polyps.
Methods: the case selection, the experimental group and the materials were divided into two groups: chronic nasosinusitis with nasal polyps and normal inferior turbinate mucosa. The nasal polyps and inferior turbinate mucous tissue were from October 2009 to August 2010 in the patients who had to be operated on the nasal endoscope in our hospital..23 nasal polyps from our department were from the nasal endoscopy. The patients with endoscopic sinus surgery were 13 male and 10 female, with the age of 20-65 years, the average age was 48.5 years old. 19 cases of normal inferior turbinate mucous membrane came from the patients with partial septum and inferior turbinate hypertrophy of the nasal septum, including 10 men, 9 women, the age of 25-63, and the average age of 45. All cases had no allergic rhinitis, asthma and other allergy history, excluded. Other systemic diseases were treated with antibiotics, corticosteroids and antihistamine drugs 4 weeks before operation. The specimens were fixed with 10% polyformaldehyde, routine dehydration, paraffin embedding, tissue section, HE staining to observe the infiltration of inflammatory cells and observing eosinophils at high magnification. Immunohistochemical staining was used to observe IL -17, IL-6 expression and expression. All data were statistically analyzed by SPSS13.0, using Wilcoxon rank sum test, chi square test and correlation analysis processing data, with a statistical significance of alpha =0.05 as a test standard.P0.05.
Result:
1 HE staining: the false stratified columnar ciliated epithelium is covered in the nasal polyps, the epithelia is a loose connective tissue with edema, and there are irregular cystic dilatation glands with varying degrees of inflammatory cell infiltration. There are a large number of eosinophils that are significantly higher than the inferior turbinate (P0.01).
2 immunohistochemical staining showed that IL-17 was mainly in the eosinophils, plasma cells and neutrophils in the nasal polyps, and a small amount in the serous acinus and positive expression of.IL-17 in the nasal polyp group was significantly higher than that in the control group (P0.01).
The positive expression of 3 IL-6 was in the inflammatory cells infiltrating under the nasal polyps, the fibroblasts, the cytoplasm or the membrane of a small amount of vascular endothelial cells, and the occasional expression of the interstitial.IL-6 had significant difference between the two groups (P0.01).
4 there was a significant correlation between the expression of IL-17 and IL-6 in nasal polyps, and the correlation coefficient r=0.77 (P0.01).
Conclusion:
1 the infiltration of eosinophils in nasal mucosa is an important pathological feature of chronic sinusitis and nasal polyps.
2 the high expression of Th17 cells may be an important reason for chronic sinusitis and nasal polyps.
3 IL-6 may cooperate with Th17 cells to participate in the development of chronic sinuses and nasal polyps.
4 there is a close correlation between IL-17 and IL-6 in chronic sinusitis and nasal polyps. It may provide a new idea for the treatment of chronic sinusitis and nasal polyps.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R765.21

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