分泌性中耳炎中耳积液中γ干扰素测定的临床意义

目的:探讨分泌性中耳炎(SOM)患者的中耳积液中IFNγ浓度测定的临床意义。方法:用双抗夹心酶联免疫吸附法检测51例(56耳)SOM患者(中耳炎组)的中耳积液、血清及24例正常成人(对照组)血清中IFNγ的浓度。结果:中耳炎组积液中IFNγ的浓度明显高于其血清中的浓度(P<0.01);中耳炎组与对照组血清中的浓度差异无统计学意义(P>0.05);SOM慢性期IFNγ浓度明显高于急性期(P<0.05);首次穿刺及第2次穿刺积液中IFNγ的浓度差异无统计学意义(P>0.05);而第3次或3次以上穿刺积液中IFNγ的浓度则明显升高(P<0.01)。结论:中耳积液中的IFNγ可由中耳腔局部产生,而非单纯由血液中渗透而来;中耳积液中IFNγ的高浓度可作为SOM转为慢性病程或迁延不愈的参考。     

流式细胞术微球阵列法检测多种细胞因子在分泌性中耳炎患者中的表达

目的检测急性分泌性中耳炎(acute secretory otitis media,SOM)患者外周血及中耳积液中IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ的表达水平,以期综合分析免疫因素在其发病中的作用。方法采用BD CBA Flex SetIL-2、IL-4、IL-6、IL-10、TNF、γ-干扰素试剂盒,利用流式细胞术微球阵列法检测37例急性上呼吸道感染诱发急性分泌性中耳炎外周血、耳积液,8例鼻咽癌患者放疗后分泌性中耳炎耳积液和10例正常人血清样本中6种细胞因子水平。结果急性上呼吸道感染诱发的中耳积液中的IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ表达水平显著高于外周血(P<0.05);其中IL-6、IL-10、TNF、IFN-γ水平明显高于放疗后耳积液水平(P<0.05)。急性分泌性中耳炎外周血上述六种因子较正常对照组外周血差异无统计学意义(P>0.05)。结论中耳粘膜参与了急性分泌性中耳炎患者局部的免疫反应,在其发病中可能起到一定作用。     

超氧化物歧化酶及白细胞因子在分泌性中耳炎中的表达

目的 :探讨超氧化物歧化酶 (SOD)和白细胞介素 - 6 (IL - 6 )、白细胞介素 - 8(IL - 8)、肿瘤坏死因子 -α(TNF-α)在分泌性中耳炎发生和转归中的作用。方法 :检测 74例 (90耳 )分泌性中耳炎患者 (中耳炎组 )血浆和中耳积液中 SOD、IL- 6、IL- 8及 TNF- α,并以 30例健康人血浆作对照。结果 :中耳炎组 SOD、IL- 6、IL- 8及 TNF- α在中耳积液中阳性表达率分别为 88.9%、86 .8%、81.5 %和 74 .6 % ;其血浆含量均较对照组高 (P <0 .0 5 )。中耳炎组中耳积液的含量均较血浆中高 (P <0 .0 1)。病程短者 IL- 6和 IL- 8含量较病程长者高 (P <0 .0 1、 P <0 .0 5 ) ;病程长者 SOD及 TNF- α含量较病程短者高 (P <0 .0 1、 P <0 .0 5 )。浆液性积液者 IL- 6和 IL- 8含量较粘液性积液者高 (P <0 .0 1、 P <0 .0 5 ) ;粘液性积液者 SOD及 TNF-α含量较浆液性积液者高 (P <0 .0 1、 P <0 .0 5 )。 SOD含量与 TNF-α含量正相关 (r =0 .5 87,P <0 .0 1)。结论 :IL - 6和 IL - 8在分泌性中耳炎发病早期参与机体的防御反应 ,促进浆液性中耳积液产生 ;SOD和 TNF-α与疾病的持续状态相关 ,并参与中耳积液中粘蛋白的分泌     

纤维蛋白原含量与分泌性中耳炎病情迁延的关系

目的:探讨中耳积液中纤维蛋白原含量与分泌性中耳炎病情迁延的关系。方法:用凝固法对98例成人患者中耳积液中纤维蛋白原进行动态检测。结果:98例患者经鼓膜穿刺治疗后62例未愈,治愈组和迁延组纤维蛋白原检测阳性率分别为30.56%和72.58%,P<0.01;浓度分别为(0.350±0.124)g/L和(0.568±0.206)g/L,P<0.05。迁延组中52例患者第2次穿刺治疗中耳积液中纤维蛋白原浓度为(1.241±0.146)g/L,明显高于第1次[(0.685±0.251)g/L],P<0.01。结论:纤维蛋白原含量与分泌性中耳炎病情迁延密切相关,可能在粘连性中耳炎形成中起重要作用。     

IL-1β和IL-8在分泌性中耳炎中耳积液中的表达及意义

目的探讨IL-1β和IL-8在分泌性中耳炎发生和转归中的作用。方法应用酶联免疫吸附法(ELISA)检测38例分泌性中耳炎患者40耳中耳积液中IL-1β和IL-8的含量。结果IL-1β和IL-8在分泌性中耳炎中耳积液中的表达率分别为80%和92.5%,早期积液中IL-1β和IL-8的含量高于晚期(P均<0.001),浆液性积液中二者的含量亦较高(P<0.002,P<0.05),IL-8与IL-1β的含量呈正相关(r=0.83,р<0.01)。结论IL-1β和IL-8是分泌性中耳炎中耳积液形成众多细胞因子中的两种,均存在于早期中耳积液中,并促进浆液性中耳积液的产生,前者对后者的产生有促进作用。     

CD4~+、CD8~+T细胞及IL-2、IL-6与急性分泌性中耳炎的关联性及临床意义研究

目的探究急性分泌性中耳炎患者外周血和中耳积液中CD4+、CD8+T细胞及细胞因子IL-2、IL-6活性特征。方法以我院收治的47例急性分泌性中耳炎患者为观察组,48例健康体检人群为对照组,对比分析两组外周血CD4+、CD8+T细胞百分比及IL-2、IL-4及IL-6水平及CD4+/CD8+与中耳积液IL-2、IL-6活性的相关性。结果观察组患者外周血CD4+、CD8+T细胞数值及CD4+/CD8+比值均显著高于对照组(P0.001)。血清IL-2、IL-4及IL-6水平组间比较比较无统计学意义(P0.05),但观察组患者中耳积液IL-2、IL-6水平显著高于两组研究对象外周血中的相应指标水平,且中耳积液IL-2、IL-6与患者外周血CD4+/CD8+比值呈正相关趋势,r分别为=0.431(P0.001)与0.462(P0.001)。结论急性分泌性中耳炎患者外周血CD4+、CD8+T细胞及中耳积液IL-2、IL-6水平显著升高,为本病发病机制研究提供了相关线索。     

糖皮质激素治疗成人亚急性分泌性中耳炎的疗效分析及对患者血浆TNF-α、IL-10作用的研究

目的探讨糖皮质激素治疗成人亚急性性分泌性中耳炎的疗效以及在转归中的可能作用机制。方法回顾性分析经鼓膜穿刺治疗的成人亚急性OME患者60例,比较激素治疗组,即糖皮质激素治疗＋术后口服糖皮质激素组（实验组）与仅鼓室内非激素药物治疗（对照组）的治疗效果;使用ELISA法检测和比较2组患者中耳积液与外周血浆的表达水平的变化,手术前后外周血浆中TNF-0c、IL-10表达水平的变化。结果激素治疗组的治疗有效率显著高于非激素治疗组（P〈0．05）,复发率明显低于非激素治疗组（P〈0．05）;TNF-d、IL～10在中耳积液中的含量显著高于外周血浆中含量（P〈0．05）,激素组患者术后3天、10天血清中的TNF-a较对照组明显下降（P〈0．05）;而IL-10含量术后3天较非激素组显著升高（P〈0．05）,而术后10天显著下降（P〈0．05）。结论糖皮质激素是治疗成人亚急性分泌性中耳炎的有效手段,可能通过提高血浆中的IL-10来抑制TNF_仅的释放来达到抑制炎症的作用。     

中耳积液中纤维蛋白原含量与分泌性中耳炎疗效的关系

目的探讨中耳积液中纤维蛋白原含量与分泌性中耳炎病情迁延的关系及巴曲酶治疗分泌性中耳炎的可能机制。方法用凝固法对156例分泌性中耳炎患者治疗过程中的中耳积液中纤维蛋白原含量进行动态检测。鼓室抽液2次（间隔1周），积液复发者随机分成巴曲酶组及地塞米松组，穿刺后分别用0．5ml巴曲酶（2BU／ml）或0．5ml地塞米松（2mg／ml）行鼓室内注射治疗，观察治疗效果。结果积液复发组第1、2次复发中耳积液中纤维蛋白原含量均明显高于痊愈组，且第2次复发者的中耳积液纤维蛋白原含量更高（P〈0．01）。巴曲酶组治疗有效率为91．6％，较地塞米松组（有效率为62．5％）差异有统计学意义（P〈0．001）。治疗后6个月巴曲酶组平均气导听阈值（0．5、1．0、2．0kHz）变化与地塞米松组比较，治疗1周后2组中耳积液中纤维蛋白原含量差异，均有统计学意义（P〈0．01）。结论纤维蛋白原可能在分泌性中耳炎发生发展中起重要作用；鼓室内注射巴曲酶比注射地塞米松治疗分泌性中耳炎，疗效差异有统计学意义，其机制可能是通过降解纤维蛋白原以解除其对咽鼓管表面活性物质的抑制作用或（和）阻止其转变成不溶性纤维蛋白聚合体。     

细胞因子、IgE及一氧化氮在小儿分泌性中耳炎中耳积液的表达

目的 :探讨细胞因子、IgE及一氧化氮 (NO)在小儿分泌性中耳炎的发生及转归中的作用。 方法 :检测 70例 (1 2 9耳 )分泌性中耳炎患儿 (患儿组 )血浆及中耳积液中细胞因子、IgE及NO含量 ,并以 30例健康儿童作对照。结果 :患儿组白细胞介素 (IL 2、4、6、8、1 0 )、肿瘤坏死因子 α(TNF α)、IgE及NO在中耳积液中含量较血浆中高 (P <0 .0 1 ) ;患儿组的血浆含量较对照组高 (P <0 .0 5 )。病程短者中耳积液中IL 2、IL 4的含量较病程长者高 ;而病程长者IL 6、IL 8、IL 1 0、TNF α、IgE及NO的表达较病程短者增加 (均P <0 .0 5 )。结论 :在儿童分泌性中耳炎的血浆及中耳积液中细胞因子、IgE及NO表达增强 ,细胞因子参与介导中耳局部的炎性反应 ,调节局部的免疫反应 ,在分泌性中耳炎的发生及转归中产生重要作用     

摘要与选登

中华耳鼻咽喉头颈外科杂志CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD ANDNECK SURGERY中耳积液中纤维蛋白原含量与分泌性中耳炎疗效的关系陈锡辉,吴旋,黄彬中华耳鼻咽喉头颈外科杂志,2006,41(8):566-569目的:探讨中耳积液中纤维蛋白原含量与分泌性中耳炎病情迁延的关系及巴曲酶治疗分泌性中耳炎的可能机制。方法:用凝固法对156例分泌性中耳炎患者治疗过程中的中耳积液中纤维蛋白原含量进行动态检测。鼓室抽液2次(间隔1周),积液复发者随机分成巴曲酶组及地塞米松组,穿刺后分别用0.5ml巴曲酶(2BU/ml)或0.5ml地塞米…     

细胞因子及白细胞介素-1β与内毒素在分泌性中耳炎中耳积液中的表达及意义

目的 :探讨分泌性中耳炎 (SOM )中耳积液中内毒素 (ET)、白细胞介素 1β(IL 1β)、正常T细胞表达和分泌、活化时调节的趋化因子 (RANTES)的表达以及它们在SOM发病中的作用。方法 :对 5 3例 72耳SOM患者行鼓膜穿刺 ,获得的中耳积液标本行细菌培养 ,然后采用鲎试验动态浊度法、放射免疫法以及双夹心抗体酶联免疫吸附法检测中耳积液中ET、IL 1β和RANTES的浓度。 结果 :①中耳积液中ET、IL 1β和RANTES阳性率分别为 80 .9%、77.8%和 70 .8% ,平均浓度为 (35 .2± 5 1.6 )EU/ml,(1.10± 0 .84 ) μg/L ,(0 .5 2± 0 .4 3) μg/L。②三者在黏液性积液中的含量高于浆液组 (P <0 .0 5 ) ;病程长者 ,ET、RANTES浓度也较高 (P <0 .0 5 ) ;细菌培养阳性中耳积液中三者的浓度亦明显高于细菌培养为阴性的积液 (P <0 .0 1)。③积液中ET含量与IL 1β呈显著正相关性 (r =0 .74 ,P <0 .0 1) ,IL 1β与RANTES之间也呈显著正相关 (r =0 .4 8,P <0 .0 1)。结论 :ET、IL 1β与RANTES参与了SOM发病的免疫机制 ,与鼓室内炎症反应的迁延 ,促使积液类型转化有关     

分泌性中耳炎中耳积液的Epstein-Barr病毒测定

目的：探讨在分泌性中耳炎（ＳＯＭ）中的发病过程中是否有Ｅｐｓｔｅｉｎ－Ｂａｒｒ病毒（ＥＢＶ）参与。方法：应用聚合酶链反应（ＰＣＲ）技术对３４例ＳＯＭ患者（ＳＯＭ组）的血清、口腔含濑液和中耳积液（ＭＥＥ）进行ＥＢＶ检测,并与２０例正常人进行比较。结果：ＳＯＭ组血清和口腔含漱液标本中ＥＢＶ的检出率明显高于对照组,ＳＯＭ组ＭＥＥ中的ＥＢＶ检出率高于其血液标本。结论：在ＳＯＭ的发病过程中有ＥＢＶ的参与。     

白细胞介素6和肿瘤坏死因子—α在分泌性中耳炎渗出液中表达及…

Using enzyme-linked immunosorbant assay (ELISA), we measured levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in middle ear effusions (MEE) from patients with secretory otitis media (SOM) undergoing auripuncture to study the role of cytokines in the pathogenesis of the disease. Significant levels of IL-6 (> 62.5 ng/L) were found in 19 (86.36%) of 22 MEEs and those of TNF-alpha (> 37.5 ng/L) in 19 (70.37%) of 27 MEEs. The mean (+/- s) levels of IL-6 and TNF-alpha were 507.68 +/- 813.11 ng/L and 186.86 +/- 166.93 ng/L, respectively. It revealed that the shorter the course, the higher the concentration of IL-6 in MEE: the longer the course, the higher the concentration of TNF-alpha in MEE. These findings suggested that during the early stages of SOM, IL-6 might participate in the defensive reaction of organism, while TNF-alpha might be closely related to the persistence of SOM, resulting in an excessive inflammatory reaction with a potential for pathological changes. It is concluded that the immunological mechanisms probably play a significant role in the pathogenesis of SOM.     

Immunoglobulin-coated bacteria in effusions from secretory and chronic suppurative otitis media

Samples of middle ear effusions from 10 children with secretory otitis media and from 10 children with chronic suppurative otitis media were subjected to qualitative and quantitative bacteriologic analysis. In addition, secretory immunoglobulin A (SlgA)- and IgG-coated bacteria were evaluated using the immunofluorescence technique. Secretory otitis media effusions harbored few, if any, immunoglobulin-coated bacteria, whereas chronic otitis media effusions as a rule had heavily IgG- and SlgA-coated bacteria. However, those chronic otitis media effusions that were culture positive for Pseudomonas aeruginosa had no immunoglobulin-coated bacteria. The effusions of very young children were completely devoid of SlgA-coated bacteria. This study demonstrates that, based on the immunoglobulin coating of bacteria obtained from the middle ear cleft, one can evaluate immunologic response during otitis media.     

Opsonization of middle ear bacteria during chronic suppurative and secretory otitis media.

Samples of middle ear effusion were obtained from 16 patients with chronic suppurative otitis media (COM) (20 ears, age range from 1 1/12 to 69 years) and 13 patients with secretory otitis media (SOM) (15 years, age range from 8 months to 13 8/12 years). Qualitative and quantitative bacteriological analyses of the effusions were performed and the intensity of immunoglobulin G (IgG) and complement component C3b adhering to the bacteria was estimated using immunofluorescence technique. In COM effusions, S. aureus in particular was intensely opsonized, whereas Ps. aeruginosa showed minimal, if any, coating with IgG and C3b. SOM effusions exhibited extremely sparse IgG- and C3b-coated bacteria. The difference in IgG and C3b coated bacteria between COM and SOM effusions was significant (p less than 0.01). Specific (IgG) as well as non-specific (C3b) coating of the bacteria that have gained access to the middle ear cavity is of importance for the host defence.     

Immunoglobulin E in mucoid secretory otitis media

19 serum and 23 middle ear mucoid fluid samples from patients with chronic secretory otitis media (SOM) were analyzed for total IgE using the PRIST technique and for specific IgE against dog epithelium, house dust mite, milk, egg-white and wheat using the RAST technique. All serum samples showed IgE values well within the normal range, and the middle ear fluid-serum ratio for total IgE was less than 1. In three sera there was a weak (score 1) positive RAST result to milk (2 cases) and to egg-white (1 case). None of the middle ear fluids showed positive reactions. Routine clinical assessment of total and specific IgE is not indicated in SOM.     

A microbiological study of secretory otitis media using an anaerobic technique

A serious anaerobic sampling and cultivation technique was used in order to obtain representative samples from 45 middle ear effusions in 30 patients with longstanding secretory otitis media (SOM). Despite the fact that an accurate sterilizing procedure was performed, 16% disclosed contaminated samples from the ear canal and tympanic membrane. Among the remaining samples, middle ear bacteria were found in 30% of which Staphylococcus epidermidis and Haemophilus influenzae contributed to the major part. Anaerobes were only occasionally found. The amount of bacteria found was sparse in all cases. It can be concluded that the inflammatory process in SOM is not maintained by anaerobic bacteria within the middle ear cavity.     

Compositional difference in middle ear effusion: mucous versus serous.

OBJECTIVES: Serous otitis media is usually responsive to medical treatment, whereas mucoid otitis media is not. The present study was undertaken to elucidate the compositional difference between serous and mucoid effusion and to investigate whether MUC5AC acts as a major mucin in the middle ear mucosa with mucoid otitis media. STUDY DESIGN: This study involved a chemical analysis of middle ear effusion and immunostaining of the middle ear mucosa. METHODS: Middle ear effusion samples were collected from 27 patients with mucoid otitis media and 18 patients with serous otitis media. The levels of mucin, lysozyme, secretory immunoglobulin A, and interleukin-8 were measured by dot blotting or enzyme-linked immunosorbent assay. Periodic acid-Schiff and immunohistochemical staining with monoclonal anti-MUC5AC antibody were performed on the serial sections of middle ear mucosa with mucoid otitis media. RESULTS: Mucoid effusions contained higher levels of mucin, lysozyme, secretory immunoglobulin A, and interleukin-8 than did serous effusions. Immunohistological study revealed that MUC5AC mucin was expressed in only a small portion of the goblet cells of middle ear mucosa with mucoid otitis media. CONCLUSIONS: The study suggests that both serous secretions and mucin might make the middle ear effusion more viscous and that mucins other than MUC5AC might have a major role in the viscosity of middle ear effusion. Further study is necessary to identify the major mucins in the middle ear effusion of otitis media with effusion.     

The kinetics of penicillin diffusion in serum and middle ear effusions in experimentally induced otitis media

The kinetics of penicillin diffusion in serum and middle ear effusions (MEE) was studied in experimentally induced serous otitis media (SOM) and purulent otitis media (POM) after systemic injection of procaine-penicillin G. A higher rate of diffusion of penicillin into the middle ear cavity was found in POM than in SOM. The time to reach peak concentrations in MEE was also shorter in POM. Elimination of penicillin from the middle ear cavity was slower in SOM than in POM.