TRPV1在鼻高反应性疾病中的作用机制

鼻高反应性疾病是临床上常见的上气道疾病,以变应性鼻炎(AR)及血管运动性鼻炎(VMR)为代表,其发病机制复杂,目前的治疗策略仅以改善症状为主,尚不能彻底治愈。近年来研究发现,瞬时受体电位(TRP)家族可能是鼻高反应性疾病治疗的重要靶点。尤其随着对TRP香草酸受体1(TRPV1)研究的不断深入,发现由其主导的神经-免疫调控网络对于鼻高反应性疾病的发生发展有着重要作用。多种药物通过靶向TRPV1,对鼻高反应性疾病显示出良好的治疗效果,反映出TRPV1诱人的临床转化前景。然而,目前对于TRPV1在鼻高反应性疾病中的研究尚缺乏系统性,因此,本文就TRPV1在鼻高反应性疾病中的作用进行综述,以期为鼻高反应性疾病的治疗提供理论依据和新的思路。     

瞬时受体电位锚蛋白1通道调节慢性鼻窦炎上皮细胞自噬及细胞间黏附分子表达的作用探究

目的　探究瞬时受体电位锚蛋白1（t ransient receptor potential ankyrin1,TRPA1）对慢性鼻窦炎（CRS）上皮细胞自噬与细胞间黏附分子（intercellular adhesion moleclar-1,ICAM-1）表达的影响。方法　通过免疫组织化学染色、实时荧光定量PCR及Western blot检测TRPA1在对照组、慢性鼻窦炎不伴鼻息肉（chronic nasal-sinusitis without nasal polyps,CRSsNP）及慢性鼻窦炎伴鼻息肉 （chronic rhinosinusitis with nasal polyps,CRSwNP）患者鼻黏膜组织中的表达水平,并采用免疫组织化学染色和Western blot观察各组患者鼻黏膜组织内自噬水平;分离培养鼻黏膜上皮细胞,利用细胞角蛋白AE1进行免疫荧光染色鉴定上皮细胞;将鼻黏膜上皮细胞随机分为对照组、脂多糖（LPS）组、LPS+TRPA1抑制剂组,实时荧光定量PCR和Western blot检测各组细胞TRPA1在mRNA和蛋白上的表达水平,以自噬双标腺病毒mRFP-GFP-LC3感染细胞并通过荧光显微镜观察各组细胞自噬情况,并使用透射电镜观测各组细胞自噬小体形成,实时荧光定量PCR和Western blot检测各组细胞ICAM-1在mRNA和蛋白上的表达水平。结果　相较于对照组,CRSsNP与CRSwNP患者鼻黏膜上TRPA1平均光密度值升高,其mRNA相对表达量和蛋白相对表达量均上调（P<0.05）,且LC3-II平均光密度值升高,LC3-II/LC3-I比值升高,Beclin-1蛋白相对表达量上调而p62蛋白相对表达量下调（P<0.05）,组织内自噬水平升 高。成功分离到生长密集、形状为梭形或多边形以及AE1呈阳性表达的鼻黏膜上皮细胞;与LPS组比较,经过LPS与TRPA1抑制剂共处理的鼻黏膜上皮细胞TRPA1 mRNA相对表达量与蛋白相对表达量均下调（P <0.05）,自噬溶酶体红色荧光减弱,自噬小体也明显减少,同时,ICAM-1mRNA相对表达量与蛋白相对表达量均下调（P<0.05）。结论  CRS中TRPA1表达异常增加,自噬水平也升高,靶向抑制TRPA1能够抑制CRS上皮细胞自噬以及ICAM-1表达的升高。     

上皮源性细胞因子在共同气道疾病中的作用及其研究进展

在"一个气道一种疾病"的概念下,上下气道炎症性疾病通常是并存的,整个气道可以看作一个器官.上呼吸道和下呼吸道表面覆盖呼吸道上皮,在免疫监视和调节中起着至关重要的作用,是抵御各种病原微生物、变应原和组织损伤的第一道防线.近年来,大量研究认为上皮源性细胞因子,如白细胞介素(IL)-25、IL-33和胸腺基质淋巴细胞生成素(...     

p75神经营养因子受体在耳聋防治中的作用

p75神经营养因子受体(p75 neurotrophin receptor,p75NTR)通过不同的信号转导通路诱导以神经细胞为主的细胞增殖、迁移、分化、生存、凋亡及突触的建立和神经的形成,对损伤后的神经元修复、残存神经元的存活等有着重要的作用.因此,抑制损伤后p75NTR上调,能及时有效的抑制细胞凋亡,从而改善听觉功...     

儿童上气道咳嗽综合征误诊140例

目的 探讨上气道咳嗽综合征（UACS）的临床特点、诊断及治疗。方法 回顾性分析UACS患者140例病历资料,诊断过程中曾误诊为慢性支气管炎102例、咳嗽变异性哮喘25例、抽动症13例,确诊后对所有患者按照鼻部疾病进行治疗。结果 经治疗14d后咳嗽消失或好转的有129例,总缓解率92.1%（129/140）。结论 UACS容易误诊,鼻咽内窥镜检查（鼻内镜或电子鼻咽镜）是诊断UACS的有力工具。明确诊断后对因治疗,UACS预后良好。     

Effect of upper airway obstruction on pulmonary arterial pressure in children

OBJECTIVE: Our aim was to examine the elevation of pulmonary arterial pressure in children with upper airway obstruction caused by adenotonsillar hypertrophy according to their disease severity assessed with symptom scoring and to demonstrate the profit for echocardiographic monitorization of the children with adenotonsillar hypertrophy regardless of their clinical status. METHODS: Thirty-nine children with a diagnosis of upper airway obstruction caused by adenotonsillar hypertrophy were included for the study. There were 16 female and 23 male patients. Ages of the children were between 3 and 10 years with a mean age of 5.78+/-1.98. Twenty children composed the control group with a similar age and sex distribution but without any sign and symptom of upper airway obstruction. Mean pulmonary arterial pressures were measured by Doppler echocardiography preoperatively and 6 months postoperatively. Symptom scores were calculated for each patient in the study group to assess their disease severity. The significances of changes and relations between pressure levels and symptom scores were calculated by statistical package for social sciences (SSPS) computer program in terms of Student's test, chi(2)-test and Mc Nemar's test. RESULTS: Mean pulmonary arterial pressure were 26.26+/-5.40 (14-36) preoperatively, 16,61+/-2.68 (10.15-22.3) postoperatively and 16.54+/-2.63 (10.5-21.7) in the control group. There were a statistically significant decrease at pressure levels postoperatively and a significant difference from the levels in the control group (Student's t-test, p<0.01). We found no correlation between the pressure levels and disease severity assessed in terms of symptom scoring. CONCLUSION: This study showed that upper airway obstruction caused by adenotonsillar hypertrophy causes significant elevation of pulmonary arterial pressures and adenotonsilectomy is an absolute therapeutic method in these children. Every child with adenotonsillar hypertrophy has some probability of having pulmonary hypertension regardless of his or her disease severity. Therefore, performing echocardiographic examination to all children with adenotonsillar hypertrophy is beneficial for assessing the cardiopulmonary status of the patient and may be useful at decision making for adenotonsilectomy.     

体位对阻塞性睡眠呼吸暂停低通气综合征患者上呼吸道形态的影响

目的 :了解体位改变对阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者上呼吸道形态的影响。方法 :经PSG确诊的OSAHS患者 31例 ,均为男性。以纤维内镜观察平静呼吸状态下 30°屈颈平卧位、平卧位和侧卧位时上呼吸道各平面形态的变化并照相 ,利用图像分析软件测量不同体位时上呼吸道各平面的横截面积、前后径、左右径 ,比较其差别。结果 :在OSAHS患者中 ,软腭后区上呼吸道横截面积、前后径 ,舌后区横截面积、左右径和前后径的测量值在 3种体位间的差异有统计学意义 ,软腭后区左右径在 3种体位间的差异无统计学意义。结论 :特定体位对患者上呼吸道形态的影响是OSAHS症状加重的基础。     

儿童上气道咳嗽综合征临床诊疗现状

儿童上气道咳嗽综合征(UACS)是临床较为常见的慢性疾病,是引起儿童慢性咳嗽的主要原因之一。由于病因复杂,发病机制尚不明确,病症、病理又牵涉儿科、耳鼻咽喉科、呼吸科及免疫科等多个学科,因此应加强科室相互合作。针对儿童UACS的流行病学状况、发病机制的最新研究、诊疗指南和治疗方案的最新进展进行综述,并对今后规范、科学、有效地诊治儿童UACS提出了新的思路和方法。     

阻塞性睡眠呼吸暂停低通气综合征上气道CT扫描临床应用

目的通过CT扫描确定阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syn-drome,OSAHS)病人上气道阻塞部位,指导临床制订治疗方案,判断治疗效果。方法对30例OSAHS病人进行上气道CT扫描,分别测量鼻咽、口咽及喉咽腔横截面积。与30名正常成人进行比较。结果OSAHS病人咽腔3个部分的横截面积自小至大顺序排列为口咽<鼻咽<喉咽;OSAHS病人鼻咽及口咽横截面积与正常成年人相比有统计学意义(P<0.01)。18例OSAHS病人在接受了悬雍垂腭咽成形术(UPPP)手术术后进行上气道CT扫描,口咽部平均横截面积由(67.5±16.78)mm2扩大至(156.63±28.62)mm2(P<0.001)。结论正常成人口咽部是咽腔最狭窄的部位;OSAHS病人口咽部横截面积小于100 mm2时,建议手术治疗。UPPP术后上气道CT扫描可客观判定手术效果。     

Morphological examination of upper airway in obstructive sleep apnea

Objectives

An aim of this study was to assess the predictive power of an otorhinolaryngological examination of the upper airway to identify risk factors of obstructive sleep apnea syndrome (OSAS) in the patients.

Methods

We examined 141 consecutive patients with OSAS. The morphological features were assessed by the designated otorhinolaryngologist while the subjects were sitting relaxedly with tidal breathing. The bilateral nasal resistance was measured using the active anterior rhinomanometry during daytime wakefulness.

Results

The body mass index (BMI), fauces's narrowness, neck circumference, lowest oxygen saturation, tonsil size and modified Mallampati grade (MMP) showed the statistically significant correlations with the apnea–hypopnea index (AHI) of an index of apnoeseverity, however, the age, Epworth sleepiness scale (ESS), nasal resistance and retroglossal space were not significantly associated with the AHI.

Conclusions

The upper airway morphology significantly associated with AHI are fauces's narrowness, tonsil size, and MMP, but not nasal resistance and retroglossal space.     

Giant laryngoceles: a cause of upper airway obstruction

Laryngoceles and saccular cysts, which are abnormal dilatations of the laryngeal saccule, are uncommon. The etiology is unknown but is probably related to both congenital and acquired factors. These structures are usually asymptomatic and are incidentally discovered through radiographic studies for unrelated symptoms. We describe two patients with upper airway obstruction, one caused by a giant laryngocele and the other by a large saccular cyst. In the former patient, acute tracheotomy had to be performed. The laryngocele and saccular cyst were removed surgically, which relieved patients’ symptoms of upper airway obstruction. Received: 19 September 2000 / Accepted: 28 December 2000     

喉显微外科技术在严重新生儿上气道梗阻中的应用

目的 探讨严重新生儿上气道梗阻病因、临床特征及喉显微外科手术疗效,以提高新生儿阻塞性呼吸困难的诊治水平。 方法 采用观察性研究,分析16例咽喉相关的严重上气道梗阻新生儿临床资料。 结果 共纳入患儿16例(男9例、女7例),出生后7~28 d出现临床症状,包括吸气性呼吸困难、喉喘鸣、三凹征等。其中先天性喉软化症6例、下咽及舌根囊肿3例、喉部血管瘤2例、喉入口畸胎瘤1例、先天性喉蹼1例、双声带麻痹1例、继发性声门下狭窄1例、插管后喉粘连1例。16例患儿均给予相应显微外科治疗,手术顺利。顺利拔管患儿15例,仅1例喉软化症患儿拔管后仍有明显呼吸困难,行气管切开。 结论 严重新生儿上气道梗阻多与咽喉病变相关,需早期行局部及全身检查明确病因及诊断,对有手术指征者积极采取微创手术治疗,可挽救患儿生命,取得满意疗效。     

Hamartoma of the larynx: an unusual cause of upper airway obstruction

Hamartomas are rare lesions in the larynx. Both clinical and histopathological findings may be misleading to both the physician and the pathologist in terms of diagnosis. A 51-year-old female with the complaints of nonproductive cough and severe dyspnea lasting for a year was found to have a subglottic, submucosal mass almost totally obstructing the laryngeal lumen. Excisional biopsy was performed under suspensory direct laryngoscopy. Histopathological examination showed numerous, large, distended blood vessels, some of which had prominent thickened walls and mature adipose tissue beneath the surface epithelium. The final diagnosis was hamartoma, but we discussed its validity and other possible identifications in accordance with the literature.