慢性上颌窦炎窦粘膜的免疫组化研究

目的：探讨慢性鼻窦炎局部粘膜中免疫活性细胞和分泌免疫成分在防御炎症过程中的作用。方法：采用免疫组化染色法对两型鼻突炎粘膜的９种免疫活性细胞和４种分泌免疫成分进行检测。结果：鼻窦炎Ⅰ型中Ｔ淋巴细胞、Ｔ４细胞亚群、Ｂ细胞、巨噬细胞明显高于正常对照组（Ｐ〈０．０１）;鼻窦炎Ⅱ型中Ｔ淋巴细胞、Ｔ８细胞亚群、Ｂ细胞、肥大细胞、嗜酸性细胞明显高于正常对照组（Ｐ〈０．０１）;两型中的Ｔ４／Ｔ８细胞比值有明显差异     

Ostial and nasal patency in chronic maxillary sinusitis. A long-term post-treatment study

In a long-term follow-up study (mean 3.5 years) after treatment of chronic maxillary sinusitis of either rhinogenous or dental origin, 72 sinuses in 66 patients were examined with respect to maxillo-ostial and nasal resistance. In sinusitis of rhinogenous etiology, the mean equivalent ostial diameter was pathologically narrowed (0.89 mm, in patients treated conservatively) whereas it was normal (2.51 mm) in sinusitis of dental etiology (dental treatment in combination with local sinus surgery). In the former group, all sinuses were diseased, compared with 3 out of 23 in the dental group. In order to distinguish between functional and organic ostial stenosis, the patients were also tested after physical exercise. The functional ostial diameter in healthy sinuses was significantly increased in contrast to the diseased sinuses. In one patient the narrow ostium was due to mucosal swelling only, but in the other cases was caused mainly by an organic stenosis. In sinusitis of rhinogenous etiology, a pathologically increased nasal resistance was found in 14.3%, while the corresponding figure in the dental group was 4.3%. Improved sinusal and nasal ventilation, achieved either pharmacologically or, preferably by surgical intervention, seems necessary for successful treatment of chronic maxillary sinusitis.     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦术后上颌窦口黏膜恢复过程观察

目的 试图通过对内镜鼻窦手术(endoscopic sinus surgery,ESS)后患者鼻腔鼻窦黏膜的内镜、光镜、透射电镜和扫描电镜下连续动态观察,揭示病变黏膜转归的过程。方法 选取2001年1-12月行ESS的慢性鼻-鼻窦炎伴鼻息肉患者31例(53侧)作为研究对象,其中Ⅱ型2期11例(20侧)、3期12例(20侧),Ⅲ型8例(13侧)。分别于ESS术前、术后2-3周、8-11周、13-16周钳取上颌窦口后囟相同部位的黏膜组织进行观察。结果 术前均可见上皮剥蚀、鳞状上皮化生、腺体及纤维组织增生(53侧);微管结构异常、线粒体减少(53侧)。术后2-3周,形态学观察与术前比较没有明显的改变。术后8-11周,纤毛柱状细胞增多,并可见许多带有微绒毛的柱状细胞和大量短纤毛,所有病例均可见病理性腺体及纤维组织增生。术后13-16周,Ⅱ型2、3期和Ⅲ型患者术腔光滑干净,上皮化较好(50侧),窦口通畅(53侧)。纤毛覆盖面积增加,方向一致(50侧)。微管结构清晰,线粒体狭长致密(49侧)。3侧无纤毛柱状细胞排列整齐,形成病理性修复。结论 ESS术后,黏膜形态的基本恢复一般需要3个月左右;有些病理改变是不可逆的;病变程度与黏膜修复情况有关;术中尽可能多地保留黏膜组织、术后局部及时清理换药,有利于黏膜纤毛的形态和功能的恢复。     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦术后上颌窦口黏膜恢复过程观察

目的 试图通过对内镜鼻窦手术(endoscopic sinus surgery，ESS)后患者鼻腔鼻窦黏膜的内镜、光镜、透射电镜和扫描电镜下连续动态观察，揭示病变黏膜转归的过程。方法 选取2001年1～12月行ESS的慢性鼻一鼻窦炎伴鼻息肉患者31例(53侧)作为研究对象，其中Ⅱ型2期11例(20侧)、3期12例(20侧)，Ⅲ型8例(13侧)。分别于ESS术前、术后2～3周、8～11周、13～16周钳取上颌窦口后囟相同部位的黏膜组织进行观察。结果 术前均可见上皮剥蚀、鳞状上皮化生、腺体及纤维组织增生(53侧)；微管结构异常、线粒体减少(53侧)。术后2～3周，形态学观察与术前比较没有明显的改变。术后8～11周，纤毛柱状细胞增多，并可见许多带有微绒毛的柱状细胞和大量短纤毛，所有病例均可见病理性腺体及纤维组织增生。术后13～16周，Ⅱ型2、3期和Ⅲ型患者术腔光滑干净，上皮化较好(50侧)，窦口通畅(53侧)。纤毛覆盖面积增加，方向一致(50侧)。微管结构清晰，线粒体狭长致密(49侧)。3侧无纤毛柱状细胞排列整齐，形成病理性修复。结论 ESS术后，黏膜形态的基本恢复一般需要3个月左右；有些病理改变是不可逆的；病变程度与黏膜修复情况有关；术中尽可能多地保留黏膜组织、术后局部及时清理换药，有利于黏膜纤毛的形态和功能的恢复。     

慢性非侵袭性鼻窦真菌病手术前后黏膜超微结构观察

目的：探讨慢性非侵袭性鼻窦真菌病术后鼻窦口黏膜的转归过程。方法：采用鼻内镜手术治疗非侵袭性鼻窦真菌病24例,疗效满意。分别于术前及术后3～4个月取相同部位的上颌窦口黏膜进行光、电镜观察,了解黏膜转归情况。结果：术中黏膜标本见鳞状上皮化生、上皮剥蚀、纤毛脱落、微管结构错乱、线粒体减少。术后3～4个月标本纤毛覆盖面积增加,微管结构正常,线粒体狭长致密。结论：慢性非侵袭性真菌性鼻窦炎的黏膜超微结构损害与普通的鼻窦炎没有明显差别,鼻窦黏膜表现为慢性炎症改变。手术彻底清除病变通畅引流以及术后的窦腔清理、冲洗是治疗本病的关键。去除真菌生长所需的环境后,经过3～4个月的清理换药,黏膜的超微结构和功能可以恢复正常。     

Lysozyme and lactoferrin in human maxillary sinus mucosa during chronic sinusitis

Summary Immunohistochemistry was used to study the localization of lysozyme (LZ) and lactoferrin (LF) in the human sinus mucosa during recurrent and chronic sinusitis. Serous cells of submucosal mixed glands and polymorphonuclear leukocytes both displayed a strongly positive staining reaction to both LZ and LF in the normal mucosa. A positive though weak staining for LZ and LF could also be found occasionally within goblet cells. In the mucosa from patients with recurrent or chronic sinusitis, the staining reaction to LZ appeared to intensify in goblet cells. Furthermore, an increased immunoreactivity of glands vis-à-vis LZ and LF was also noted occasionally. Atypical glands were frequently found in mucosa from patients with chronic sinusitis. The epithelium of these latter glands often showed an intense staining reaction to LF, but a rather weak reaction to LZ. The results of the present study suggest that the observed increase in LZ and LF secreting activity of goblet cells, epithelial cells and newly formed atypical glands may play a part in the defense mechanism of the sinus mucosa during the course of chronic sinusitis. Correspondence to: M. Fukami     

慢性鼻窦炎患者上颌窦粘膜微循环观察

目的:探讨慢性鼻窦炎患者上颌窦粘膜微循环血流量的变化。方法:在鼻窦内窥镜引导下应用激光多普勒血流计检测10例慢性单纯性鼻窦炎患者(慢性单纯性鼻窦炎组),10例慢性鼻窦炎伴鼻息肉患者(慢性鼻窦炎伴鼻息肉组)及10例健康者(正常对照组)上颌窦粘膜微循环血流量的状况。结果:慢性单纯性鼻窦炎组和慢性鼻窦炎伴鼻息肉组上颌窦粘膜的微循环血流量均下降,分别与正常对照组相比较,其差异均有显著性意义(分别为P<0.05和P<0.01),但两组间比较,其差异无显著性意义(P>0.05)。结论:慢性鼻窦炎患者上颌窦粘膜微循环血流量明显减少。     

Bacteriological study in chronic maxillary sinusitis.

The bacterial findings of 73 maxillary sinuses in 48 patients with chronic maxillary sinusitis, together with 7 non-inflamed sinuses, are reported. Employing an intraoperative technique and simultaneous collection of 3 different types of specimens in the present investigation made possible comparison of their bacterial characteristics. The results indicated that intraoperative culture of antral mucosa seems to provide the most reliable finding of bacterial flora in chronic maxillary sinusitis. The anaerobic bacteria were never found in the mucosal culture of non-inflamed sinus. The anaerobes appeared to invade the sinus cavity following the sealing of the ostium through the lymphatic or venous system and maintain the inflammatory process. Microbiological analysis of the results between the infected and non-inflamed sinuses established anerobic bacteria as the most important pathogen in chronic maxillary sinusitis. The predominant anaerobes recovered in descending order of frequency were Veillonella sp., Peptococcus sp., Propionibacterium acne and anaerobic nonspore-forming GPB. Statistical analysis of the results of mucosal culture of inflamed and control materials demonstrated that those aerobic and faculatative bacteria recovered in the inflamed sinus appeared to be the normal inhabitants of non-inflamed sinus mucosa. The presence of normal flora in the normal healthy sinus mucosa may explain the chain of events that follows the occlusion of the ostium. These aerobic bacteria may become pathogenic and play a role in the pathogenesis of sinusitis.     

诱生型一氧化氮合酶在慢性上颌窦炎黏膜的表达

目的 观察诱生型一氧化氮合酶(inducible nitric oxide synthase，iNOS)在慢性鼻窦炎病人鼻窦粘膜中的表达。方法 将实验分为两组：对照组为正常成人，无鼻窦病变。实验组为确诊为慢性上颌窦炎的病人。在局麻鼻内镜下行鼻窦黏膜活检，石蜡包埋、切片，用免疫组织化学的方法观察iNOS在两组上颌窦黏膜中的表达。结果 iNOS在正常上颌窦炎黏膜呈阴性表达，在慢性上颌窦炎黏膜呈阳性表达，阳性区域主要在黏膜上皮细胞。结论 iNOS在慢性上颌窦炎黏膜呈阳性表达，提示一氧化氮在慢性上颌窦炎的发病机制中起重要作用。     

Activated T cells in the nasal mucosa of patients with grass-pollen allergy. A pilot study.

Six patients with grass-pollen allergy were provoked with water-soluble grass pollen until a pronounced allergic reaction occurred. This was performed outside the grass-pollen season, and the allergen was administered on the edge of the inferior turbinate. Biopsies were taken both before provocation and during the reaction, 15-30 minutes after provocation. The nasal population of immunohistochemically positive cells for HLA-DR, CD1, interleukin-2-receptor, IgE, CD4 and CD8 were studied. There was a marked increase of IL2-R-positive cells (activated T lymphocytes) in the nasal mucosa after provocation, whilst the other cell populations approximately remained unchanged (apart from a certain increase of IgE). The increase of activated T lymphocytes may imply that certain subsets of T cells play a role in the allergic response, and that the role of helper T cells very likely is much more complex than the regulation of mast cells and eosinophils. The concomitant presence of Langerhans' cells (CD1-positive) and activated T lymphocytes may indicate a possible association on site between an antigen-presenting cell and both effector as well as memory cells in allergic reactions.     

干酪性上颌窦炎伴鼻息肉一例

患者男，36岁，因左侧鼻塞、流涕、头痛1年就诊。间断左侧眼眶疼，曾有左眼视力下降，于某院就诊，诊断为“角膜炎”，给予对症治疗，已治愈。就诊时已在外院作鼻窦CT检查，示左侧鼻腔与左侧上颌窦已融为一个大腔，鼻腔外侧壁、上颌窦内侧壁已破坏，左侧鼻腔、上颌窦、筛窦、额窦均可见低密底影（图1）。