EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists

The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.     

European position paper on rhinosinusitis and nasal polyps 2007

Rhinosinusitis is a significant and increasing health problem which results in a large financial burden on society. This evidence based position paper describes what is known about rhinosinusitis and nasal polyps, offers evidence based recommendations on diagnosis and treatment, and considers how we can make progress with research in this area. Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (including nasal polyps) is defined as inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip), +/- facial pain/pressure, +/- reduction or loss of smell; and either endoscopic signs of polyps and/or mucopurulent discharge primarily from middle meatus and/or; oedema/mucosal obstruction primarily in middle meatus, and/or CT changes showing mucosal changes within the ostiomeatal complex and/or sinuses. The paper gives different definitions for epidemiology, first line and second line treatment and for research. Furthermore the paper describes the anatomy and (patho)physiology, epidemiology and predisposing factors, inflammatory mechanisms, evidence based diagnosis, medical and surgical treatment in acute and chronic rhinosinusitis and nasal polyposis in adults and children. Evidence based schemes for diagnosis and treatment are given for the first and second line clinicians. Moreover attention is given to complications and socio-economic cost of chronic rhinosinusitis and nasal polyps. Last but not least the relation to the lower airways is discussed.     

Evolution of guidelines for pediatric rhinosinusitis

Rhinosinusitis is a prevalent disorder in the pediatric population. Unfortunately, during the past two decades, guidelines related to definitions, diagnostic procedures and management have been much more focused on adult than on pediatric rhinosinusitis. First consensus document on management of pediatric rhinosinusitis was published in 1998, followed by several documents related only to acute rhinosinusitis. The most extensive consensus document on rhinosinuistis, including pediatric rhinosinusitis, is European position paper on rhinosinusitis and nasal polyps, EPOS, updated in 2012.     

Endoscopic sinus surgery in chronic rhinosinusitis and nasal polyposis: a comparative study

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12?months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1?year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1?year follow up in the nasal polyp group.     

Increased expression of pendrin in eosinophilic chronic rhinosinusitis with nasal polyps

IntroductionChronic rhinosinusitis with nasal polyps is a heterogeneous disease and appropriate diagnostic algorithms in individual cases are necessary for effective medical treatment.ObjectiveThe purpose of this study was to clarify the relationship between the pendrin expression of nasal polyps and clinical and pathological characteristic features of eosinophilic chronic rhinosinusitis.MethodsA total of 68 patients were classified into eosinophilic chronic rhinosinusitis or non-eosinophilic chronic rhinosinusitis groups according to the degree of eosinophilic infiltration into the nasal polyps. Clinical, hematological, and immunohistochemical analyses were performed and statistically compared between both groups.ResultsThirty-eight were classified into eosinophilic chronic rhinosinusitis and 30 into non-eosinophilic chronic rhinosinusitis groups. There were no significant differences in age distribution, sex ratio, prevalence of asthma, or any other complications between the groups. The mean Lund–Mackay score and the number of serum eosinophils was significantly higher in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. The pendrin expression was more frequently detected in the epithelial surface layer of nasal polyps in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. In addition, mucin 5AC was more widely expressed in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis.ConclusionIncreased expression of pendrin and mucin 5AC in the nasal polyps would be associated with development of eosinophilic chronic rhinosinusitis. This finding could allow the development of a novel therapeutic agent targeted specifically to patients with eosinophilic chronic rhinosinusitis.     

基于表型和内在型的慢性鼻窦炎诊治进展

慢性鼻窦炎(CRS)是一种具有复杂表型和内在型的异质性疾病。根据是否有鼻息肉,CRS的表型可分为伴或不伴息肉。CRS的其他表型分类还包括是否伴有过敏、哮喘、阿司匹林不耐受等。近年来,关于CRS内在型致病机制的研究如2型炎症和非2型炎症取得突破性进展,为CRS的治疗引入了有效的生物制剂。阐述慢性鼻窦炎最新表型和内在型分类和基于表型和内在型的最新治疗进展,为临床更好地结合内在型和表型,对慢性鼻窦炎更精确的诊断和更精准的个性化治疗提供思路。     

Macrolide treatment decreased the size of nasal polyps and IL-8 levels in nasal lavage

Recently, epidemiologic and experimental studies have been reported that long-term macrolides are effective for the treatment of chronic airway inflammatory diseases including diffuse panbronchiolitis, chronic rhinosinusitis, and cystic fibrosis (Jaffe A, Francis J, Rosenthal M, et al. Long-term azithromycin may improve lung function in children with cystic fibrosis. Lancet 351:420, 1998), and that macrolides can directly reduce the production of IL-8 by nasal epithelial cells (Suzuki H, Shimomura A, Ikeda K, et al. Inhibitory effect of macrolides on interleukin-8 secretion from cultured human nasal epithelial cells. Laryngoscope 107:1661-1666, 1997). In this study we administered macrolides with 14-membered rings to patients with nasal polyps due to chronic rhinosinusitis for at least 3 months and measured the IL-8 level in nasal lavage from those patients. The IL-8 levels in nasal lavage from patients with nasal polyps were reduced during macrolide treatment. There was significant correlation between decreased IL-8 levels in nasal lavage and the clinical effect of macrolides on the size of the nasal polyps. In the group whose polyps were reduced in size, the IL-8 levels dramatically decreased from 231.2 pg/mL to 44.0 pg/mL (p < 0.05), and were significantly higher before macrolide treatment than those in the group whose polyps showed no change (p < 0.005). This reduction in IL-8 may be an important aspect of the effect of macrolide treatment on nasal polyps in chronic rhinosinusitis.     

Micronucleus count in nasal epithelial cells from patients with chronic rhinosinusitis and polyps

IntroductionChronic rhinosinusitis with nasal polyps, a prevalent disease affecting around 2% of the world population, is characterized by symptomatic inflammation of the nasal mucosa and impairment of quality of life. Chronic rhinosinusitis with nasal polyps has a multifactorial etiology, involving a dysfunctional host response to environmental factors. Thus, inflammatory models may be useful to shed light on the pathophysiology of this disease. Micronucleus count has been used to screen DNA damage in various tissues.ObjectiveTo investigate the association between frequency of micronucleus in exfoliated cells from the nasal cavity of patients with chronic rhinosinusitis with nasal polyps and disease severity.MethodsThis cross-sectional study included 21 patients with chronic rhinosinusitis with nasal polyps and 19 controls without disease. None of the participants were smokers.ResultsMean micronucleus count was 3.690 per 1000 cells (±2.165) in individuals with vs. 1.237 per 1000 cells (±0.806) in controls; (Student's t test = 4.653, p < 0.001). Nasal surgery in the past 5 years and aspirin-exacerbated respiratory disease were not associated with nicronucleus count (p = 0.251).ConclusionMicronucleus count seems to be linked to chronic rhinosinusitis with nasal polyps, providing a new perspective for the evaluation of this disorder.     

Interferon-α action in cytokine profile in eosinophilic nasal polyp cultures

IntroductionChronic rhinosinusitis is currently classified into two types: chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps. In the West, approximately 80% of chronic rhinosinusitis with nasal polyps cases are characterized by a predominantly eosinophilic cell infiltrate and a Th2 cytokine pattern.ObjectiveTo evaluate the effect of Interferon-α on cytokine levels of the eosinophilic nasal polyp cell culture supernatant.MethodsCell cultures were performed based on nasal polypoid tissue samples collected from 13 patients with eosinophilic chronic rhinosinusitis with nasal polyps. Polyps were considered eosinophilic according to the histopathological examination. Cell cultures were stimulated with 3000 IU of interferon-α. Before and after the stimulus, concentrations of Interferon-γ, tumor necrosis factor αand IL 2, 4, 6 and 10, using cytometric bead array, were assessed.ResultsCell samples from eosinophilic nasal polyps from 13 patients were included in the study. Twenty-four hours after interferon-α stimulation, eosinophilic nasal polyp culture supernatants showed significantly decreased IL-4 concentrations and increase in interferon-γ, IL-10 and IL-6 concentrations compared to controls. There were no significant differences in tumor necrosis factor -α and IL-2 concentrations.ConclusionWe demonstrated that interferon-α in vitro alters the pattern of cytokines in cell cultures of eosinophilic nasal polyps. Analysis of these alterations suggests that interferon-α promotes a rebalancing of inflammatory profiles in cell cultures, favoring the expression of Th1 and regulatory cytokines over Th2 cytokines.     

Chronic nasal dysfunction

Chronic nasal dysfunction is a clinical concept in the diagnostic and therapeutic management of sinonasal diseases, based on the evo-devo theory of formation of the nose according to which the nose is not a single organ but rather an association of three organs: olfactory nose, respiratory nose and paranasal sinuses. In chronic nasal dysfunction theory, etiological diagnosis takes account of the possible pathophysiological independence of nasal symptoms, in accordance with the different origins and physiology of the three organs constituting the nose. The diagnostic approach of the chronic nasal dysfunction concept breaks down the pathology so as to propose treatment(s) adapted to the diseased organ(s) and to the capacity for physiological resolution of dysfunction induced in one organ by pathology in a neighboring nasal organ. The ethmoid is not a sinus according to evo-devo, and therefore functional endoscopic endonasal surgery (FEES) cannot be restricted to functional endoscopic sinus surgery (FESS). Evo-devo theory and the chronic nasal dysfunction concept offer an alternative to the concept of chronic rhinosinusitis with or without polyps for the management of sinonasal diseases.     

儿童慢性鼻-鼻窦炎伴随因素分析及治疗策略再探讨

目的分析儿童慢性鼻-鼻窦炎的伴随因素及相互关系,探讨合理的治疗策略。方法慢性鼻-鼻窦炎患儿175例,分别应用鼻内镜检查、鼻窦骨窗位高分辨率CT、变应原检测、晨起咽后壁分泌物酸碱度检测等方法确认是否存在伴随因素。对无明确伴随因素及有明确伴随因素但拒绝接受针对伴随因素进行治疗的病例采取内科保守治疗＇有明确伴随因素的病例在内科保守治疗的基础上执行针对伴随因素的治疗。12个月后评价疗效。结果80例（45．7％）有明确的伴随因素存在,分别为腺样体肥大Ⅲ。（10．3％）、胃食管反流（9．7％）、变应性鼻炎（9．1％）、解剖性鼻窦引流通道狭窄（8．6％）、以及变应性鼻炎同时伴腺样体肥大Ⅲ度（8．0％）;另95例（54．3％）未查及明确伴随因素。有明确伴随因素的病例在内科保守治疗的同时针对伴随因素进行治疗,其疗效明显优于仅执行内科保守治疗（无论是否查及明确伴随因素）的病例（P〈0．01）。结论在诊断和治疗儿童慢性鼻-鼻窦炎时不仅仅只关注鼻腔鼻窦黏膜炎症本身,还应该对与鼻腔鼻窦炎症发生发展密切相关的伴随因素进行诊断和治疗,才能达到更好的治疗效果。     

Amphotericin B nasal spray has no effect on nasal polyps

Nasal polyps and chronic rhinosinusitis are the products of an inflammatory process. Recently, fungal involvement has been thought to stimulate the development of polyps, and administration of antifungal agents was therefore considered a potential treatment. Several studies have been published indicating amphotericin B as an effective treatment for nasal polyps and chronic rhinosinusitis. The aim of our investigation was to evaluate the efficacy of intranasal applied amphotericin B on the growth of nasal polyps in a three-month, prospective, open trial. Our results show that nasal amphotericin B spray is not effective for nasal polyps and may even cause deterioration.     

慢性鼻-鼻窦炎患者症状学特点及内镜鼻窦手术后主要症状的转归

目的：探讨慢性鼻-鼻窦炎患者的症状学特点及内镜鼻窦手术前后患者主观症状的变化。方法：采用视觉模拟量表对119例慢性鼻-鼻窦炎患者（52例不伴鼻息肉和67例伴鼻息肉）的鼻塞、头昏（头痛）、面部疼痛（胀满感）、嗅觉障碍和鼻分泌物（后鼻漏）5个主要症状进行评分,比较内镜鼻窦手术前和手术后12个月评分的变化。结果：伴和不伴鼻息肉的慢性鼻-鼻窦炎患者出现最多的症状均依次为鼻塞、鼻分泌物（后鼻漏）、头昏（头痛）、面部疼痛（胀满感）和嗅觉障碍。不伴鼻息肉的慢性鼻-鼻窦炎患者较伴鼻息肉者鼻分泌物评分显著增高（P〈0．01）,但嗅觉障碍评分者显著降低（P〈0．01）。在最令人困扰的症状方面,不伴鼻息肉和伴鼻息肉的慢性鼻-鼻窦炎患者分别是鼻分泌物（后鼻漏）和嗅觉障碍。术后伴鼻息肉和不伴鼻息肉的慢性鼻-鼻窦炎患者各个症状出现的频率和评分均较术前显著降低（P〈0．01）。结论：伴鼻息肉和不伴鼻息肉的慢性鼻-鼻窦炎患者症状学具有不同的特点,内镜鼻窦手术可以显著改善患者的主观症状,视觉模拟量表评估患者的主观症状是一简便、易于开展的慢性鼻-鼻窦炎疗效主观评估方法。     

Familienuntersuchung bei Patienten mit ASS-Intoleranz und Rhinosinusitis

The high prevalence of aspirin intolerance in asthmatics and patients with nasal polyps as well as reports of familial clustering suggest a genetic disposition of this disease. Our study aimed at obtaining further evidence of hereditary factors in this disease. We included 33 unselected patients from 28 families with aspirin intolerance and rhinosinusitis in this study. Controls were recruited from individuals treated in our ENT clinic for diseases other than aspirin intolerance (n = 52). A questionnaire focused on family histories as well as reports on diseases of the upper respiratory tract or allergies. ASS intolerance was verified either by bronchial or nasal provocation tests. We found cases of aspirin intolerance among parents, siblings, and children of ASS intolerant probands. The children of probands had nasal polyps and rhinosinusitis more often than the children of controls. We propose that ASS intolerance with nasal polyps and asthma represents a complex phenotype, with genetic and environmental factors contributing to its manifestation.     

Fluctuating olfactory sensitivity and distorted odor perception in allergic rhinitis.

OBJECTIVE: To characterize the relationship between allergic rhinitis, the severity and duration of nasal disease, olfactory function, and self-reported olfactory symptoms, including fluctuations or distortions in odor perception. DESIGN: Assessment of olfactory function and symptoms of 90 patients with allergic rhinitis. SETTING: A clinic of a university teaching hospital and research facility. PATIENTS: Sixty patients who presented to the Taste and Smell Clinic who had positive allergy test results and 30 patients who presented to the Allergy-Immunology Clinic. The Taste and Smell Clinic patients were grouped by nasal-sinus disease status (30 without chronic rhinosinusitis or nasal polyps, 14 with chronic rhinosinusitis but without polyps, and 16 with nasal polyps). MAIN OUTCOME MEASURES: Subjective olfactory symptom questionnaire and objective olfactory function tests. RESULTS: The Allergy-Immunology Clinic patients were diagnosed as being normosmic and the Taste and Smell Clinic patients as being hyposmic or anosmic with olfactory loss that increased significantly with nasal-sinus disease severity. Comparisons with normative data confirm that olfactory scores observed in all groups were significantly lower than expected because of the aging process alone. The self-reported duration of olfactory loss increased significantly with nasal-sinus disease severity. The Taste and Smell Clinic patients without chronic rhinosinusitis or nasal polyps reported the greatest incidence of olfactory distortions and olfactory loss associated with upper respiratory tract infections. CONCLUSIONS: There appears to be a continuum of duration and severity of olfactory loss in allergic rhinitis that parallels increasing severity of nasal-sinus disease. As a result of the increased frequency of respiratory infection associated with allergic rhinitis, these patients are at risk for damage to the olfactory epithelium.     

不伴有下气道疾病的慢性鼻-鼻窦炎患者肺功能及相关因素分析

目的 探讨不伴有下气道疾病的慢性鼻-鼻窦炎伴息肉患者的肺功能及其影响因素。 方法 选取161例慢性鼻-鼻窦炎伴鼻息肉患者(CRSwNP组),26例慢性鼻-鼻窦炎不伴鼻息肉患者(CRSsNP组)和34例正常人(对照组)进行肺功能检测,比较三组肺功能的各项指标,并分析CRSwNP组肺功能和临床各参数之间的关系,这些参数包括外周血嗜酸粒细胞数、血清特异性IgE、Lund-Mackay评分、呼出一氧化氮水平和视觉模拟量表评分(VAS)。 结果 CRSwNP组患者的肺功能指标FEV₁%pre低于正常组,差异有统计学意义(P=0.045);血清特异性IgE(sIgE)与VC%、FEV₁%pre、FEV₁/FVC呈负相关(P<0.05)。 结论 不伴下气道疾病的CRSwNP患者存在潜在的阻塞性肺功能改变;sIgE与CRSwNP的肺功能异常有关。     

Local and systemic eosinophilia in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis with and without polyposis

Eosinophils play a key role in the pathophysiology of sinonasal polyposis; their role in chronic rhinosinusitis without polyposis is less clear. To investigate this further, we biopsied diseased sinonasal tissue from 116 patients undergoing endoscopic sinus surgery and normal nasal mucosa from 24 controls. The patients were grouped, according to the nasal endoscopic appearance of their disease, into four clinical groups: chronic rhinosinusitis with no polyps, grade 1 polyps, grade 2 polyps, and grade 3 polyps. We also measured the peripheral blood eosinophil count. Histological analysis of the inflammatory cell content of the biopsies was carried out. The percentage of eosinophils in tissue from each of the clinical groups was significantly higher than that from the controls. There was no significant difference between the percentage of eosinophils in any of the clinical groups, but a trend. Peripheral eosinophil count increased with increasing severity of nasal disease.     

Herpes viruses and human papilloma virus in nasal polyposis and controls

IntroductionChronic rhinosinusitis with nasal polyps is a multifactorial disease entity with an unclear pathogenesis. Contradictory data exist in the literature on the potential implication of viral elements in adult patients with chronic rhinosinusitis.ObjectiveTo compare the prevalence of human herpes viruses (1–6) and Human Papilloma Virus in adult patients with chronic rhinosinusitis with nasal polyps and healthy controls.MethodsViral DNA presence was evaluated by real-time polymerase chain reaction application to nasal polyps specimens from 91 chronic rhinosinusitis with nasal polyps patients and nasal turbinate mucosa from 38 healthy controls.ResultsEpstein–Barr virus positivity was higher in nasal polyps (24/91; 26.4%) versus controls (4/38; 10.5%), but the difference did not reach significance (p = 0.06). Human herpes virus-6 positivity was lower in nasal polyps (13/91; 14.29%) versus controls (10/38; 26.32%, p = 0.13). In chronic rhinosinusitis with nasal polyps group, 1 sample was herpes simplex virus-1-positive (1/91; 1.1%), and another was cytomegalovirus-positive (1/91; 1.1%), versus none in controls. No sample was positive for herpes simplex virus-2, varicella-zoster virus, high-risk-human papilloma viruses (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and low-risk-human papilloma viruses (6, 11).ConclusionDifferences in Epstein–Barr virus and human herpes virus-6 positivity among patients with chronic rhinosinusitis with nasal polyps and healthy controls are not statistically significant, weakening the likelihood of their implication in chronic rhinosinusitis with nasal polyps pathogenesis.     

Superantigens and chronic rhinosinusitis: detection of staphylococcal exotoxins in nasal polyps

OBJECTIVE/HYPOTHESIS: The role of infectious agents in the etiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. Recent studies have provided indirect evidence of exposure to staphylococcal exotoxins in the blood and polyp tissue of patients with CRSwNP. These exotoxins have the capacity to act as superantigens, bypassing normal antigen processing and directly stimulating a massive inflammatory response. The objective of the study was to analyze mucus and polyp tissue samples from patients with CRSwNP for the presence of staphylococcal exotoxins. STUDY DESIGN: Prospective study. METHODS: Tissue and mucus samples were obtained from 42 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and 11 normal control patients. Twenty-nine of 42 patients had chronic rhinosinusitis with bilateral nasal polyposis, 2 had antrochoanal polyps, and 11 had chronic rhinosinusitis without nasal polyps. Eleven patients without chronic rhinosinusitis or polyps served as normal control patients. Specimens were analyzed for the presence of five staphylococcal exotoxins (SEA, SEB, SEC, SED, and toxic shock syndrome toxin type 1 [TSST-1]) using enzyme-linked immunosorbent assay (ELISA). Histological analysis of specimens and mean eosinophil counts were correlated with the presence of toxin. RESULTS: At least one toxin was detected in 14 of 29 patients with bilateral nasal polyposis. Nine of the 14 patients also had positive findings for additional toxins. The dominant histological pattern in the CRSwNP patient group was polypoid mucosa with edema, which was found in both ELISA-positive and ELISA-negative patients. Mean eosinophil counts tended to be higher in ELISA-positive patients with polyps compared with patients without toxin detection. No toxin was detected in the 11 specimens taken from normal control patients. Only 1 of the 13 patients with CRS without polyps had positive ELISA results for toxin. CONCLUSION: The current study demonstrates the presence of superantigen toxins in 14 of 29 patients with CRSwNP, with SEB and TSST-1 being the most common. Further studies are necessary to correlate the presence of toxin with the pathological changes present in polyp tissue.     

转化生长因子β受体Ⅰ型及Ⅱ型在慢性鼻-鼻窦炎和鼻息肉组织中的表达

目的:探讨转化生长因子β受体(TGFβR)Ⅰ型及Ⅱ型在慢性鼻-鼻窦炎、鼻息肉及正常下鼻甲组织中表达的差异性,以及Ⅰ、Ⅱ型受体在慢性鼻窦炎、鼻息肉发病机制中可能的作用。方法:采用免疫组织化学方法检测TGFβRⅠ、TGFβRⅡ在25例慢性鼻-鼻窦炎、21例鼻息肉、17例下鼻甲组织中的表达,并比较TGFβRⅠ、TGFβRⅡ在慢性鼻-鼻窦炎、鼻息肉、正常下鼻甲组织中表达的差异。结果:TGFβRⅠ、TGFβRⅡ表达的平均灰度值在正常下鼻甲黏膜分别为175.78±7.06、165.00±1.79;在慢性鼻-鼻窦炎组织中分别为147.33±8.15、147.77±4.62;而在鼻息肉组织中分别为125.91±11.26、129.82±1.46。慢性鼻-鼻窦炎及鼻息肉组织中TGFβRⅠ、TGFβRⅡ的表达均比正常下鼻甲黏膜中的表达高,均差异有统计学意义(均P<0.01);且TGFβRⅠ、TGFβRⅡ在鼻息肉组织中的表达比在慢性鼻-鼻窦炎病变黏膜中的表达高,均差异有统计学意义(均P<0.01)。结论:TGFβRⅠ、TGFβRⅡ在慢性鼻-鼻窦炎、鼻息肉组织中具有不同的表达水平及分布特点,提示其可能在慢性鼻-鼻窦炎、鼻息肉的发生发展过程中发挥不同的作用。