分泌性中耳炎中耳积液P物质含量的放射免疫测定

应用放射免疫技术测定３４例（４２耳）分泌性中耳炎（ＳＯＭ）患者血浆和中耳积液中Ｐ物质含量，并以２２例正常人血浆中的ＳＰ含量为对照，结果发现：ＳＯＭ组血浆中ＳＰ浓度明显增高（Ｐ〈０．０１），ＭＥＥ中ＳＰ浓度较血浆中增高（Ｐ〈０．０５），ＭＥＥ中ＳＰ浓度浆液组比粘液组明显（Ｐ〈０．０１），ＭＥＥ中ＳＰ浓度与ＭＥＥ量呈正相关（ｒ＝０．９８５７，Ｐ〈０．０１）。提示：ＳＰ是ＳＯＭ的重要炎性递质，ＭＥＥ中Ｓ     

P物质及组胺受体拮抗剂对分泌性中耳炎中耳积液的影响

采用免疫组化ＡＢＣ－ＧＤＮ及图象分析技术研究分泌性中耳炎中耳粘膜Ｐ物质含量的变化与中耳积液的关系，并观察ＳＰ受体拮抗剂ｓｐａｎｔｉｄｅ及组胺Ｈ２受体阻滞剂ｃｉｍｅ－ｔｉｄｉｎ对ＭＥＥ的影响，探讨ＳＰ在ＳＯＭ中的作用。结果发现，在ＳＯＭ条件下，中耳粘膜ＳＰ含量有逐渐增多趋势，并和ＭＥＥ量呈正相关。     

分泌性中耳炎中耳积液成分研究进展

分泌性中耳炎(SOM)是指以传导性聋及鼓室积液为主要特征的不伴有急性炎性表现的中耳积液的非化脓性中耳炎。其病因与生理机制复杂,以耳闷、耳鸣、耳痛等耳部症状为主,各年龄段均可发生,而学龄前儿童是高发人群。目前,SOM病因及发病机制尚未完全阐明,对SOM中耳积液的成分分析是研究SOM病因及发病机制的常见方法,也是指导临床治疗的重要途径,本文通过查阅国内外发表的相关文献,对SOM中耳积液的成分研究进展进行比较总结,以提高临床医师对该病的认识。     

分泌性中耳炎中耳积液血小板活化因子的测定

目的 :探讨血小板活化因子 (PAF)在分泌性中耳炎 (SOM)发生和转归中的作用。方法 :采用高效液相色谱法测定了 5 6例 (6 8耳 )SOM患者血浆和中耳积液 (MEE)中PAF的含量 ,并以 4 0例正常人血浆作为对照。结果 :SOM患者MEE中PAF浓度明显高于其血浆中的浓度 (P <0 .0 1) ,SOM患者血浆中PAF浓度明显高于对照组血浆中的浓度 (P <0 .0 5 ) ;黏液性中耳积液中的PAF浓度明显高于浆液性中耳积液中的浓度 (P <0 .0 1)。结论 :PAF是SOM中耳积液中的重要炎性递质 ,它与疾病的持续状态相关 ,可能在SOM的病因和发病机制中起着重要的作用     

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。     

分泌性中耳炎患儿腺样体与中耳积液中IgE相关性的研究

目的:探讨反复发作的分泌性中耳炎(OME)患儿腺样体和中耳积液中的IgE是否存在相关性.方法:选取35例OME患儿为实验组,31例腺样体肥大患儿为对照组,实验组取中耳积液和腺样体标本,对照组取腺样体标本,其中腺样体标本制成组织匀浆,用酶联免疫分析技术测定腺样体和中耳积液中IgE的含量.运用SPSS 18.0统计软件对所有相关数据进行处理分析.结果:实验组腺样体和中耳积液中IgE的含量比对照组明显增高(P<0.05).实验组中耳积液和腺样体中IgE的含量呈直线正相关(r=0.580,P<0.05).结论:OME的发生与免疫因素有关,肥大腺样体内的Ⅰ型免疫反应增强,可能与OME的反复发作、迁延不愈有关.     

分泌性中耳炎中耳积液的内毒素含量测定及其意义

测定34例分泌性中耳炎患者中耳积液与皿浆内毒素含量,并以22例正常人血浆内毒素含量作对照。结果为:患者中耳积液内毒素均值(X±SE)为629.4±99.1ng/L,是血浆内毒素(46.4±6.7ng/L)的13.6倍,p<0.01;94％的患者中耳积液内毒素值超过正常人血浆内毒素含量上限。表明分泌性中耳炎中耳积液定量测定,较之定性测定和细菌培养,更具敏感、精确、简便、快速等优点,对估计预后和临床用药有指导意义。     

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     

分泌性中耳炎中耳积液中TGF—β1检测的临床意义

目的 探讨转化生长因子-β1(transforming growth factor β1,TGF-β1)在成人分泌性中耳炎(secretory otitis media,SOM)发生发展过程中的作用机制.方法采用双抗体夹心酶联免疫吸附试验法检测36例(45耳)SOM患者中耳积液、外周血浆及30例正常人外周血浆中TGF-β1的表达水平.结果 TGF-β1在中耳积液、SOM患者血浆及正常人血浆中的阳性检出率均为100%;慢性SOM患者中耳积液及外周血浆中TGF-β1含量均显著高于急性SOM患者(P＜0.01,P＜0.01);急性SOM患者中耳积液中TGF-β1含量与同组患者血浆中含量差异无统计学意义(P＞0.05).而后者与正常人血浆中含量差异无统计学意义(P＞0.05);慢性SOM患者中耳积液中TGF-β1含量与同组患者血浆中含量差异无统计学意义(P＞0.05),但后者显著高于正常人血浆中含量(P＜0.01);接受2次及以上鼓膜穿刺和/或置管的SOM患者中耳积液及血浆中TGF-β1的含量均高于首次鼓膜穿刺和/或置管的SOM患者(P＜0.01,P＜0.05);TGF-β1的含量在黏液性和浆液性中耳积液组间差异无统计学意义(P＞0.05).结论 TGF-β1作为重要的免疫介质,参与成人SOM的发生发展,尤其在SOM的慢性病程中发挥重要作用.     

Lymphangioma of the middle ear and mastoid simulating chronic otitis media with effusion

Lymphangiomas are benign congenital malformations of the lymphatic system. Middle ear lymphangioma is extremely rare entity. A 14-year-old male patient with otitis media with effusion, which was previously diagnosed to be middle ear and mastoid lymphangioma, was treated. There were no cerebrospinal fluid fistula, solitary mass, and meningitis findings. All properties of chronic otitis media with effusion were present in that case. This case is unique with these clinical properties. Middle ear and/or mastoid lymphangioma should be remembered in the differential diagnosis of chronic middle ear effusions.     

分泌性中耳炎中耳积液嗜酸细胞阳离子蛋白与IgE测定

目的：通过测量分泌性中耳炎（OME）患者中耳积液中嗜酸细胞阳离子蛋白（MECP）、中耳积液IgE（MIgE）及血ECP（SECP）的含量,进一步探讨OME发病机制与变态反应的关系。方法：对31例OME患者,用Uni-CAP-100型变应原体外检测系统分别测量MECP、MIgE及SECP含量,得出结果并统计学处理。结果：31例OME患者检测到MECP均值为56．88μg／L,明显升高9例,占28．1％;MIgE均值为27．2ku／L,明显升高3例,占9．7％。MECP与MIgE呈正相关（P〈0．05）;SECP均值为5．6μg／L。结论：ECP存在于OME的鼓室积液中,部分OME是中耳的局限性变态反应炎性过程。OME发病过程中存在着复杂的变态反应机制。     

糖皮质激素对急性中耳炎中耳积液影响的研究

目的:探讨糖皮质激素对急性中耳炎(AOM)中耳积液的疗效.方法:以43例(43耳)有明显鼓室压图异常的AOM患者为对象,采用前瞻性随机对照研究,对其中的23例(23耳)使用地塞米松加头孢呋辛钠进行治疗(试验组),另外20例(20耳)仅使用头孢呋辛钠进行治疗(对照组),随访治疗后鼓室压图的变化.结果:对照组鼓室压图恢复正常的时间为(54.6±6.2)d,试验组的时间为(38.5±6.1)d,经t检验2组间差异有统计学意义(P《0.05);在治疗后3个月,试验组的鼓室压图恢复率高于对照组.结论:糖皮质激素对AOM急性期中耳积液有明显的改善作用,可明显缩短中耳积液的时间,且对长程或慢性的中耳积液有一定的改善作用,是一种有效的辅助治疗方法.     

A bacteriological study of otitis media with effusion. Concurrent coagulase-negative staphylococcal infections in the middle ear

Summary We investigated the bacteriology of 50 chronic middle ear effusions from 30 children (mean age, 5 years 4 months) and compared this with the microorganisms present in the external ear canals and adenoids of each patient to distinguish pure middle ear bacteria from probable contaminations. Coagulase-negative staphylococci (CS), formerly considered to be non-pathogens, were the most frequently isolated bacteria in the middle ear effusions and were followed in incidence by -hemolytic streptococci and group D streptococci. CS were found in 24% of all effusions and in 44% of the infected effusions. Most of the CS strains belonged to the species of Staphylococcus epidermidis. Although the majority of CS isolated from the middle ear effusions studied proved not to be contaminants, the populations of CS in the middle ear and external ear canal showed similar biochemical reaction patterns, antimicrobial susceptibilities, and in vitro production of mucus. No correlation was found between the bacteria present in adenoidal tissue and middle ear effusions.     

Change of middle ear transfer function in otitis media with effusion model of guinea pigs

Otitis media with effusion (OME) is an inflammatory disease of the middle ear that causes most cases of conductive hearing loss observed in the pediatric population. With the long term goal of evaluating middle ear function with OME, the aim of the current study was to create an animal model of OME in which middle ear transfer functions could be measured. In guinea pigs, OME was created by injecting lipopolysaccharide (LPS) into the middle ear. Evidence of OME was assessed by otoscopy, tympanometry, histology, and by measuring the volume of fluid in the middle ear. Vibrations of the umbo and round window membrane were measured with a laser Doppler vibrometer at frequency range of 200-40kHz in three groups of 3, 7, and 14 days after injection of LPS. Changes in displacement of the umbo and round window membrane in response to 80dB SPL sound in the ear canal were measured across the frequency range. Displacement of both the umbo and round window membrane was reduced at all time points following LPS injections. Further, the change of the displacement transmission ratio (DTR) from the tympanic membrane to the round window occurred mainly in chronic (e.g. 14 days post-LPS injection) OME ears. This study provides useful data for analyzing the change of middle ear transfer function in OME ears.     

Immunohistochemical quantitation of collagen types I,II, IV and V in the ventilated and non-ventilated rabbit middle ear with otitis media with effusion

Morphometric quantitation of the area fractions of collagen types I, II, IV and V was determined in the normal rabbit middle ear mucosa and in relation to otitis media with effusion (OME) using a three-layered peroxidase-antiperoxidase technique. The effects of substituting normal low-oxygen middle ear gas (non-ventilated) with atmospheric air (ventilated) were studied in both healthy ears and ears with OME. Based upon previous histological examinations in rabbits, only ears with OME for more than 8 weeks were included to ensure the presence of chronic inflammation (COME). Atmospheric air was introduced into the middle ears by insertion of ventilation tubes or by an enlarged myringotomy. Collagen type I was predominant in all groups studied. The area fractions of collagen types I, II and IV were increased significantly in COME, with collagen type II elevated in particular. Ventilation of the normal ears resulted in a significantly increased area fraction of cells, while the area fractions and distributions of the collagen types were unaffected. None of the ventilated ears in COME improved or healed spontaneously. The total fraction of collagen in COME was not changed significantly by the introduction of atmospheric air. However, the individual distribution of the collagen types was altered, with significantly larger area fractions of types II and V found in ventilated ears with COME. Possible explanations for the differences found are discussed, including the role of oxygen-derived free radicals.     

Vascular permeability of the middle ear mucosa in otitis media with effusion

Summary Vascular permeability (VP) of the middle ear mucosa (MEM) in chronic otitis media with effusion (OME) was estimated in both pediatric and adult patients by calculating the middle ear effusion (MEE) to serum concentration ratios of albumin and of four protease inhibitors: 1-antitrypsin (1-AT), 1-antichymotrypsin (1-X), inter--trypsin inhibitor (I--I) and 2-macroglobulin (2-M). The levels of albumin and 1-AT in MEE were higher while those of I--I and 2-M were lower than their serum levels in both adult serous and pediatric mucoid groups. There was a negative correlation between molecular weight and the mean value of the ratio (MEE/serum) of the four inhibitors in both serous (r=–0.989) and mucoid (r=–0.924) groups. Vascular permeability of the MEM seems to be variable in both serous and mucoid groups during middle ear inflammation. Selective leakage of proteins by molecular weight appears to occur in MEM. Our findings further indicate that a high level of the high-molecular-weight inhibitor 2-M in MEE may be a significant index reflecting the remarkably enhanced VP of the MEM.     

儿童分泌性中耳炎耳积液中免疫相关指标表达分析

目的 探讨儿童分泌性中耳炎患者中耳积液中的免疫相关指标变化情况。 方法 选取2016年12月至2017年12月收治的30例分泌性中耳炎患儿设为研究组,选取同期体检的健康儿童30例设为对照组。比较两组外周血中CD4⁺T、CD8⁺T细胞百分数及CD4⁺ /CD8⁺比值。比较研究组中耳积液及血浆中IL-2、IL-4、IL-6水平。将研究组外周血CD4⁺,CD8⁺T细胞值与中耳积液中IL-2、IL-4、IL-6值进行相关性分析。 结果 研究组外周血中CD4⁺T、CD8⁺T细胞百分数均明显高于对照组,CD4⁺ /CD8⁺比值明显低于对照组,差异有统计学意义(P<0.01)。研究组中耳积液中IL-2、IL-4、IL-6水平均明显高于血浆,差异有统计学意义(P<0.01)。研究组血浆中IL-2、IL-4、IL-6水平均明显高于对照组,差异有统计学意义(P<0.01)。Pearson直线相关分析结果显示,研究组中耳积液中IL-2、IL-4、IL-6水平与外周血CD4⁺T、CD8⁺T含量均呈显著正相关(P<0.01)。 结论 分泌性中耳炎与强烈的免疫反应密切相关,存在CD4⁺T、CD8⁺T细胞亚群显著升高的现象,IL-2、IL-4、IL-6对于儿童分泌性中耳炎的诊断具有一定的临床意义。