交感,舌咽神经切断对中耳粘膜神经肽及积液的影响

采用免疫组化ＡＢＣ－ＧＤＮ及计算机辅助图象分析技术，研究猫的交感神经、舌咽神经切断对中耳粘膜的Ｐ物质（ＳＰ）、神经肽Ｙ（ＮＰＹ）免疫反应及中耳积液的影响。结果发现：交感神经切断后，中耳粘膜ＮＰＹ免疫反应明显减少，中耳积液量和ＮＰＹ免疫反应光密度值呈负相关。切断舌咽神经对中耳积液有ＳＰ、ＮＰＹ免疫反应无影响。并就中耳粘膜ＳＰ、ＮＰＹ的起源及其含量变化的意义进行了讨论。     

分泌性中耳炎中耳积液中肿瘤坏死因子—α的检测

目的：为探讨分泌性中耳炎（ＯＭＥ）患者中耳积液（ＭＥＥ）中肿瘤坏死因子－α（ＴＮＦα）的存在及其在ＯＭＥ发生中的作用。方法：运用酶联免疫吸附法（ＥＬＩＳＡ）检测３３例ＯＭＥ患者ＭＥＥ及血清中ＴＮＦα的浓度。结果：ＭＥＥ中ＴＮＦα的含量明显高于对应血清中含量（Ｐ＜０００１）；粘液组ＭＥＥ中ＴＮＦα的含量明显高于浆液组ＭＥＥ中的含量（Ｐ＜０００１）；儿童组中耳积液ＴＮＦα水平明显高于成人组（Ｐ＜０００１）。结论：中耳局部可产生ＴＮＦα，ＴＮＦα可能与ＭＥＥ的形成有关；粘液性中耳炎ＴＮＦα明显增高，反映其局部炎症程度较浆液性中耳炎重；儿童、成人ＭＥＥ中ＴＮＦα的水平差异表明发病机理可能有所差别。     

分泌性中耳炎中耳积液免疫复合物和抗核抗体测定

４０例（４５耳）中耳积液分别用聚乙二醇沉淀法测免疫复合物（ＩＣ）和荧光显微镜法检测抗核抗体（ＡＮＡ）。结果显示ＩＣ的Ａ值均大于正常人的血清阈值０．１２，波动范围在０．１２４～０．５１２。ＡＮＡ阳性者３２耳，占７１．１％。可以认为，免疫复合物的沉积损伤中耳粘膜是造成中耳积液的重要致病原因。     

分泌性中耳炎的中耳共振频率变化

对正常人６０耳及分泌性中耳炎８４耳，进行中耳共振频率和鼓室导抗图测试，显示正常人组中耳共振频率为８１４±１６４Ｈｚ，中耳积液组中耳共振频率为２９２±１３４Ｈｚ，中耳积液时，质量增大，要达到共振，共振频率必须向低频区移动。治愈后１～２个月，有３８耳再进行多频率扫描，中耳共振频率为７８６±１３９Ｈｚ，与正常人组接近。分泌性中耳炎８４耳中，鼓室导抗图分别为：Ｂ型６９耳、Ｃ型１０耳、Ａ型５耳；而８４耳中中耳共振频率有７９耳＜４２６Ｈｚ（积液组Ｘ＋Ｓ）。在临床上，中耳共振频率的改变、Ｂ型鼓室导抗图，结合鼓膜改变，能更迅速、更准确地诊断本病     

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。     

喉癌患者的免疫状况研究

对５８例喉癌患者的外周血Ｔ淋巴细胞总数（ＣＤ３）和亚群（ＣＤ４、ＣＤ８）以及部分患者的血清ＩｇＡ、ＩｇＧ、ＩｇＭ、唾液ＳＩｇＡ进行测定，并与正常健康人比较。结果喉癌组ＣＤ３、ＣＤ４的百分率及ＣＤ４／ＣＤ８的比值较对照组明显降低，ＣＤ８的百分率明显升高；血清ＩｇＡ、ＩｇＧ的含量明显降低，而其唾液ＳＩｇＡ的含量却明显升高，两组比较，在统计学上均有显著性差异。表明喉癌患者的全身细胞免疫水平不但降低，而且     

中耳积液中胆固醇含量及细胞成分的研究

采用瑞士罗氏公司产ＣＯＢＡＳ－ＦＡＲＡ－Ⅱ型全自动生化分析仪以酶法测量４４例中耳积液中胆固醇含量，发现老年病人明显高于青少年患者，二者差异显著（Ｐ〈０．０５）；粘液者显著高于浆液者，二者差异非常显著（Ｐ〈０．０１）；病程４个月以上者显著高于２个月以内者，二者差异极为显著（Ｐ〈０．０１）。各细胞成分组间胆固醇含量均值无显著差异（Ｐ〉０．０５）。表明：分泌性中耳炎患者，尤其是积液呈粘液性者，越是年纪大     

分泌性中耳炎血清,中耳积液中β2微球蛋白水平及临床意义

测定44例(53耳)SOM患者的血清和中耳积液中β_2M、S-IgA、IgE浓度。并以25例正常人作为对照。结果是:SOM组与对照组血清中3种物质浓度比较无显著差异;SOM组中耳积液中亦均测到,且β_2M、S-IgA明显高于血清中含量,双耳组同一患者双耳积液中β_2M、S-IgA浓度各不相同;鼻咽癌组中耳积液中β_2M、S-IgA、IgE与一般SOM组相同,但血清中β_2M、S-IgA浓度高于一般SOM组和对照组;中耳积液中β_2M与S-IgA浓度变化呈正相关。提示:①中耳积液中β_2M、S-IgA主要由局部中耳粘膜产生。是重要的中耳粘膜的局部免疫应答物质;②血清β_2M、S-IgA含量测定或可作为鼻咽癌的“肿瘤标记物”。     

分泌性中耳炎中耳积液免疫复合物和抗核抗体测定

４０例（４５耳）中耳积液分别用聚乙二醇沉淀法测免疫复合物和荧光显微镜法检测抗核抗体。结果显示ＩＣ的Ａ值均大于正常人的血清阈值０．１２，波动范围在０．１２４－０．５１２，ＡＮＡ阳性者３２耳，占７１．１％，可以认为，免疫复合物的沉积损伤中耳粘膜是造成中耳积液的重要致病原因。     

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。     

Lysozyme levels in middle ear effusion and serum in otitis media

Lysozyme concentrations in middle ear effusion and serum were determined in patients with otitis media with effusion. Lysozyme concentrations in middle ear effusion were significantly higher than in serum. Children with mucoid otitis media showed significantly higher levels of lysozyme in middle ear effusion than children with serous otitis media and adults with otitis media with effusion. Higher levels of lysozyme were observed in the group of children younger than 5 years old compared with the age group of 6- to 10-year-olds. Lysozyme concentrations of middle ear effusion in adults were significantly lower than those of mucoid otitis media in children. These results indicate that lysozyme plays an important role in the disease process of otitis media.     

Influence of nasal allergic reactions on the clearance of middle ear effusion

In order to investigate the influence of nasal allergic reactions on the clearance of middle ear effusion, an animal model of nasal allergy and otitis media with effusion was produced in the same guinea pigs simultaneously by passive sensitization with serum of homologous animals containing IgE antibodies (for nasal allergy) and by inoculation of immunocomplex into the tympanic cavity (for otitis media with effusion). Usually, middle ear effusion appeared within 2 to 3 days and disappeared within 7 to 9 days after the inoculation of immunocomplex. Three days after the inoculation of immunocomplex, intranasal antigen challenge was performed three times daily and continued until the animals were killed. Disappearance of middle ear effusion appeared to be delayed in animals in which nasal allergic reactions were induced. Middle ear effusion was not found in those ears that were not inoculated with immunocomplex. Findings of the present study indicate that IgE-mediated allergic reactions of the mucous membrane lining the nose, nasopharynx, and eustachian tube constitute a factor indicative of a chronic state of disease, rather than a cause of otitis media with effusion.     

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.     

声反射在成人分泌性中耳炎中的诊断价值

目的提高耳科门诊成人分泌性中耳炎中耳积液的检出率,探讨声反射在协助诊断分泌性中耳炎是否伴有中耳积液中的临床价值。方法回顾性分析耳鼻咽喉科门诊169例确诊为分泌性中耳炎伴有中耳积液的成年患者的临床资料,并对听力正常与听力下降患者的鼓室图、同侧声反射及纯音测听等资料进行对比。结果169例(237耳)经鼓膜穿刺证实为中耳积液的患者中,223耳(94.1%)未引出声反射,14耳(5.9%)引出声反射;鼓室图异常200耳(84.4%),正常者37耳(15.6%);216耳(91.1%)有传导性听力下降,21耳(8.9%)听力正常。不论听力是否下降,同侧声反射的未引出率均高于异常鼓室图的概率(P<0.05);在不同听力及不同类型鼓室图中,声反射的未引出率没有差异(P>0.05),具有无创、快捷及客观等优点,能更好的帮助临床工作者评估分泌性中耳炎的疗效及预后。结论声反射能协助提高成人分泌性中耳炎伴中耳积液的检出率,具有无创、快速及客观等优点,能更好地帮助临床工作者评估分泌性中耳炎的疗效及预后。     

白介素-2在分泌性中耳炎中的临床意义

目的本实验对分泌性中耳炎患者的中耳积液标本进行白介素-2(IL-2)浓度检测和分析,以探索其在分泌性中耳炎中的临床意义.方法用双抗夹心酶联免疫吸附法检测中耳积液、患者血清及对照血清中IL-2的浓度.结果实验组中耳积液中IL-2的浓度明显高于血清中的浓度;实验组血清中IL-2的浓度较对照组血清高;急性期组IL-2含量较慢性期组高;行首次穿刺及二次穿刺患者之间,中耳积液中IL-2的浓度无明显差异(P＞0.05);而行三次或三次以上穿刺者中耳积液中该因子的浓度则明显升高(P＜0.01).结论中耳积液中的IL-2是由中耳腔局部产生的,而非单纯由血液中渗透而来;中耳积液中IL-2的高浓度可作为分泌性中耳炎转为慢性病程或迁延不愈的参考.     

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。     

Ciliary beat frequency of nasal and middle ear mucosa in children with otitis media with effusion.

Impaired mucociliary function of respiratory tract mucosa is associated with secretory otitis media in some well recognized syndromes. Ciliary activity per se may now be assessed directly by determination of ciliary beat frequency by a photoelectric technique. 49 children with otitis media with effusion undergoing surgical treatment were studied. Middle ear mucosa and nasal epithelial cells were obtained by biopsy and cytological brushings respectively at the time of surgery (myringotomy +/- grommet insertion under general anaesthesia). From these samples mean nasal ciliary beat frequency was 11.0 Hz and mean middle ear ciliary beat frequency was 11.2 Hz. A positive correlation exists between mean ciliary beat frequency of nasal and middle ear samples from individual patients. A comparison of mean ciliary beat frequency between children who were effusion positive and effusion negative at the time of surgery revealed no statistically significant difference. In addition, no difference existed between those children with recurrent otitis media with effusion and newly presenting cases. No prima facie evidence exists of impaired ciliary function in this population of children with otitis media with effusion.     

Middle ear effusion and allergy in childhood

Besides mechanical or infectious factors in the genesis of secretory otitis media IgE-mediated hypersensitivity has often been discussed. In order to estimate the importance of an allergic reaction in the development of middle ear disease, we examined 27 children having adenoids and a secretory otitis media. We documented the patients' history of allergy and determined the IgE-levels in the serum, the middle ear effusions and the adenoid tissue. 5 out of 27 children suffered from an allergy of the upper respiratory tract, but only in one child we found an elevated level of IgE in middle ear effusion. On the basis of our investigations and recent literature, we suggest that an allergic rhinitis might cause an Eustachian tube dysfunction in a few patients. There is no evidence of a local allergic reaction of the middle ear mucosa.     

Antibody response in experimental Haemophilus influenzae otitis media

Because Haemophilus influenzae is one of the most common pathogens in otitis media with effusion, we have investigated the antibody response in the serum and middle ear effusion (MEE) in nontypable H influenzae-induced experimental acute otitis media in the chinchilla, using an enzyme-linked immunosorbent assay. During acute otitis media, a reasonable antibody titer was observed: local antibody titers in the MEEs were equal to or greater than those of the serum samples for four of five MEE samples obtained at one week after inoculation. By two weeks, titers in both serum and MEE samples were increased significantly. However, the bacteria persisted in the middle ear cavity, even in the presence of increasing antibody titers, for up to five weeks after infection. The reason for this persistence of the bacteria in the middle ear is unknown.