外周血嗜酸粒细胞比例在慢性鼻-鼻窦炎伴鼻息肉分类中的作用

目的 探讨伴或不伴嗜酸粒细胞增多的慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者的临床特点以及外周血嗜酸粒细胞比例在分类中的作用.方法 回顾性分析119例确诊为CRSwNP患者的临床资料.根据术后鼻息肉组织病理检测结果,分为嗜酸粒细胞浸润组(ECRSwNP)与非嗜酸粒细胞浸润组(non-ECRSwNP).将两组患者血嗜酸粒细胞比例、血清总IgE水平、嗅觉评分、鼻窦CT Lund-Mackay评分以及皮肤点刺试验结果分别进行统计学分析,比较两组的差异.同时,将各指标与病理结果进行相关性分析,筛选与病理结果相关性较强的临床指标,采用ROC曲线方法计算曲线下面积及ECRSwNP的诊断截断值.以SPSS 17.0软件进行数据统计分析.结果 ECRSwNP患者组63例,non-ECRSwNP患者组56例.两组患者术前外周血嗜酸粒细胞比例(7.31％:3.90％)、血清总IgE水平(60.9 IU/L∶28.9 IU/L)、嗅觉评分分别为(5.8∶0.4),差异均有统计学意义(U值分别为620.01、1020.53、1092.52,P值均＜0.05).两组上颌窦Lund-Mackay 评分分别为2.0、2.5,差异有统计学意义(U=12.01,P＜0.05)；两组额窦、前筛、后筛、蝶窦及窦口鼻道复合体区的Lund-Mackay评分差异均无统计学意义(U值分别为27.5、23.5、22.5、31.5、28.5,P值均＞0.05).两组皮肤点刺试验结果差异无统计学意义(x2=1.96,P=0.19).外周血嗜酸粒细胞比例与血清总IgE均与病理结果中嗜酸粒细胞浸润程度呈正相关趋势(r值分别为0.55、0.24,P值分别为0.001、0.01).ROC曲线下面积为0.818,外周血嗜酸粒细胞比例5.65％为ECRSwNP的诊断截断值.结论 伴或不伴嗜酸粒细胞增多的两组CRSwNP患者在临床特点上有显著差异；可根据患者术前外周血嗜酸粒细胞的比例是否大于5.65％进行初步分类.     

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。     

鳞状细胞癌抗原在慢性鼻窦炎伴鼻息肉患者血清中的表达及组织分型中的意义

目的探讨鳞状细胞癌抗原(SCCA)在慢性鼻窦炎伴鼻息肉(CRSwNP)患者血清中的表达情况及其在组织分型中的应用价值。方法选取74例CRSwNP患者以及40例健康志愿者作为研究对象,根据CRSwNP患者术后组织病理切片中嗜酸性粒细胞浸润情况将CRSwNP分为非嗜酸性CRSwNP组(non-eCRSwNP,n=33)和嗜酸性CRSwNP组(eCRSwNP,n=41)。术前收集入组患者的外周血检测SCCA在血清中的浓度,观察其与临床指标的联系及其在不同组织分型患者中浓度差异。结果与对照组相比,CRSwNP组患者血清SCCA表达水平显著升高(P＜0.000 1);与non-eCRSwNP组相比,eCRSwNP组患者血清SCCA表达水平显著升高(P＜0.000 1)。CRSwNP患者血清SCCA浓度与外周血嗜酸性粒细胞计数(r=0.404,P=0.000 4)、组织嗜酸性粒细胞比例(r=0.283,P=0.015)均呈正相关。二元Logistic回归及受试者工作曲线(ROC)分析提示血清SCCA水平与CRSwNP组织亚型具有明显的相关性并能较好地将两者进行区分[曲线下面积(AUC)=0.844,P=0.000]。结论CRSwNP患者血清SCCA表达上调且与组织嗜酸性炎症相关,其表达水平可能有助于术前鉴别CRSwNP亚型。     

慢性鼻-鼻窦炎伴与不伴鼻息肉患者临床特征的比较

目的　比较慢性鼻-鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）与不伴鼻息肉（chronic rhinosinusitis without nasal polyps，CRSsNP）的临床特征，为制定合理治疗策略提供依据。方法　回顾性分析2018年11月～2019年12月住院手术的苏皖地区225例慢性鼻-鼻窦炎（CRS）患者术前血常规、血生化、血清总IgE（total IgE，tIgE）、特异性IgE（specific IgE，sIgE）、鼻窦CT及术后病理检查等临床资料，进行统计学分析。结果　225例中，CRSwNP组148例（65.8%），CRSsNP组77例（34.2%）。患者的性别、年龄、住院时间、外周血白细胞及分类、血生化指标在两组间差异无统计学意义（P >0.05）。CRSwNP和CRSsNP患者中至少1种变应原阳性分别占34.5%和40.3%，其中尘螨过敏最多见，阳性率分别为23.0%和26.0%，两组间差异均无统计学意义（P >0.05）。血清tIgE阳性率、20种变应原sIgE浓度等级和阳性率、吸入性及食物性变应原阳性率在两组间差异也均无统计学意义（P >0.05）。鼻窦CT扫描Lund-Mackay评分中，两组各鼻窦、窦口鼻道复合体及CT总分CRSwNP组都高于CRSsNP组，差异均有统计学意义（P <0.05）。在病理组织中，两组患者淋巴细胞及浆细胞浸润均为60%以上，但嗜酸性粒细胞（Eos）在CRSwNP组的阳性率为43.2%，显著高于CRSsNP组的阳性率22.1%，差异有统计学意义（P <0.05）。结论　本地区CRS患者目前仍以淋巴细胞/浆细胞性炎症为主，但CRSwNP息肉组织中Eos阳性率达43.2%，需引起重视并进一步关注。CRSwNP和CRSsNP患者变应原阳性率分别为34.5%和40.3%，两者无明显差异，尘螨为主要致敏原。     

患者术前临床特征对嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的预测价值

目的 探讨患者的术前临床特征对嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉(ECRSwNP)的预测价值,并构建用于临床实践的诺模图。方法 选取2019年9月—2020年9月就诊于新乡医学院第一附属医院并行功能性鼻内镜手术治疗的慢性鼻窦炎伴鼻息肉(CRSwNP)患者97例,根据术后病理结果嗜酸性粒细胞(EOS)浸润程度将其分为ECRSwNP组和非嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉(nonECRSwNP)组,收集并比较两组患者的临床特征资料,采用单因素及多因素二元Logistic回归分析筛选对ECRSwNP有预测价值的术前特征资料,并构建用于临床实践的诺模图。采用SPSS 26.0和R语言软件4.1.2对数据进行分析。结果 两组患者在是否合并哮喘史、外周血嗜酸性粒细胞(EOS)计数、外周血嗜碱性粒细胞(Baso)计数、日本难治性嗜酸性慢性鼻窦炎流行病学调查(JESREC)评分、上颌窦评分、前后组筛窦评分、CT总分、E/M(筛窦与上颌窦的Lund-Mackay评分比值)上差异具有统计学意义(P<0.05)。单因素及多因素二元Logistic回归分析并构建的诺模图显示,基于哮喘史、外周血EOS、外周血...     

IL-5及其受体IL-5Rα在慢性鼻-鼻窦炎伴息肉 患者息肉组织中的表达及意义

目的探讨IL 5及其受体IL 5Rα在慢性鼻-鼻窦炎伴息肉（CRSwNP）患者息肉组织中的表达及意义。方法89例CRSwNP患者根据嗜酸性粒细胞在摘除的鼻息肉组织中的浸润程度将患者分为ECRSwNP组（n=41）和对照组（n=48）,收集患者一般临床资料,利用HE染色计数鼻息肉组织中嗜酸性粒细胞表达,利用RT PCR技术检测IL 5和IL 5Rα在鼻息肉组织中表达。结果ECRSwNP组患者变应性鼻炎史比例、双侧鼻息肉比例、鼻窦累及数、鼻息肉病变程度评分和Lund Mackay评分均高于对照组,差异均有统计学意义（P<0.05）,ECRSwNP组患者嗜酸性粒细胞计数、嗜酸性粒细胞百分比和总IgE均大于对照组,差异均有统计学意义（P<0.05）;ECRSwNP组患者鼻息肉组织中每个高倍视野嗜酸性粒细胞平均计数为（36.5±14.2）,远高于对照组患者（1.2±0.6）,差异具有统计学意义（t=17.146,P=0.000）,Pearson相关分析显示,ECRSwNP组患者鼻息肉组织中嗜酸性粒细胞计数与生化指标中血嗜酸性粒细胞计数和百分比均呈正相关（r=0.703和0.652,均P<0.05）;ECRSwNP组患者鼻息肉组织中IL 5 mRNA和IL 5Rα mRNA相对表达量均高于对照组,差异均有统计学意义（P<0.05）,Pearson相关分析显示,ECRSwNP组患者鼻息肉组织中IL 5 mRNA相对表达量与IL 5Rα mRNA相对表达量呈正相关（r=0.454,P=0.003）。结论IL 5和IL 5Rα在ECRSwNP患者鼻息肉组织中表达量显著增加,可能与ECRSwNP发病及进展有关。     

不同类型鼻息肉患者外周血Th17细胞含量的变化及意义

目的：研究不同类型鼻息肉患者外周血Th17细胞含量及其与炎性细胞浸润的关系;探讨其与预后的关系。方法对81例鼻息肉和20例鼻中隔偏曲患者进行研究。外周血Th17细胞含量采用流式细胞仪检测;鼻息肉组织嗜酸性粒细胞、中性粒细胞、淋巴细胞、浆细胞浸润程度以每高倍视野每104μm2面积所含有的数量表示;内镜表现采用Lund-Kennedy评分;主观症状采用VAS评分;影像学CT表现采用Lund-Mackay评分。结果嗜酸性鼻息肉组和非嗜酸性鼻息肉组患者外周血Th17细胞百分比分别为2.10%（3.75%,1.40%）和1.10%（1.70%,0.73%）,两组差异有统计学意义（Mann-Whitney U=358.0,Z=-2.965,P=0.001）;外周血Th17细胞百分比与鼻息肉组织中嗜酸性粒细胞呈正相关（r=0.408,P＜0.001）,与术后3个月内镜评分有中等程度相关性（r=0.458,P＜0.001）。结论 Thl7细胞表达可能与噬酸性鼻息肉发病及预后有关。     

慢性鼻窦炎伴鼻息肉患者嗅觉障碍的影响因素分析

目的分析慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者嗅觉障碍的影响因素。方法回顾性分析2014—2018年就诊于北京安贞医院行内镜鼻窦手术治疗的CRSwNP患者88例,男性22例,女性66例,年龄(48.1±11.3)岁(±s,下同)。所有入选患者均于术前行Sniffin′Sticks嗅觉测试、Lund-Mackay评分及改良鼻窦CT嗅区评分、鼻阻力及声反射检查、血常规及血生化等实验室检测、血清特异性IgE检测;术中取鼻息肉组织进行嗜酸粒细胞计数。根据Sniffin′Sticks嗅觉测试结果将患者分成嗅觉功能正常组和嗅觉功能障碍组,两组之间进行临床基线资料比较,根据单因素分析结果,结合临床有意义的指标进一步行多因素Logistic回归模型分析,并初步建立CRSwNP嗅觉障碍的预测模型。设P<0.05为差异有统计学意义。结果88例CRSwNP患者中,嗅觉正常32例(36.4%),嗅觉障碍56例(63.6%),其中嗅觉下降40例(45.5%)、失嗅16例(18.2%)。单因素分析发现,两组间组织嗜酸粒细胞数、血嗜酸粒细胞百分比、血尿素的差异存在统计学意义[12.7[2.0,52.3]个/高倍视野(M[P25,P75],下同)比38.6[16.2,87.0]个/高倍视野、2.75[1.60,4.80]%比4.35[2.50,6.60]%、(5.56±1.15)mmol/L比(4.98±1.33)mmol/L,P值均<0.05];改良鼻窦CT嗅区评分、除窦口鼻道复合体评分外的Lund-Mackay评分的差异均存在统计学意义(P值均<0.05)。多因素Logistic回归模型分析发现,改良鼻窦CT双侧嗅区总分和血尿素的差异具有统计学意义,其中双侧嗅区总分是嗅觉功能的危险因素(OR=2.108,95%CI:1.407~3.159,P<0.001);一定浓度的血尿素是嗅觉功能的保护因素(OR=0.461,95%CI:0.240~0.884,P=0.020)。进一步研究发现,由组织嗜酸粒细胞计数、血嗜酸粒细胞百分比、改良鼻窦CT双侧嗅区总分、总吸气、血尿素组成的预测模型受试者工作特征(ROC)曲线下面积(AUC)的值为0.888(P<0.01),对CRSwNP嗅觉障碍预测效果较好。结论改良鼻窦CT嗅区评分与CRSwNP患者的嗅觉障碍密切相关,一定程度的血尿素升高可能对CRSwNP患者的嗅觉功能有保护作用。     

慢性鼻-鼻窦炎骨炎严重程度影响因素分析

目的：探讨慢性鼻-鼻窦炎（CRS）骨炎严重程度的影响因素。方法收集CRS患者82例,男59例,女23例。采用整体骨炎评分系统（global osteitis scoring scale, GOSS）评价骨炎严重程度,并用Lund-Mackay评分及Lund-Kennedy评分来客观评价患者CRS的严重程度,检测外周血嗜酸性粒细胞数和嗜酸性粒细胞百分比,并收集外周血Th17细胞含量、血清总IgE、特异性IgE含量及C反应蛋白含量。GOSS与Lund-Mackay评分及Lund-Kennedy评分、血嗜酸性粒细胞含量及百分比、外周血Th17细胞百分比、血清总IgE及特异性IgE含量及C反应蛋白含量之间的相关性,采用SPSS13.0软件包进行统计学分析。结果骨炎GOSS评分与Lund-Mackay评分之间呈显著正相关性（r=0.823,P＜0.01）;骨炎GOSS评分与Lund-Kennedy存在高度正相关性（r=0.683,P＜0.01）;骨炎GOSS评分与血中的总IgE呈正相关性（r=0.3,P＜0.1）,但有骨炎组与无骨炎组患者外周血特异性IgE含量无明显差别;骨炎GOSS评分与血Th17细胞百分比、血嗜酸性粒细胞含量及C-反应蛋白含量均无相关性。结论 CRS骨炎严重程度与血中总IgE密切相关,与患者鼻窦黏膜炎症严重程度相关。     

糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响

目的 探讨糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响。 方法 将嗜酸粒细胞性慢性鼻窦炎伴鼻息肉患者40例,以随机数字表法分为对照组(20例)和观察组(20例),分别给予糖皮质激素短疗程喷鼻和雾化吸入方案治疗。比较两组患者近期疗效,治疗前后鼻部症状VAS评分,内镜Lund-Kennedy评分,嗜酸性粒细胞绝对值(EOS)计数水平、血清皮质醇水平及随访复发率等。 结果 观察组患者治疗显效率和总有效率均高于对照组(P<0.05);观察组患者治疗后鼻部症状VAS评分和内镜Lund-Kennedy评分均低于对照组及本组治疗前(P<0.05);观察组患者随访3个月和6个月复发率均低于对照组(P<0.05);观察组患者治疗后EOS计数水平均低于对照组及本组治疗前(P<0.05);同时两组患者治疗前后血清皮质醇水平比较差异无统计学意义(P>0.05)。 结论 相较于喷鼻方案,糖皮质激素短疗程雾化吸入方案治疗嗜酸粒细胞性鼻窦炎伴鼻息肉可有效缓解鼻部症状体征,抑制嗜酸性粒细胞聚集,降低远期复发风险,且未对肾上腺皮质功能产生明显影响。     

以耳部症状首发、合并鼻咽占位的肉芽肿性多血管炎1例并文献复习

目的 探讨1例临床少见的以耳部症状首发、合并鼻咽部占位的肉芽肿性多血管炎(GPA)的临床特征、实验室检查、病理表现及诊疗过程。方法 回顾性分析患者的病例资料,总结病例特点并回顾国内外GPA相关文献。结果 患者以中耳炎、迷路炎症状为首发表现,合并鼻咽部占位,病程中逐渐出现面瘫,三叉神经刺激症状加重。多次留取耳及鼻咽部活检示急慢性炎症细胞浸润。升级抗生素,同时为避免中耳炎侵犯岩骨及颅内行乳突开放术。中耳局部炎症改善后其耳痛、面瘫等仍不缓解,但激素治疗有效,遂进一步完善自免病相关检查并再次行鼻咽部活检,最终确诊为GPA,予激素及免疫抑制剂治疗得以控制症状。术后3个月暂无显著肺部及肾脏受累表现。结论 临床上发现不典型的中耳炎或常规治疗反复不愈,且逐渐进展出现内耳、颅神经侵犯表现如眩晕发作、面神经麻痹等,同时激素治疗有效,且合并鼻咽部占位、鼻窦炎影像学表现,或累及其他器官如肺、肾脏时,均应考虑到GPA的可能。当反复留取病理活检未能取得特异性确诊依据时,动态监测抗中性粒细胞胞浆抗体、红细胞沉降率、尿潜血、胸部CT、血肌酐等也具有重要的提示意义。     

Polymyositis with dysphagia treated with endoscopic balloon dilatation

Polymyositis is characterized by non-specific inflammatory disease associated with an autoimmune disorder involving muscles of the limbs and neck. We report a case of an 80-year-old man who was referred to our clinic with a chief complaint of dysphagia and muscle weakness in all four limbs. The patient was diagnosed with polymyositis based on pathological findings, muscle weakness, electromyogram findings, and an elevated creatine phosphokinase level. The patient was also positive for HLA-DR3. Intravenous predonine administration was initiated, but dysphagia was not improved. We considered a cricopharyngeal myotomy, but this could not be performed because of heart failure. Endoscopic balloon dilation was performed and dysphagia improved on the same day. Therefore, we suggest that this method is a safe and effective approach for polymyositis with dysphagia.     

Cytokines in children with otitis media with effusion

We assayed 38 middle ear effusions from 23 children aged 4–13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1β, IL-8, and IL-10 were found in all of the effusions. TNF-α was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-α, IL-1β, IL-8, and IL-10 was, respectively, 0.423 ± 1.39, 30.58 ± 68.7, 7001.9 ± 6743, and 56 ± 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-α and IL-1β (r = 0.87, P = 0.001) and between IL-1β and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-α, IL-1β, IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state. Received: 25 August 1999 / Accepted: 5 January 2000     

Decreased miRNA-320e correlates with allergy in children with otitis media with effusion

ObjectiveOtitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups.Materials and methodsThis study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973).ResultsMiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant.ConclusionsMiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.     

Experience with vertical partial laryngectomy with special reference to laryngeal reconstruction with cervical fascia

In this paper we report our experience of vertical partial laryngectomy using the superficial cervical fascia; we describe the technique and present the functional and oncological results of this method of treatment. A total of 42 patients with squamous cell carcinoma of the true vocal folds, in stage T(1) (n = 28) or T(2) (n = 14), were treated in our department using vertical partial laryngectomy during the decade 1987-1997. Nine patients had post-operative radiotherapy. The shortest follow-up time was three years. There were six recurrences in all, four in the larynx and two in the neck. All four of the laryngeal recurrences were treated with total laryngectomy and are doing well. Both the patients with neck metastases, who were treated with neck dissection, died. Permanent tracheotomy was necessary in one patient. There were no problems with aspiration. The recurrence rate was 14 per cent, the three-year survival index was 95.2 per cent and the three-year larynx preservation index was 90 per cent. According to our experience, vertical partial laryngectomy, using the method we describe, has a good functional and oncological result for stage T(1) and T(2) tumours.     

Vestibular rehabilitation with biofeedback in patients with central imbalance

Central Nervous System disorders may cause important functional unbalance in the maintenance of balance and posture. There is no effective rehabilitation for these symptoms until now.ObjectiveThe aim of this paper is to evaluate the use of tongue electrotactile stimulation on patients with central imbalance using BrainPort.Materials and MethodsThis is a prospective case series study. We evaluated 8 patients with central imbalance, 6 men and 2 women, with mean age of 67.75 years. The patients were submitted to Computed Dynamic Posturography (CDP) and then received 18 sessions of electrotactile stimulation by BrainPort® device for 20 minutes, twice a day. Then they were submitted to a new CDP test and to a self-perception scale to assess symptom remission, partial improvement and no improvement at all.Results75% of the patients reported being more stable. There was no improvement in the balance control of the mass center in these patients.ConclusionThe patients were able to use the electrotactile stimulus to improve their balance control.