A型肉毒杆菌毒素对血管运动性鼻炎的作用及组织形态学影响

目的：探讨A型肉毒杆菌毒素(BTA)治疗血管运动性鼻炎的作用及机制。方法：32例血管运动性鼻炎患者鼻腔注射BTA，每侧鼻腔各注射两点，每点2．5U，总量10U。记录注射前后鼻溢液、鼻塞、喷嚏、鼻黏膜水肿的情况并评分。12只豚鼠随机分为BTA组和对照组。BTA组左侧鼻腔以浸有10U(0．2ml)BTA的Merocel海绵作用1h；对照组以生理盐水代替BTA。分别于用药后第7、14、28天全麻下切取豚鼠左侧下鼻甲黏膜，行苏木精-伊红染色及电镜观察。结果：鼻溢液亢进完全缓解26例(81．3％)，明显缓解6例(18．8％)；打喷嚏完全缓解10例(31．3％)，部分缓解4例(12．5％)，无缓解18例(56．3％)；鼻塞完全缓解4例(14．8％)，部分缓解5例(18．5％)，无缓解18例(66．7％)；鼻黏膜肿胀完全缓解8例(25．0％)，明显缓解6例(18．8％)，部分缓解4例(12．5％)，无缓解14例(43．8％)。12例患者有一过性鼻干或注射当天鼻溢液加重，无其他并发症。BTA局部应用7、14d，豚鼠鼻黏膜下腺上皮及导管上皮退化、变性，部分腺细胞呈不可逆变性；28d后大部分腺细胞恢复正常。结论：BTA可引起鼻黏膜腺细胞变性，明显减轻血管运动性鼻炎鼻溢液亢进的症状。

The influence of botulinum toxin type A on vasomotor rhinitis and morphological study

OBJECTIVE: To investigate the effect and mechanisms of botulinum toxin type A(BTA) on vasomotor rhinitis. METHOD: A retrospective study of 32 patients with vasomotor rhinitis who received BTA injection at 4 points in bilateral nasal cavities with 2.5 units at each point had been done. The state of rhinorrhea, nasal obstruction, sneeze and nasal mucosa edema of each patient were recorded and scored before and after the application of BTA respectively with follow-ups of 6-30 months. Twelve guinea pigs were randomly divided into 2 groups: BTA group and control group. Merocel sponge soaked with 10 units (0.2 ml) BTA was put into left nasal cavity under general anesthesia for one hour in BTA group. Saline replaced BTA in control group. The inferior turbinate mucosa of guinea pig ware harvested under general anesthesia at 7, 14, 28 days after BTA treatment and was observed with HE staining and electron microscope. RESULT: Rhinorrhea improved significantly in all 32 patients while sneeze, nasal obstruction and mucosa edema reduced partly. The reducing of rhinorrhea lasted averagely 6 weeks. Twelve patients had an episode of nasal dryness or increased rhinorrhea at the day of injection. No other complications were found. Seven, fourteen days after local BTA application, the degenerations of glandular epithelium and canal epithelium were observed in nasal mucosa of guinea pigs. Most of the glandular cells showed normal at 28 days after BTA treatment. CONCLUSION: BTA can induce the degeneration of glandular cells in nasal mucosa and thus obviously relieve over rhinorrhea of patients with vasomotor rhinitis.