阿奇霉素对慢性鼻-鼻窦炎患者术腔黏膜中NF-kBp65IL-8表达的影响

目的 观察阿奇霉素对慢性鼻-鼻窦炎患者术腔黏膜中NF-kBp65、IL-8表达的影响,探讨阿奇霉素治疗术腔慢性炎症的机制。方法 将45例慢性鼻-鼻窦炎术后2周的患者随机分成阿奇霉素组、头孢菌素组和对照组进行随访治疗，所有患者均应用布地奈德喷鼻、生理盐水冲洗术腔，阿奇霉素组加用阿奇霉素500mg口服，每日1次；头孢菌素组加用头孢菌素500mg口服，每日1次；对照组继续同前治疗，连续3周后，取术腔病变黏膜作为实验标本，应用免疫组织化学PV-6000二步法检测各组治疗前后及三组间术腔黏膜上皮细胞、炎性细胞中NF-kBp65和IL-8表达的情况，计数阳性细胞数。结果 慢性鼻-鼻窦炎患者术腔黏膜呈慢性炎症表现，NF-kBp65主要表达在术腔黏膜的黏膜上皮细胞、炎性细胞的胞浆和部分胞核。IL-8主要表达在黏膜的上皮细胞、炎性细胞的胞浆。三组治疗后NF-kBp65和IL-8在上皮细胞和炎性细胞中的表达均较治疗前减少(P<0.05)；阿奇霉素组治疗后术腔黏膜上皮细胞和炎性细胞中NF-kBp65、IL-8的表达均较头孢菌素组、对照组明显减少(P<0.05)；头孢菌素组与对照组治疗后上皮细胞和炎性细胞中NF-kBp65、IL-8的表达无明显差别(P>0.05)。结论 阿奇霉素联合应用布地奈德抑制慢性鼻-鼻窦炎患者术腔黏膜上皮细胞、炎性细胞中NF-kBp65、IL-8的表达，较单独应用布地奈德明显，可能是阿奇霉素治疗慢性炎症的机制之一，对慢性鼻-鼻窦炎患者术腔黏膜慢性炎症的转归具有促进作用。

Effect of Azithromycin on NF-kBp65 and IL-8 in nasal mucosa of chronic sinusitis after endoscopic sinus surgery

Objective To observe the effect of azithromycin on expressions of NF-kBp65 and IL-8 in nasal mucosa of chronic sinusitis after endoscopic sinus surgery. Methods 45 patients with chronic sinusitis and/or nasal polyps who were treated with endoscopic surgery 2 weeks previously were divided into 3 groups: 15 patients treated with local glucocorticoid as the control group, 15 patients were added with cephalosporin(500mg, once a day) as another control group, others were added with Azithromycin(500mg, once a day) as the experimental group. The PV-6000 immunohistochemical method was applied to explore expressions of NF-kBp65 and IL-8 in nasal mucosa before and after 3-week medical therapy while counting the quantity of positive cells. Results Chronic inflammation was observed in nasal mucosa after endoscopic sinus surgery by HE staining. There were many inflammatory cells such as neutrophil cells and eosinophil cells under the mucosal epithelium, and the neutrophil cells were the key cells. Expression of NF-kBp65 was positive in the cytoplasm and some nuclei of the mucosal epithelia and the inflammatory cells in nasal mucosa. Expression of IL-8 was positive in the cytoplasm of the mucosal epithelia and inflammatory cells in nasal mucosa. Expressions of NF-kBp65 and IL-8 were significantly reduced in the mucosal epithelia and inflammatory cells of nasal mucosa after 3 weeks medical treatment compared with that of pre-treatment in the three groups(P<0.05). The difference of expressions of NF-kBp65 and IL-8 in the mucosal epithelia and inflammatory cells of the nasal mucosa were statistically significant in the azithromycin group compared with the cephalosporin group and the control group after treatment(P<0.05).There were no statistical significance of expressions of NF-kBp65 and IL-8 in the mucosal epithelia and inflammatory cells of the nasal mucosa between the cephalosporin group and the control group after treatment(P>0.05). Conclusion Azithromycin in combination with local glucocorticoid is better than glucocorticoid to inhibit expressions of NF-kBp65 and IL-8 in mucosal epithelia and inflammatory cells in nasal mucosa of chronic sinusitis and/or nasal polyps after endoscopic sinus surgery. It is an effective method to cure chronic inflammation of nasal mucosa in the nasal cavity after endoscopic sinus surgery.