三种促炎因子在鼻息肉及术后两周紧邻术区鼻黏膜的变化

目的 研究鼻息肉及鼻内镜术后2周紧邻术区鼻黏膜中血管细胞黏附分子（vascular cell adhesion molecule，VCAM）-1、嗜酸粒细胞亲合素（Eotaxin）及血管内皮生长因子（vascular endothelial growth factor，VEGF）的表达及相关性，探讨鼻息肉术后复发的可能机制。方法 应用链霉亲和素-过氧化物酶（SABC）免疫组化法检测30例鼻息肉及其中22例鼻内镜术后2周患者紧邻术区鼻黏膜的VCAM-1、eotaxin和VEGF的表达情况；HE染色光镜下观察组织结构、炎性细胞浸润情况。结果 ①HE染色可见鼻息肉组织嗜酸粒细胞大量浸润，术后则明显减少（t=2．891，P〈0．05）；②VCAM-1在鼻息肉手术前后均呈阳性表达，阳性面积差异无统计学意义（t=-2．051，P〉0．05），平均吸光度术后减弱（t=3．670，P=0．05）；Eotaxin手术前后阳性面积差异无统计学意义（t=0．739，P〉0．05），平均吸光度术后明显减弱（t=4．428，P〈0．05），Eotaxin术后腺体阳性率明显增加（t=-2．899，P〈0．05）；③VEGF阳性面积及平均吸光度手术前后表达差异均无统计学意义（t值分别为-0．037、0．825，P值均〉0．05）。结论 ①鼻息肉鼻内镜手术后嗜酸粒细胞数量明显减少，说明紧邻术区水肿状组织不同于鼻息肉。②VCAM-1、Eotaxin术后紧邻术区鼻黏膜阳性表达，说明Eotaxin有可能上调VCAM-1在血管内皮的表达，促进嗜酸粒细胞黏附于内皮细胞，穿内皮细胞问隙迁移到组织中，可能是息肉复发的基础。其中Eotaxin术后腺体阳性表达明显增加，推测其可能在鼻息肉复发早期发挥重要作用。③VEGF术后高表达，提示VEGF可促进术区血管增生及通透性增强，使局部组织增生、水肿，从而可能成为息肉复发过程中的重要因素之一。

Vascular cell adhesion molecule-1, eotaxin and vascular endothelial growth factor in nasal polyps after endoscopic surgery

OBJECTIVE: To study the different expression of VCAM-1, eotaxin and VEGF in nasal polyp tissues and in the nasal mucosa of the operative cavity after endoscopic surgery and its significance. METHODS: Paraffin sections of nasal polyps and the nasal mucosa of the operative cavity were studied with immunohistochemical technique and HE staining. RESULTS: (1) Abundant eosinophils were observed in the nasal polyps, however, it was rarely seen in the nasal mucosa of the operative cavity (t = 2.891, P <0.05). (2) The positive expression of VCAM-1 and eotaxin was in nasal polyps and nasal mucosa of operative cavity, and both of the positive area were not statistically significant (t = - 2.051, P > 0.05), but their average density of light was decreased in the nasal mucosa of the operative cavity (t = 3.670, P = 0.05). The positive glandulae of eotaxin were increased after endoscopic surgery (t = -2.899, P < 0.05). (3) Expression of VEGF was similar in both groups (t = - 0.037, 0.825, P > 0.05, respectively). CONCLUSIONS: (1) It is suggested that the nasal mucosa of the operative cavity was different from the nasal polyps. (2) The positive expression of VCAM-1 and eotaxin in the nasal mucosa of the operative cavity after endoscopic surgery indicates that eotaxin may up-regulate the expression of VCAM-1 in vessel endothelium and promote adhesion and migration of eosinophils, as a result, to lead to the recurrence of nasal polyps. The glandulous expression of eotaxin may play a key role in the early stage. (3) The expression of VEGF in nasal musosa after surgery may contribute to the growth of blood vessel and induce increasing of vascular permeability and tissue edema. This may be an important factor in the process of nasal polyp recurrence.