难治性鼻-鼻窦炎黏膜胶原纤维沉积的研究

目的本研究观察难治性鼻-鼻窦炎（difficult-to-treat rhinosinusitis,DTRS）的鼻窦黏膜胶原纤维沉积程度,同时还探讨其与TGF-β1、嗜酸性粒细胞及影像学表现的关系。方法根据患者就诊时临床特点和纳入标准将51例慢性鼻-鼻窦炎患者分为难治组（12例）、复发组（14例）、初治组（15例）和对照组（10例）。术前对所有研究对象行血常规和鼻内镜检查,同时对术前鼻窦CT行LundMackay评分;术中取黏膜组织进行Masson染色、HE染色和ELISA检测。结果①难治组的黏膜胶原纤维面积百分比高于复发组、初治组和对照组;②胶原纤维面积百分比与TGF-β1浓度、黏膜嗜酸性粒细胞计数和Lund-Mackay评分均有相关性;而与全血嗜酸性粒细胞计数无相关性。结论①鼻窦黏膜纤维组织增生可能是DTRS病理特征之一,可能与发病有关;②TGF-β1高表达、黏膜嗜酸性粒细胞浸润丰富和高Lund-Mackay评分可能是胶原纤维沉积的危险因素。

Collagenous fiber deposition of mucosa in difficult-to-treat rhinosinusitis

Objective To survey the severity of collagenous fiber deposition of mucosa in difficult-to-treat rhinosinusitis（ DTRS）,also to analyze its relations with TGF-β1,eosinophils and radiological appearance. Methods All the patients received preoperative blood routine examination,endoscopy and sinus computerized tomography（ CT）. According to their clinical characteristics,they were divided into DTRS group（ 12 cases）,recurrent group（ 14 cases）,initial treatment group（ 15 cases） and normal control group（ 10 cases）. Masson staining,H-E staining and ELISA were performed in mucosa specimens from all the 4 groups. Results ① The percentage of collagenous fiber area of the DTRS group was higher than those of the others. ② The percentage of collagenous fiber area was correlated with TGF-β1 concentration,the mucosal eosinophil count and Lund-Mackay score,but not with peripheral eosinophil count. Conclusions ① Mucosal collagen fiber deposition may be the pathologic feature of DTRS,which may contribute to DTRS.② Significant TGF-β1 expression,mucosal eosinophil infiltration and high Lund-Mackay scores may be the risk factors of collagen fiber deposition.