鼻用糖皮质激素治疗兔急性细菌性上颌窦炎的组织病理学及超微结构观察

目的探讨鼻用糖皮质激素喷雾剂布地奈德（budesonide）对兔急性细菌性上颌窦炎的黏膜组织病理学及超微结构的影响。方法健康成年新西兰白兔48只,采用鼻腔置入Merocel高分子膨胀海绵并注入肺炎链球菌建立急性细菌性上颌窦炎模型,10d后取出鼻腔膨胀海绵,随机分成抗生素治疗组（A组）、抗生素加鼻用激素治疗组（B组）、鼻用激素治疗组（C组）及对照组（D组）,每组各12只。分别于治疗2周及4周后每组各处死6只动物,行上颌窦黏膜组织病理学及超微结构观察。结果组织病理学观察结果示治疗2周及4周后A、B组上颌窦黏膜纤毛缺失及上皮层溃疡形成均轻于C、D组,尤其是B组上颌窦黏膜炎性细胞浸润明显轻于C、D组,差异均有统计学意义（P〈0.05）;A组上颌窦黏膜病理定性分析示炎性细胞浸润轻于C、D组,但差异无统计学意义（P〉0.05）。A、B两组之间上颌窦黏膜炎性细胞浸润在治疗2周后差异无统计学意义（P〉0.05）,治疗4周后,B组上颌窦黏膜炎性细胞浸润明显轻于A组（P〈0.05）。透射电镜观察示A、B两组兔上颌窦黏膜超微结构改变具有相似性。结论鼻用糖皮质激素治疗急性细菌性上颌窦炎,能减轻上颌窦黏膜的炎性细胞浸润,但尚不能作为取代抗生素的单一治疗。抗菌合并抗炎治疗会取得更好的疗效。

Effects of intranasal corticosteroids on the treatment for experimental acute bacterial maxillary sinusitis in rabbits

Objective To determine the the possible effects of budesonide, an intranasal corticosteroid, on mucosal histomorphologie changes in experimental acute bacterial maxillary sinusitis in rabbits. Methods Acute bacterial maxillary sinusitis was induced in 4 8 rabbits. Animals were treated with antibiotic （group A ） , antibiotic and corticosteroid combination （ group B ） , corticosteroid （ group C ） , and control （ group D ） . Six rabbits in each group were sacrificed after 2 or 4 weeks of treatment. Maxillary sinusitis were removed for whole- mount histological analysis. Results Semiquantitative analyses showed that epithelial ulceration and ciliary loss in groups A and B were less pronounced than that in groups C and D （ P 〈 0. 0 5 ） ; infiltration of inflammatory cells were diminished more significantly than that in group B than in groups C and D （ P 〈 0. 0 5 ） . Significant difference in inflammatory cell infiltration between groups A and B was found at the fourth week （ P 〈 0. 05 ）. Uhrastrueture changes showed that there was a similar trend in both group A and group B. Conclusion Intranasal eortieosteroids can lessen infiltration of inflammatory cells. In the treatment for acute bacterial maxillary sinusitis, intranasal eorticosteroids cannot substitute for antibiotic treatment as a single therapy, but intranasal eortieosteroids administered with antibiotics can provide better efficacy.