鼻息肉复发与炎症因子的关系及预防

Analyze relationship between concentration of factorial inflammation in recurrent nasal polyps and prevent

目的 :探讨复发性鼻息肉与炎症因子的关系 ,以及预防复发的措施。方法 :复发性多发性鼻窦炎鼻息肉 10例中 ,女 3例 ,男 7例 ;平均 5 7岁 (2 0～ 79岁 )。鼻息肉手术史平均 3.5次 (2～ 13次 ) ,9例是作者手术过并一直随访的患者 ,每例发生囊泡型复发息肉 3次以上。皮肤变应源试验 9例有 1项以上阳性反应 ,测定复发性鼻息肉组织和周围血清的总IgE、特异性IgE(霉菌和螨 )与白细胞介素 - 5 ,8的含量。取患者周围静脉血 3ml ,以上清作对照。息肉组织制成匀浆、保存、复融、离心和分析。观察分析术后采取的预防复发措施的效果 ,预防复发采用术后鼻腔填塞含地塞米松 5mg和卡那霉素 1g溶液的明胶海绵 1周 ,口服红霉素片0 .2 5g ,2次 /d ,持续 6个月以上 ;取出填塞后用辅舒良 (丙酸氟替卡松 )喷鼻 3个月以上 ,1～ 2次 /d ,平均随访18.8个月 (12～ 2 0月 )。结果 :白介素 - 5血清中为 3.83± 2 .0 8μg/ml,息肉标本为 2 .86± 1.89μg/ml。二者均在正常值范围内。白介素 8血清中为 1.92± 3.4 0 μg/ml,10例中 6例在正常范围 (正常值 0 .2～0 .4 4μg/ml) ;息肉标本为 6 .83± 2 .92 μg/ml均高于正常值 ;血清与息肉IL - 8的含量经t检验 3.2 9>2 .88(P <0 .0 1)。特异性IgE检测了尘螨和霉菌 ,尘螨的血清特异性IgE?

Objective: To explore relationship between the recurrent nasal polyps and factorial inflammation, and result of prevention recurrent methods. Methods: There were 10 cases with recurrent and multitude nasal polyps, female 3, male 7, mean 56.9 years old(20-79 years old). They had been operated mean 3.5 times(range 2～13).Of them, 9 cases had been followed-up over 3 years and had repeating water-cyst at least 3 times. They were test with derma allergen,9 cases had over 1 item positive response. They were examined same time general IgE, speciality IgE(mycosis, acarus), interleukin-5(IL-5), interleukin-8(IL-8) in recurrent nasal polyps and circulation serum. They were measured plugger in nasal cavity with sponge soakage dexamexasone and kanamycin a week post-operation, aryzeromycin 0.25g were take orally Bid last over half year, and topical spray with Fudicarson over 3 months. Mean they were followed up 18.8 months(range 12～20 months).Result:IL-5 in serum was 3.83±2.08 μg/ml,polyps was 2.86± 1.89 μg/ml.IL-5 in serum and polyp was all normal. IL-8 in serum was 1.92±3.40μg/ml,6 cases of 10 cases were normal;polyps was 6.83±2.92μg/ml,10 cases were all over normal. The IL-8 content in serum and polyps were analyzed by t test: T=3.29>2.88,P<0.01,it had statistics signification. Serum general IgE,3 cases were normal ,7 cases were over normal 3～5times. 10 cases were used measuring for preventing recurrent polyps, they had no again water-cyst. Conclusion:IL-8 and general IgE can play an important role in recurrent polyps. Topical spray steroid and orally erythromycin can prevent recurrent.