细胞因子及白细胞介素-1β与内毒素在分泌性中耳炎中耳积液中的表达及意义

The expression of RANTES interleukin 1β and endotoxin in the effusion of secretory otitis media

目的 :探讨分泌性中耳炎 (SOM )中耳积液中内毒素 (ET)、白细胞介素 1β(IL 1β)、正常T细胞表达和分泌、活化时调节的趋化因子 (RANTES)的表达以及它们在SOM发病中的作用。方法 :对 5 3例 72耳SOM患者行鼓膜穿刺 ,获得的中耳积液标本行细菌培养 ,然后采用鲎试验动态浊度法、放射免疫法以及双夹心抗体酶联免疫吸附法检测中耳积液中ET、IL 1β和RANTES的浓度。 结果 :①中耳积液中ET、IL 1β和RANTES阳性率分别为 80 .9%、77.8%和 70 .8% ,平均浓度为 (35 .2± 5 1.6 )EU/ml,(1.10± 0 .84 ) μg/L ,(0 .5 2± 0 .4 3) μg/L。②三者在黏液性积液中的含量高于浆液组 (P <0 .0 5 ) ;病程长者 ,ET、RANTES浓度也较高 (P <0 .0 5 ) ;细菌培养阳性中耳积液中三者的浓度亦明显高于细菌培养为阴性的积液 (P <0 .0 1)。③积液中ET含量与IL 1β呈显著正相关性 (r =0 .74 ,P <0 .0 1) ,IL 1β与RANTES之间也呈显著正相关 (r =0 .4 8,P <0 .0 1)。结论 :ET、IL 1β与RANTES参与了SOM发病的免疫机制 ,与鼓室内炎症反应的迁延 。

Objective:To study the protein expression of endotoxin , interleukin 1β(IL-1β) and regulated upon activation, normal T expressed and secreted(RANTES) in effusions of secretory otitis media and their roles in the pathogenesis of secretory otitis media.Method:Seventy-two effusion samples were taken from 53 patients with secretory otitis media by tympanocentesis. After swabs they were taken for bacteria culture.Limulus amebocyte lysate(LAL) test was used to quantify the content of endotoxin, radioimmunoassay to analyze the level of IL-1β and enzyme-linked immunosorbent assay (ELISA) to detect the concentration of RANTES.Result:Endotoxin, IL-1β and RANTES were detectable in 80.9%, 77.8% and 70.8% of middle ear effusion, with mean levels of( 35.2± 51.6) EU/ml,( 1.10± 0.84)μg/L and( 0.52± 0.43)μg/L respectively. All of them showed higher concentration in the mucoid-type effusions than those in the serous-type effusions(P< 0.05). Higher levels of the endotoxin and RANTES(P< 0.05)were found in longer course patients. The effusions with positive bacteria culture displayed more abundant endotoxin, IL-1β and RANTES protein than those with negative culture. Significant correlations were found between endotoxin and IL-1β(r= 0.74,P< 0.01), also between IL-1β and RANTES(r= 0.48,P< 0.01).Conclusion:Endotoxin, IL-1β and RANTES may take part in maintaining the inflammatory response in the tympanic cavity and stimulating mucin secretion. It indicates that they play an important role in the immune pathogenesis of secretory otitis media.