鼻窦源性葡萄球菌肠毒素B在溃疡性结肠炎发病中的作用

Role of Staphylococcus aureus enterotoxin B from sinusitis in pathogenesis of ulcerative colitis

目的研究鼻窦源性葡萄球菌肠毒素B在溃疡性结肠炎发病中的作用.方法选择32例同时患有慢性鼻窦炎和溃疡性结肠炎病例,另选10例没有患慢性鼻窦炎的溃疡性结肠炎病人作为对照,20例健康志愿者作正常对照组,所有病例进行病变程度计分(0～4分,0分为无症状,4分为疾病严重).回收上颌窦冲洗液,进行鼻内镜手术,做血清葡萄球菌肠毒素B特异性IgE、IL-4、IL-5、IL-13和IFN-γ含量测定.结果经鼻内镜治疗后临床症状显著改善,29/32(90.6%)的病例慢性鼻窦炎临床症状计分降至0或1,21/32(65.6%)病例的溃疡性结肠炎临床症状计分为0或1,鼻内镜手术后Th1/Th2失平衡状态逆转,血清IL-4、IL-5、IL-13和IFN-γ含量均接近正常对照组(P＜0.05).术前上颌窦冲洗液中均检测到较高浓度的葡萄球菌肠毒素B[(154.6±18.6) pg/ml],血清中也检测到葡萄球菌肠毒素B特异性抗体,术后上颌窦冲洗液中葡萄球菌肠毒素B和血清抗葡萄球菌肠毒素B抗体含量比术前显著降低(P＜0.05).结论鼻窦源性葡萄球菌肠毒素B可能是溃疡性结肠炎的发病原因之一.

Objective To study the role of Staphylococcus aureus enterotoxin B from sinusitis in pathogenesis of ulcerative colitis. Methods There were 32 patients with both chronic sinusitis and ulcerative colitis, another 10 patients with ulcerative colitis only as control group, and 20 healthy volunteers as normal control. Of these patients, scores of the level of lesions were counted （Range of scores was 1 to 4, symptomless as 0 and worst as 4）. The sinus irrigation was collected. They were treated by nasal endoscopic surgery （NES）, and IgE which was specific to Staphylococcus aureus enterotoxin B, IL-4, IL-5, IL-13 and IFN-γ in serum was measured. Results Patients＇ clinical symptoms were significantly improved by NES and their scores were lower to 0 or 1 among 29/32 （90.6%） of chronic sinusitis patients and 21/32 （65.6%） of ulcerative colitis ones. The unbalance of Th1/Th2 recovered, and serum IL-4, IL-5, IL-13 and IFN-γ declined to the levels of normal control （P （0.05）. Staphylococcus aureus enterotoxin B was （ 154.6 ± 18.6） pg/ml in sinus irrigation before operation and its specific antibody was detected too. The two indexes decreased dramatically after NES（P〈0.05）. Conclusion Staphylococcus aureus enterotoxin B from sinusitis may be one of reasons resulted in ulcerative colitis.