鼻黏膜诱发型一氧化氮合酶的表达与鼻内镜术后鼻黏膜转归关系的探讨

Relationship between expression of inducible nitric oxide synthase in nasal mucosa and outcome after endoscopic sinus surgery

目的:观察慢性鼻窦炎(CRS)患者鼻黏膜中诱发型一氧化氮合酶(iNOS)的表达水平,探讨iNOS在CRS炎症中的作用以及与鼻内镜术后鼻黏膜转归的相关性。方法:根据血清总免疫球蛋白E(TIgE)水平将所有CRS病例分为TIgE水平高的A组(TIgE≥90kU/L)和TIgE不高的B组(TIgE<90kU/L),2组皆于鼻内镜术(ESS)前取病变鼻黏膜检测iNOS的表达并参照Lund-Kennedy系统对鼻窦冠状位CT进行评分。追踪2组病例术后同侧术腔完成上皮化的时间。分析CT评分以及鼻黏膜iNOS表达与术腔上皮化时间的相关性。结果:A组的上皮化时间与鼻黏膜iNOS的表达之间呈正相关(P<0.05);与鼻窦CT评分无明显相关。B组的上皮化时间与鼻窦CT评分呈正相关(P<0.05),而与鼻黏膜iNOS的表达无相关。结论:iNOS对预测CRS术后术腔恢复有价值,TIgE高的情况下,iNOS的表达强度与术后完成上皮化的时间呈正相关。伴变应性因素的CRS患者,术前鼻黏膜高强度的iNOS表达,很可能预示着术后上皮化需要较长的过程。

Objective：To explore the role of the inducible nitric oxide synthase （iNOS） in the physiological mechanism of chronic rhinosinusitis （CRS）, and to elucidate the relationship between the expression of iNOS in nasal mucosa and the outcome of endoscopic sinus surgery （ESS）. Method： Thirty-one patients of CRS were divided into two groups according to the levels of IgE in blood serum： Group A with high levels of serum TIgE （TIgE≥90 kU/L） and Group B with low levels of serum TIgE （TIgEG90 kU/L）. Immunohistochemical procedures were taken to determine the expression of iNOS in the nasal mucosa of each CRS patient, and the CT scans of sinuses were evaluated by the Lund-Mackay CT staging system. The time of the operative cavity epithelialized （OCE） was recorded by the unit of week. Associated between time of OCE and the the expression of iNOS or the CT staging was analyzed. Result：The time of OCE was positive correlated with the expression of iNOS in Group A（ P 〈0.05） and did not show a clear correlation with the CT staging, while in Group B it was positive correlated with the CT staging（ P 〈0.05） and did not correlate with the expression of iNOS. Conclusion： iNOS may be a predictive factor in the outcome of ESS. In cases of CRS patients with high levels of TIgE, time of OCE is positive correlated with the expression of iNOS in the nasal mucosa.