慢性扁桃体炎组织活检病理学研究

Research on relationship of histopathological changes and symptomalogy of chronic tonsillitis

目的探寻反映慢性扁桃体炎疾病本质与病变程度的客观指标。方法91例住院慢性扁桃体炎患者和18例正常健康志愿者，术前均取样双侧扁桃体组织；进行咽拭子细菌培养、活检组织细菌培养、电镜、免疫荧光、免疫组化分析。用SPSS13．0对上述资料进行统计，计数资料用χ＾２检验，计量资料用t检验。结果与健康对照组比较，慢性扁桃体炎组扁桃体表面细菌培养无统计学差别P〉0．05，而组织活栓细菌培养在统计学上有显著性差异P〈0．05。慢性扁桃体炎患者，扫描电镜下，隐窝多形扁平上皮细胞表面可见大量异常小颗粒；透射电镜下，上皮细胞间有中性粒细胞与非中性粒细胞浸润，并在上皮细胞内有球菌状细菌浸润。滤泡边缘及冠区的CD4＾＋T细胞与CD8＾＋T细胞比值，健康对照组为3：1，慢性炎性扁桃体组为1：1。对比健康对照组，慢性扁桃体炎组标本均有不同程度角化。结论扁桃体活检培养可以真实反映慢性扁桃体炎病原，是研究扁桃体实质细菌学可行的途径及方法；电镜发现隐窝上皮细胞角化并可直接找到细菌学证据，进一步佐证活检培养结果；CD4＾＋T细胞与CD8＾＋T细胞比率的变化提示局部细胞免疫起了一定作用；抗隐窝上皮角蛋白研究显示慢性扁桃体炎存在不同程度的角化。

Objective We attempted to determine a potential relationship between the surgical indication and laboratory tests regard to chronic tonsillitis. Methods A total of 91 patients with chronic tonsillitis and 18 healthy volunteers were studied from the Clifford Hospital of Guangzhcu TCM University. We had collected specimens from bilateral tonsils before operation and then assessed through a series of biopsy, elec- tron microscopy,immunofluorescence, immunohistochemistry and so on. The data were analysed by using the SPSS 13.0 statistical software package for Windows. Results Contrast to healthy volunteers, bacterial culture of tonsil surface was not significant different（ P 〉 0. 05 ）, while ger- miculture of tissue biopsy was significant different （P 〈 0. 05 ）. Under electron microscopy, obviously abnormal keratosis of crypt epithelial cells and bacteria could be seen in the chronic tonsillitis group. On transmission electron microscopy, neutrophilc granulocyte and nonneutrophile granulocyte could be find between the crypt epithelial ceils, even coccic bacteria could be encuntered in the crypt epithelial cells. The ratio of CD4 ^＋ T cells to CD8 ^＋ T ceils is 3 ： 1 in the control group and 1 ： 1 in the chronic tonsillitis group, analyzing data from specimens of follicle and eoranal. Comparing to control group,there were different degrees of keratosis in the chronic tonsillitis group. Conclusion Germiculture of tonsilar biopsy was a feasible method to investigate the pathogeny of chronic tonsillitis ; electron microscopy corroboratesd the results of germicuhure of biopsy, finding obviously abnormal keratosis of crypt epithelial cells and pathogenic bacteria; the ratio of CD4 ^＋T cells to CD8 ^＋T cells demonstrated cel- lular immunity playing an important role in developement of chronic tonsillitis ; research of keratin authenticatesd different degree of keratosis of chronic tonsillitis.