鼻黏膜炎症血清IL-12和IL-4水平及扫描电镜观察

Serum levels of IL-12,IL-4 and pathologic changes by scanning electron microscope of nasal mucous inflammation

目的:通过检测变应性鼻炎、慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)、慢性鼻-鼻窦炎不伴鼻息肉(CRSsNP)及鼻中隔偏曲患者血清中IL-12和IL-4水平变化,为CRSwNP和CRSsNP免疫机制的认识提供更多的证据,初步探讨鼻中隔偏曲这种解剖结构畸形所导致的鼻黏膜炎症的免疫机制,并用扫描电镜观察这4种鼻科疾病鼻黏膜的病理变化特点。方法:ELISA法检测实验组和健康对照组血清IL-4、IL-12水平,并在实验组中各选择1例进行扫描电镜观察。结果:变应性鼻炎组、鼻中隔偏曲组IL-4水平明显高于健康对照组,差异有统计学意义(P<0.01)。CRSwNP组和CRSsNP组IL-4、IL-12水平均明显高于健康对照组(P<0.01或P<0.05)。4种鼻科疾病中鼻甲外侧鼻黏膜病理变化存在共同点:①纤毛分布减少,有纤毛区、无纤毛区交替分布;②柱状上皮细胞间隙增宽,细胞脱落。结论:鼻中隔偏曲能够导致鼻黏膜的慢性炎症,表现为Th2细胞的免疫偏向;在CRSwNP和CRSsNP免疫机制中,有Th1、Th2细胞的共同作用。参与鼻黏膜慢性炎症的免疫细胞种类及其所分泌的细胞因子和炎症递质越多,鼻黏膜的病变程度越重。

Objective：The serum levels of interleukin-4,interleukin-12 will be detected to elucidate and compare the involvement of Th1 and Th2 cells and the surface structures of nasal mucosa will also be observed in patients with allergic rhinitis（AR）,chronic rhinosinusitis with nasal polyps（CRSwNP）,chronic rhinosinusitis without nasal polyps（CRSsNP） and nasal septal deviation（NSD） to obtain the characteristics and regularity of pathological changes.Method：The serum levels of interleukin-4,interleukin-12 were detected by enzyme linked immunosorbent assay method.Four pieces of nasal mucosa on lateral side of middle turbinate were sampled from four patients and observed by scanning electron microscope.Result：The levels of interleukin-4 in AR and NSD groups were significantly higher than the healthy controls（P0.01）.The levels of interleukin-4 and interleukin-12 in CRSwNP and CRSsNP groups were both higher than the healthy controls（P0.01 or P0.05）,but no differences of the interleukin-4 and interleukin-12 levels were found between them（P0.05）.There were two points of regularity with different degrees in our observations： ①disoriented and absence of cilium;②the cellular separations at cell junctions were obvious,even with cells lost.Conclusion：There was an immunologic deviation towards Th2 pattern in patients with NSD the same as AR.Both Th1 and Th2 with hyperactivity participated in chronic inflammatory process of CRSwNP and CRSsNP.The pathological changes of ciliated columnar epithelium in patients with the four types of rhinitis,suggest that a comprehensive treatment including antral irrigations,multiple antibiotics,topical steroid sprays,or antihistamines,as well as nasal surgery to correct nasal deformities should be adopted,which can effectively prevent the development and expanding of the nasal mucosa inflammation.