干扰素γ及白细胞介素4在慢性分泌性中耳炎患者中耳积液及外周血中的表达及意义

Expression and significance of IFN-y and IL-4 in the effusion and peripheral blood of chronic otitismedia with effusion patients

目的探讨Th2／Thl细胞失衡模式在慢性分泌性中耳炎发病机制中的作用。方法通过流式细胞技术（FCM）及流式微球分析法（CBA法）检测Th2型细胞因子白细胞介素4（IL-4）和Th1型细胞因子干扰素γ（IFN-γ）在2011年4月至2012年7月就诊于首都医科大学附属北京同仁医院的30例慢性分泌性中耳炎患者外周血及中耳积液及20名健康对照人群外周血中的表达，对比病例组及健康对照组外周血，病例组外周血及中耳积液之间IL-4和IFN-γ水平以及两者比例变化。结果与健康对照组相比，病例组外周血IL-4水平显著高，差异有统计学意义（P〈0．05）；IFN-y阳性细胞／IL-4阳性细胞在病例组明显低于健康对照组，差异有统计学意义（17±13比35±19，P〈0．05）。而病例组IFN-γ水平略低于健康对照组，差异无统计学意义（12％±8％比13％±8％，P〉0．05）；病例组外周血与中耳积液中IL-4、IFN-γ水平差异无统计学意义。结论Th2活化亢进，Th2／Th1平衡失衡，可能是慢性分泌性中耳炎发病的重要基础；过敏反应主要在全身起作用，中耳局部的免疫反应有待进一步进行探索。

Objective To explore the shift of Th2/Thl type cytokine profiles in middle ear and peripheral blood of chronic otitis media with effusion （COME） patients. Methods Middle ear effusions （MEEs） and peripheral bloods were collected from 30 COME patients between April 2011 and July 2012 at Department of Otolaryngology, Beijing Tongrcn Hospital, Capital Medical University. Peripheral blood samples were collected from 20 healthy controls. The expressions of IFN-y（Th1 cytokine） and IL-4 （Th2 eytokine） in peripheral blood and middle ear fluid were assessed by flow cytometry and cytometric bead array. The expression levels of cytokines in peripheral blood were compared between patient and control groups. Moreover, the levels of eytokines in the Middle ear fluid and the supernatant of COME patients were also compared. Results Compared to the control group, the level of IL-4 in peripheral blood of COME patients significantly increased（0. 7% ±0. 8% vs 2.4% ±4. 5%, P 〈0. 05）. The ratio of IFN-y positive eells/IL-4 positive cells was significantly lower in peripheral blood of COME patients than that of control group（ 17± 13 vs 35 ± 19, P 〈 0.05）. However, the level of IFN-y showed no signifieant difference between two groups（12% ±8% vs 13%±8%, P 〉0.05）. The levels of IL-4 and IFN-y in middle ear fluid and the supernatant of the case group showed no significant difference. Conclusions COME may be a Th2 predominant disease. Thl/Th2 imbalance is probably involved in the pathogenesis of COME. The roleof the allergic reaction in middle ear microenvironment remains uncertain.