糖皮质激素在鼻内镜术后鼻粘膜重塑中的作用机制

The mechanism of action of glucocorticoids in nasal mucosa remodelingafter endoscopic sinus surgery

目的探讨糖皮质激素在鼻内镜术后鼻粘膜重塑中的作用机制。方法 60例鼻息肉患者组织中的鼻粘膜病变,鼻内窥镜手术切除是术前组;然后再把鼻息肉内镜术后的患者分成两组:激素组和对照组,前者是在术后进行连续12周的糖皮质激素喷鼻剂喷鼻,2次/d,后者是术后没有应用鼻部药物及全身用药。患者在术后以无菌生理盐水对鼻腔进行冲洗,并定期进行检查,对术腔进行清理。在术后的第1个月和第3个月采集患者的前组筛窦粘膜样本。各次检查均在鼻内镜下,记录检查所见。另取6例鼻中隔下鼻甲手术作为正常对照。用免疫组化法检测,在术后激素组与对照组标本中的MMP-9、FGF-2的蛋白表达,并进行统计学分析。结果正常对照组未见FGF-2、MMP-9的阳性表达,术后第1个月时,激素组与对照组的症状、鼻内镜检查、组织病理学及MMP-9、FGF-2的蛋白表达,差异无统计学意义(P>0.05)。但是在术后第3个月,却出现了上述各指标激素组比对照组有改善显著,鼻部症状出现改善,水肿像对较轻,术腔上皮化趋势明显;免疫组化显示:激素组在阳性炎性细胞中MMP-9、FGF-2蛋白表达,明显低于对照组,差异有统计学意义(t=2.32,P<0.05)。结论糖皮质激素对鼻内镜术后鼻粘膜重塑有明显抑制作用,与MMP-9、FGF-2蛋白表达减少可能有关,早期规范应用糖皮质激素,可促进黏膜上皮化,能减轻并延缓鼻粘膜发生重塑;术后坚持应用糖皮质激素不少于12周。

objective To investigate the mechanism of glucocorticoid in nasal mucosaremodeling after endoscopic sinus surgery.Methods Nasal mucosal lesions in 60 cases of nasal polyps tissues, nasal endoscopic operation excision as a preoperative group; nasal polypsafter endoscopic surgery in patients with hormone group （equally divided between the two gro ups： postoperative to glucocorticoid nasal spraynasal spray, two, daily for 12 weeks） and control group （nasal drug andsystemic medication without the use of postoperative）. Postoperative patients with sterile saline nasal irrigation, debridement, periodic re view,cavity. Article 1,3 months after surgery, review takes its anterior ethmoid sinus mucosa specimens. An inspection under nasal endoscope,recording the findings. Another 6 cases of nasal septum and inferior turbinate surgery as normal control. Was detected byimmunohistochemical method, the expression of MMP-9 and FGF-2proteins in the specimens in the two groups after operation, and carries on statistics analysis.Results First months after operation, the hormone group and the control group of symptoms, nasal endoscopy, pathology and MMP-9, FGF-2 protein expression showed no significant difference. And third months after operation, the hormone group the index group had significant improvement compared with the control, the performance of the nosesymptoms, edema, surgical cavity epithelial trend significantly;immunohistochemistry showed： the quantity of hormone group MMP-9,FGF-2 positive inflammatory cells, significantly lower than the control group, there is statistical significance （t=2.32, P〈0.05）.Conclusion Corticosteroid on nasal mucosa after endoscopic sinus surgery can significantly inhibit and reduce the role of remodeling, and expression of MMP-9, FGF-2 protein may be related to reduced, reasonable application of glucocorticoids, promotin g mucosa, can reduce and delay the nasal mucosa remodeling; insist on the application of glucocorticoids is not less than12weeks after operation.