鼻硬结病的临床及病理研究

Clinical and pathological analysis of rhinoscleroma

目的：鼻硬结病是一种少见的慢性感染性肉芽肿疾病，通过回顾性观察鼻硬结病的临床病理学和组织学特点，初步探讨鼻硬结病的发病、发展及转归。方法以43例鼻硬结病患者的组织标本为研究对象，用HE及组织化学Warthin-Starry（W-S）染色，其中13例组织分别用CD43（T淋巴细胞）、CD20（B淋巴细胞）、CD68（巨噬细胞）、溶菌酶抗体免疫组化ABC法染色。结果全部标本均检测到鼻硬结杆菌，W-S染色和电镜观察均在Mikulicz细胞内检测出大量鼻硬结杆菌。全部患者采用抗生素治疗，13例辅助手术治疗，3例辅助放疗。随访1～26年，11例复发，31例一次治愈，1例未控。结论临床和组织学特征分析有助于鼻硬结病早期诊断。宿主细胞免疫功能障碍是潜在致病机制。以抗生素为主包括放疗和手术的综合治疗可以有效清除鼻硬结杆菌感染。

OBJECTIVE Rhinoscleroma is a chronic granulomatous bacterial disease of the nasal mucosa. We summarized the clinical pathology and histology associated with rhinoscleroma to explore the pathogenesis, development and outcome. METHODS The clinical and pathologic features of 43 cases were retrospectively studied. Histochemical examination of biopsy samples was performed, including hematoxylin-eosin staining and Warthin-Starry. In addition, immunohistochemical staining for CD43, CD20, CD68, and lysozymes was performed in 13 specimens. RESULTS Klebsiella rhinoscleromatis （KR） infection was confirmed in all the 43 samples. All patients were treated with antibiotics, among which 13 cases were assisted with surgeries and 3 cases were assisted radiotherapy. All patients were followed up for 1 to 26 years. Eleven patients relapsed, 31 cases were successfully cured and 1 case was out of control. CONCLUSION Early diagnosis can be improved by combining clinical findings with histologic analysis. Immune dysfunction of host is a potential pathogenic mechanism. Antibiotic therapy combined with other therapies can successfully eradicated KR infection.