鼻部和咽部非变应性炎症对下气道高反应的影响

Effect of Non-allergic Inflammation in Nasal and Pharyngeal Area on Lower Airway Hyperresponsiveness

目的探讨慢性鼻窦炎、慢性扁桃体炎等上气道黏膜非变应性炎症对下气道支气管黏膜反应的影响及相关关系。方法选择2014年8月至2015年8月在新疆医科大学第一附属医院耳鼻喉科就诊的慢性鼻窦炎以及慢性扁桃体炎患者,随机选取109例分为两组,慢性鼻窦炎58例、慢性扁桃体炎51例,并选取50例排除上下气道黏膜非变应性炎性症状以及体征的人群作为阴性对照组,在排除药物影响以及肺功能正常前提下均接受支气管激发试验、鼻内镜、变应原皮肤点刺试验检测,将检测结果结合患者症状进行比较分析。结果支气管激发试验测试结果显示鼻部组(65.5%)相较于咽部组(43.1%)以及对照组(40.0%)的下气道黏膜反应性阳性率增高,而咽部慢性炎症患者的下气道反应阳性率较对照组高,差异有统计学意义(P<0.05),其中鼻部组并发变应性鼻炎比例明显高于其他两组(28/58 vs.8/51和3/50)。结论上气道黏膜慢性炎症与下气道黏膜反应性增高具有相关关系,其中鼻部慢性炎症对下气道反应的影响作用较咽部慢性炎症更明显,鼻部组阳性率受变应性鼻炎因素影响明显。

Objective To investigate the influence of chronic non-allergic inflammation of upper airway muco- sa on responsiveness of lower airway （bronchial） mucosa. Methods 109 patients with chronic sinusi- tis or chronic tonsillitis were enrolled randomly and divided into two groups： chronic sinusitis group （n = 58） and chronic tonsillitis group （n = 51 ）, whereas 50 persons without upper and lower airway mucosa non-allergic inflammation symptoms and signs were also enrolled as negative control. Bronchial provocation test, nasal endoscopy, and allergen skin prick test were performed under normal lung func- tion and exclusion of drug influence, while the test results were compared with the symptoms of patients. Results Based on the results of bronchial provocation test, the positive rate of lower airway mucosa re- sponsiveness of nasal group （65.5%） was higher than both of pharyngeal （43.1% ） and the control group （40.0%） , while the positive rate of pharyngeal group was higher than control group. The differ- ences were statistically significant （ P 〈 0.05 ）. The positive rate of lower airway mucosa responsivenessof nasal group with allergic rhinitis was obviously higher than the other two groups （28/58 vs. 8/51, 3/50）. Conclusion The chronic inflammation of the upper airway mucosa was correlated with the low- er airway mucosa hyperresponsiveness. The influence of chronic nasal inflammation was more potent than that of the pharyngeal chronic inflammation. The positive rate of lower airway mucosa responsive- ness in nasal group was influenced by concomitant allergic rhinitis significantly.