破骨细胞分化因子及其相关因子在慢性化脓性中耳炎肉芽组织中的表达

The expression of osteoclast differentiation factor and its related factors in the granulation tissue of chronic suppurative otitis media

目的探讨破骨细胞核因子кB受体活化因子配体(Receptor activator of nuclear factor-kappa B ligand,RANKL,又称破骨细胞分化因子)和其配体核因子-κB受体活化因子(Receptor activator of nuclear factor-kappa B,RANK)及骨保护素(Osteoprotegerin,OPG)在慢性化脓性中耳炎肉芽组织中的表达情况。方法选择2015年2月至2018年4月在本院接受治疗的慢性化脓性中耳炎患者37例(慢性化脓性中耳炎组)、中耳胆脂瘤患者44例(中耳胆脂瘤组)、外伤性鼓膜穿孔患者20例(对照组)作为研究对象。采用免疫组织化学法检测慢性化脓性中耳炎组和中耳胆脂瘤组患者的肉芽组织以及对照组患者外耳道皮肤中RANKL、RANK、OPG的表达情况。结果3组患者均可见RANKL、RANK、OPG的表达;慢性化脓性中耳炎组、中耳胆脂瘤组RANKL、RANK表达水平高于对照组,OPG/RANKL低于对照组,差异均有统计学意义(P<0.05);中耳胆脂瘤组RANKL、RANK表达水平高于慢性化脓性中耳炎组,OPG/RANKL低于慢性化脓性中耳炎组,差异均有统计学意义(P<0.05),3组患者OPG表达水平比较差异无统计学意义(P>0.05)。OPG/RANKL与慢性化脓性中耳炎组和中耳胆脂瘤组的骨质破坏程度呈显著负相关(r=-0.582,-0.621,P=0.025,0.011)。结论RANKL、RANK、OPG在正常外耳道皮肤及慢性化脓性中耳炎和中耳胆脂瘤患者肉芽组织中均有表达,表达水平与骨质破坏程度有关,RANKL、RANK表达水平的升高和OPG表达水平的降低在慢性化脓性中耳炎和中耳胆脂瘤的骨质破坏机制中发挥了重要作用,OPG与RANKL的比值则可作为一个可靠的评价骨质破坏的指标。

Objective To explore the expression of receptor activator of nuclear factor-kappa B ligand(RANKL,also known as osteoclast differentiation factor)and its receptor activator of nuclear factor-kappa B(RANK)and osteoprotegerin(OPG)in the granulation tissue of chronic suppurative otitis media.Methods From February 2015 to April 2018,37 patients with chronic suppurative otitis media(chronic suppurative otitis media group),44 patients with middle ear cholesteatoma(middle ear cholesteatoma group)and 20 patients with traumatic perforation of tympanic membrane(control group)were selected as study objects.The expression of RANKL,RANK and OPG of granulation tissue of the chronic suppurative otitis media group and the middle ear cholesteatoma group and the external auditory canal skin of the control group were detected by immunohistochemistry.Results The levels of RANKL,RANK and OPG were observed in the three groups.The levels of RANKL and RANK in the chronic suppurative otitis media group and the middle ear cholesteatoma group were higher than those of the control group,and the ratio of OPG to RANKL was significantly lower than that of the control group,with statistically significant differences(P<0.05).The levels of RANKL and RANK in the middle ear cholesteatoma group was significantly higher than that in the chronic suppurative otitis media group,and the ratio of OPG to RANKL was lower than that in the chronic suppurative otitis media group(P<0.05).The levels of OPG of the three groups had no significant difference(P>0.05).The ratio of OPG to RANKL was significantly negatively correlated with the degree of bone destruction in chronic purulent otitis media group and middle ear cholesteatoma group(r=-0.582,-0.621,P=0.025,0.011).Conclusion RANKL,RANK,OPG expressed in the normal external auditory canal skin and granulation tissue of the chronic suppurative otitis media patients and the middle ear cholesteatoma patients and the levels associated with bone destruction.The rise of levels of RANKL and RANK and the decline of levels of OPG played an important role in bone destruction mechanism in patients with chronic suppurative otitis media and the middle ear cholesteatoma.The ratio of OPG to RANKL can be used as a reliable evaluation index for bone destruction in clinical application.