慢性鼻窦炎钩突内外侧面黏膜组织病理学差异

The investigation of the histological differences between the mucosa on the nasal and sinus sides of uncinate process of chronic rhinosinusitis

目的:探讨慢性鼻窦炎患者钩突内外侧面黏膜组织病理学差异及息肉发生的组织病理学基础。方法:收集2016年10月—2017年4月在北京同仁医院耳鼻咽喉头颈外科因慢性鼻窦炎行鼻内镜手术的患者及正常对照者的钩突。同时采集患者病史,分析基膜厚度、固有层腺体的面积、杯状细胞及其他炎性细胞数目等指标。结果:连续入组116例,包括慢性鼻窦炎伴息肉组(CRSwNP组)38例,慢性鼻窦炎不伴息肉组(CRSsNP组)58例,正常对照组20例。3组年龄、性别分布差异无统计学意义(P>0.05)。对照组和CRSsNP组内侧面基膜厚度均明显厚于外侧面(P<0.05);CRSwNP组和CRSsNP组内外侧面基膜厚度均较对照组相应侧面厚(P<0.05)。CRSwNP组和CRSsNP组内、外侧面炎性细胞明显较对照组相应侧面多,且内侧面明显比外侧面多(P<0.05)。3组钩突外侧面杯状细胞数目均比内侧面多,CRSsNP组和对照组比较差异有统计学意义(P<0.05)。CRSwNP组和CRSsNP组钩突内外侧面腺体面积较对照组相应侧面大,且CRSwNP组内侧面腺体面积明显比外侧面大,差异有统计学意义(P<0.05)。结论:慢性鼻窦炎患者钩突内外侧面组织病理学存在差异,内侧面比外侧面易发生息肉,可能与基膜增厚、炎性细胞增多、腺体面积增大有关。

Objective: The aim of this study is to check whether histopathological differences exist between the nasal side and the sinus side of uncinate process of chronic rhinosinusitis and the histopathological basis of nasal polyp was discussed. Methods: The uncinate processes of chronic rhinosinusitis and control subjects were enrolled from October 2016 to April 2017. The following histopathological data were assessed: height of basement membrane, the proportion of glands in the sub-epithelium, the numbers of goblet cells and inflammatory cells. Results: A total of 116 patients were recruited, including 38 chronic rhinosinusitis with nasal polyps(CRSwNP), 58 chronic rhinosinusitis without nasal polyps(CRSsNP) and 20 controls. There was no significant difference between age and gender distribution(P>0.05). The basement membrane was significantly thinner on the sinus side of the 3 groups’ uncinate processes than on the nasal side except CRSwNP group(P<0.05). The basement membrane of CRSwNP and CRSsNP was significantly higher than control uncinate processes(P<0.05). Inflammatory cells number were significantly increased in CRSwNP and CRSsNP than in the control uncinate processes, and the nasal side was obviously more than the sinus side in the CRSwNP and CRSsNP groups(P<0.05). The number of goblet cells was more on the sinus side of the 3 groups uncinate processes than on the nasal side, that of CRSsNP and control were significant difference between the nasal side and sinus side(P<0.05). The proportion of glands was larger on the sinus and nasal side of the uncinate processes in CRSwNP and CRSsNP than that of the control uncinate processes(P<0.05), and the proportion of glands was significantly greater on the nasal side than on the sinus side of the uncinate processes in CRSwNP(P<0.05). Conclusion: Histopathological differences exist between the nasal side and sinus side of the ups of CRSwNP, CRSsNP and control. The nasal side is more prone to polyps than the sinus side, which may be related to the thickening of basement membrane, the increase of inflammatory cells and gland area, and the decrease of goblet cells.