慢性鼻窦炎和变应性鼻炎患者的外周血炎症细胞和血清总IgE的比较

Comparison of serum inflammation cell and serum total IgE between chronic rhinosinusitis and allergic rhinitis

背景 慢性鼻窦炎和变应性鼻炎本质上都是鼻部慢性炎性疾病,其炎症过程涉及一系列免疫细胞的活化和趋化,多种细胞组成的细胞网络发挥着重要作用。但这些细胞及炎性介质在三类疾病中的差异并不十分清楚。目的比较慢性鼻窦炎不伴鼻息肉(CRSs NP,以下简称s NP)、慢性鼻窦炎伴鼻息肉(CRSw NP,以下简称w NP)、变应性鼻炎患者的外周血炎症细胞和血清总Ig E的差异。方法 纳入慢性鼻窦炎不伴鼻息肉患者61例(s NP组),慢性鼻窦炎伴鼻息肉患者63例(w NP组),变应性鼻炎患者60例(AR组),并纳入健康对照50例。采用全自动血细胞计数仪进行血常规检测,采用血清过敏原检测系统检测吸入物变应原特异性Ig E和血清总Ig E。按变应原特异性Ig E阳性与否进一步将s NP组和w NP组分为阳性组(s NP^(+)、w NP^(+)),和阴性组(s NP^(-)、w NP^(-)),分别分组比较AR组和s NP^(+)、w NP^(+)组,以及s NP^(-)、w NP^(-)组及对照组的总Ig E水平及各组外周血细胞计数和百分比。结果 ①s NP组变应原呈阳性9例(s NP^(+)组),阴性52例(s NP^(-)组);w NP组变应原呈阳性16例(w NP^(+)组),阴性47例(w NP^(-)组)。②s NP^(-)组、w NP^(-)组、AR组和对照相比仅嗜碱性粒细胞、嗜酸性粒细胞和血清总Ig E在组间存在统计学差异(均P<0.05)。AR组的嗜碱性粒细胞百分比最低,w NP^(-)组的嗜碱性粒细胞百分比最高。嗜酸性粒细胞百分比在变应性鼻炎和鼻息肉组均升高(P<0.01),而s NP^(-)组和对照组无差异(P>0.05)。血清总Ig E水平在AR组最高,w NP^(-)介于AR组和s NP^(-)组之间(P<0.01)。③AR组、s NP^(+)组、w NP^(+)组和对照相比,仅嗜碱性粒细胞百分比、嗜酸性粒细胞百分比、血清总Ig E在各组间有统计学差异(P<0.05)。AR组的嗜碱性粒细胞百分比最低,s NP^(+)、w NP^(+)组和对照组无明显差异(P>0.05)。嗜酸性粒细胞百分比在AR组、s NP^(+)组、w NP^(+)组均显著升高(均P<0.05),AR组最高。血清总Ig E在AR、s NP^(+)组、w NP^(+)组较之对照组均显著升高(P<0.01),AR组血清Ig E水平最高,w NP^(+)组次之,s NP^(+)组水平最低。④相关性分析结果显示,各组血清总Ig E水平和嗜酸性粒细胞百分比、嗜碱性粒细胞百分比均无相关性(P>0.05)。结论 嗜酸性粒细胞、嗜碱性粒细胞、血清总Ig E在变应性鼻炎和鼻息肉的发病机制中均发挥了作用,鼻息肉患者外周血嗜酸性粒细胞、嗜碱性粒细胞和血清总Ig E均呈升高趋势,可能作为鼻息肉发生的预测指标。

Background Both chronic rhinosinusitis and allergic rhinitis are nasal chronic inflammation diseases.The inflammation process is involved in a series of activating and chemotaxis of immune cells.Many cells form network and play an important role.However,the difference of the inflammatory cells and the medium remains unclear.Objective To compare the serum inflammatory cell and serum total Ig E (t Ig E) among chronic rhinosinusitis with nasal polyps group (CRSw NP,ab.wNP),chronic rhinosinusitis without nasal polyps group (CRSs NP,ab.sNP) and allergic rhinitis group.Methods A totle 61 chronic rhinosinusitis without nasal polyps patients (s NP),63 chronic rhinosinusitis with nasal polyps patients (w NP),60 allergic rhinitis patients(AR),and 50normal controls were invovlved.Blood routine examination was detected by automatic blood cell counter.Serum inhalation allergen specific Ig E and t Ig E were detected by ImmunoCAP system.According to whether or not it is positive for the inhalation allergen,the s NP or w NP was divided into positive group or negative group,respectively.Such as s NP^(+)、w NP^(+),and s NP^(-)、w NP^(-).Then the serum total Ig E and peripheral blood cells count and percentage were compared among groups.Results①9 allergen positive and 52 allergen negative in s NPgroup;16 allergen positive and 47 allergen negative in w NPgroup.②There were significant differences for the serum Ig E level,blood eosinophil count and basophilic granulocyte count among the AR,s NP^(-)、w NP^(-)and control (all P<0.05).Basophilic granulocyte percentage was lowest in AR,and highest in w NP^(-).The eosinophil percentage increased significantly in AR and w NP^(+)(both P<0.01),while no change in s NP^(+).The-t Ig E was the hightest in AR,w NP^(-)was lower than AR while higher than s NP^(-)(P<0.01).③There was significant difference for the eosinophil percentage,the basophilic granulocyte percentage and t Ig E when compared among groups (P<0.05).The basophilic granulocyte percentage is lowest in AR group,while it has no difference between s NP^(+)and control,same as w NP^(+).The eosinophil percentage increased significantly in AR and s NP^(+)、w NP^(+)(both P<0.05),it was highest in AR.The t Ig E also increased significantly in AR,s NP^(+)and w NP^(+)group when compared to control(P<0.01),and it was highest in AR,then w NP^(+),s NP^(+)in turn.④Correlation analysis showed t Ig E has no association with the eosinophil percentage and basophilic granulocyte percentage(P>0.05).Conclusion eosinophil,basophilic granulocyte and t Ig E may play a potential role in the mechanism of AR and nasal polyps.The peripheral blood eosinophil,basophilic granulocyte and serum t Ig E are all increased in patients with nasal polyps,and may be used as a predictive index for the occurrence of nasal polyps.