经骨播散在慢性鼻-鼻窦炎发病机制中作用的实验研究

目的　观察慢性鼻-鼻窦炎（CRS）兔模型中接种侧和对侧上颌窦的黏膜和骨组织病理学变化,探讨经骨播散在CRS发病机制中的作用。方法　用绿脓杆菌将新西兰大白兔制成单侧上颌窦炎动物模型。造模前和造模12周后分别进行鼻窦CT扫描,造模12周后取双侧上颌窦内容物做细菌培养及大体标本进行染色观察。结果　14只（100%）兔子接种侧上颌窦黏膜出现慢性炎症组织学改变,并发现骨质发生类似于慢性骨髓炎的病理改变。9只（64%）兔子的对侧上颌窦出现骨髓炎的改变,5只（36%）对侧上颌窦黏膜出现慢性炎症。结论　绿脓杆菌性鼻窦炎显示累及骨组织的能力,在不影响黏膜病变的前提下可以感染远离原发部位的骨组织。这说明炎症可能通过骨性结构进行播散,可能在CRS发病过程中起到一定的作用。     

慢性鼻-鼻窦炎细菌生物膜形态观察

目的 观察慢性鼻-鼻窦炎患者,鼻内镜所取钩突、筛泡或上颌窦黏膜样本是否存在细菌牛物膜及其形态特征.方法 本实验共取鼻内镜术中黏膜样本12份,实验组为慢性鼻.鼻窦炎鼻内镜手术患者6例,对照组为阻塞性睡眠呼吸暂停综合征鼻内镜手术患者6例.样本用标准的扫描电镜方法 处理.实验组详细记录患者的年龄、性别、症状、鼻窦CT、鼻内镜检查和变应原皮肤点刺试验结果 .结果 扫描电镜下见慢性鼻一鼻窦炎患者鼻腔鼻窦黏膜纤毛缺失、倒伏、排列紊乱,实验组中5例可见不同形成阶段、各种形态的细菌生物膜,1例可见丝状真菌样结构.实验组细菌生物膜出现率为83.3%.对照组6例均未观察到细菌生物膜.结论 慢性鼻-鼻窦炎鼻腔鼻窦黏膜纤毛有不同程度的损伤,黏膜表面存在处于生命周期不同阶段的细菌牛物膜.     

不伴鼻息肉的慢性鼻及鼻窦炎黏膜重构的组织病理学研究

目的观察不伴鼻息肉的慢性鼻及鼻窦炎（chronic rhinosinusitis without nasal polyps, CRSsNP）黏膜是否具有相似的组织重构的特征。方法选取50例CRSsNP患者和20例对照组的钩突黏膜,分别进行HE染色、Masson2色胶原染色、VanGieson染色（VG染色）和阿辛蓝一过碘酸．希夫（alcian blue-periodic acid-Schiff,AB-PAS）染色,观察黏膜上皮损伤、基底膜厚度、黏膜下胶原和腺体增生等情况。结果所有CRSsNP组黏膜均存在上皮脱落、基底膜增厚、黏膜下胶原沉积和黏液腺细胞增生等组织病理学特征,且均较对照组严重。结论黏膜组织重构是CRSsNP的普遍现象。     

慢性鼻窦炎病变黏膜和鼻息肉组织中超氧化物歧化酶活性和丙二醛含量的变化及其意义

目的 观察慢性鼻窦炎病变组织及鼻息肉中超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量及其与病变程度的关系.方法 分别采用黄嘌呤氧化酶法和TBA法检测15例慢性鼻窦炎病变黏膜和鼻息肉组织术中及术后2周、1个月、2个月、3个月术区黏膜标本中SOD活性和MDA含量,其中Ⅰ、Ⅱ和Ⅲ型病例各5例;同时以5例正常中鼻甲黏膜作为对照组.结果 慢性鼻窦炎病变黏膜中SOD活性较对照组明显降低,且病变越重,SOD活性越弱;鼻息肉中SOD活性较同型病变黏膜更低.术后各型恢复期黏膜SOD活性随时间延长而逐渐增强.鼻窦炎病变黏膜中MDA含量显著高于鼻息肉和对照组黏膜,且随病变程度加重而增高;术后各型恢复期黏膜中MDA含量显著低于术中病变黏膜,且随术后时间延长而逐渐降低.SOD活性和MDA含量呈负相关.结论 自由基损伤程度与慢性鼻窦炎的病变严重性密切相关,自由基代谢紊乱可能在慢性鼻窦炎的发病机制中起重要作用.     

P物质在慢性鼻窦炎嗅黏膜中的表达及其意义

目的 :探讨慢性鼻窦炎患者嗅觉功能障碍的发病机制。方法 :采用免疫组织化学方法对慢性鼻窦炎5 5例和对照组 11例的嗅黏膜进行P物质 (SP)检测 ;用苏木精 伊红染色方法观察嗜酸性粒细胞的浸润程度。结果 :鼻窦炎组嗅黏膜嗜酸性粒细胞阳性者 4 9例 (89.1% ) ,对照组 1例 (18.2 % ) ,差异有统计学意义 (P <0 .0 5 ) ;SP在慢性鼻窦炎嗅黏膜的嗅细胞、支持细胞、基底细胞、腺体、血管上皮及部分淋巴细胞、嗜酸性粒细胞中均有阳性表达 ,鼻窦炎组阳性表达 4 5例 (81.8% ) ,对照组 1例 (9.1% ) ,差异有统计学意义 (P <0 .0 1)。结论 :慢性鼻窦炎嗅黏膜的变态反应性改变是引起嗅觉功能障碍的主要因素之一 ,与SP在嗅黏膜中表达增高有关。     

慢性鼻-鼻窦炎CT筛窦分型组织病理学与预后相关性

目的 观察评价慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)CT筛窦分型的组织病理学特点及其与预后的关系.方法 回顾性分析112例CRS患者,按术前轴位鼻窦CT进行筛窦分型;观察筛窦标本骨质病理学改变,并对筛窦骨质重塑活性进行评分;采用Lund和Kennedy鼻内镜评分评价预后;分析不同CT筛窦分型间筛窦骨质组织病理评分和鼻内镜评分的差异以及骨质组织病理评分和鼻内镜评分的相关性.结果 Ⅲ型(骨质增生型)25例,占22.3%;Ⅱ型(空泡型)44例,占39.35;Ⅰ型(蜂窝型)43例,占38.4%.Ⅲ型骨组织病理改变程度和术后随访鼻内镜评分分别与Ⅰ型和Ⅱ型间差异有统计学意义(P值分别为0.01,0.02).CBS患者的筛窦骨组织病理评分和术后鼻内镜评分有明显相关性(X2=9.78,P=0.002).结论 CBS的CT筛窦分型具有相应组织病理学基础;新骨形成或重塑是反映鼻窦疾病严重程度的重要指标,筛窦骨组织病变程度能够反映患者术后预后情况;CT筛窦分型对鼻内镜外科手术疗效的预测具有现实应用意义.     

细菌生物膜的电镜下特征及其与慢性鼻-鼻窦炎的关系

目的 观察慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者鼻内镜下所取钩突、筛窦黏膜标本是否存在细菌生物膜(bacterial biofilms,BF)及其形态学特征,探讨细菌生物膜在CRS发病机制中的作用.方法 对15例CRS伴有鼻息肉患者(试验组)和11例无CRS的鼻骨骨折患者(对照组),在鼻内镜下取钩突、筛窦黏膜(患者均知情同意),扫描电镜电镜下观察,判断标本中是否存在细菌生物膜,并描述其形态学特征.分析试验组与对照组之间的差异,对细菌生物膜的存在与部分临床指标进行相关分析.所有患者均行鼻窦CT检查并行CT评分.计量资料实验数据采用t检验,计数资料采用卡方检验,小样本计数资料用Fisher精确检验.结果 试验组15例患者中发现9例有细菌生物膜;对照组11例患者中发现1例有细菌生物膜,两者比较差异有统计学意义(χ~2=6.949,P<0.01).扫描电镜下,试验组9例患者标本中发现具有水通道、三维结构、基质包被的球形和椭圆形小体等典型特征的细菌生物膜.5例(包括1例对照组)标本发现除具有典型细菌生物膜特征外,还可见到与普通炎症导致的纤毛排列紊乱、缺失不同的纤毛黏聚.试验组细菌生物膜阳性患者的鼻窦CT评分(15.89±6.30)高于细菌生物膜阴性的患者(9.50±5.79),两者比较差异有统计学意义(t=2.14,P<0.05).结论 扫描电镜下可观察到CRS患者鼻黏膜中存在水通道、三维结构、基质包被的球形和椭圓形小体的典型形态特征的细菌生物膜.纤毛黏聚可能是细菌生物膜形成过程中的一种特有表现,是否也可以作为判断细菌生物膜存在的标志,有待于今后进一步研究.细菌生物膜的存在与CRS的发病密切相关,与疾病的严重程度相关,也可能是CRS难治的原因之一.     

鼻腔黏膜干燥、出血及糜烂损伤修复的临床观察与评估

目的:使用桃金娘油、透明质酸、褐藻寡糖、花青素4种植物提取液的鼻喷合剂(商品名:毕罗芬)对161例鼻黏膜干燥、糜烂、出血患者进行前瞻性治疗前后的临床观察,了解该制剂在鼻黏膜保湿、糜烂面修复及控制黏膜出血的效果.方法:①诊断:结合患者主诉与鼻内镜检查确定鼻中隔黏膜干燥、糜烂、出血的患者.②病情评定:采用VAS评分法对主观...     

溶菌酶和乳铁蛋白在慢性鼻窦炎黏膜中的表达

目的研究慢性鼻窦炎上颌窦开口处黏膜中溶菌酶(lysozyme,LZ)、乳铁蛋白(lactoferrin,LF)、IgA、IgG、补体等分泌免疫成分在局部防御慢性炎症过程中的作用.方法采用免疫组化SABC法,检测LZ、LF、IgA、IgG、补体C3在慢性鼻窦炎20例(Ⅰ型与Ⅱ型各10例)和健康对照10例的上颌窦自然开口处黏膜中的表达.结果鼻窦炎Ⅰ型中LZ、LF明显高于健康对照(P＜0.01).鼻窦炎Ⅱ型中LF、补体C3明显高于健康对照(P＞0.01).2例鼻窦炎Ⅰ型IgA为阴性,余均有不同程度的阳性表达.结论上颌窦窦口黏膜中LZ、LF、IgA、IgG补体等在慢性鼻窦炎病理过程中起一定作用,两型鼻窦炎局部免疫状况可能存在差异.     

综合治疗在慢性鼻及鼻窦炎黏膜炎症恢复中的作用

目的观察综合治疗在控制慢性鼻及鼻窦炎黏膜炎症过程中的作用。方法对30例慢性鼻及鼻窦炎进行功能性鼻内镜手术及围手术期治疗。分别于术后1、3和6个月随访并行鼻内镜检查取黏膜活检,比较患者临床症状、黏膜炎症的恢复情况。结果术后6个月,30例术腔黏膜上皮化,但10例(33%)术腔黏膜仍轻度肿胀,持续有黏液样分泌物。黏液纤毛输送速率(mucociliarytransportrate,MTR)术前(3.63±1.74)毫米/分钟,术后6个月(6.27±1.31)毫米/分钟,明显加快(P<0.01)。上颌窦黏膜炎性细胞浸润减少,水肿减轻。但杯状细胞数和黏膜下腺体无明显改善(P>0.05),表面超微结构未完全恢复正常。结论慢性鼻及鼻窦炎经综合治疗6个月,虽可达临床治愈,但黏膜炎症仍存在。     

Mucosal remodeling in chronic rhinosinusitis

BACKGROUND: Despite pathophysiologic similarities, mucosal remodeling is well described in asthma but not chronic rhinosinusitis (CRS). OBJECTIVE: This study attempts to identify mucosal remodeling in CRS and correlate it with clinical information. METHODS: Charts and histopathology from 53 CRS patients who underwent functional endoscopic sinus surgery were reviewed. Clinical data and basement membrane (BM) thickness were recorded. BM thickness was graded as 0 (no thickening), 1 (mild thickening), 2 (moderate thickening), or 3 (marked thickening). Control mucosae from ten patients without CRS were analyzed for comparison. RESULTS: Duration of CRS symptoms positively correlated with BM thickness (p = 0.007). Also, patients with a markedly thickened BM (score of 3) had a significantly greater duration of CRS symptoms (120 months) compared to patients with a thinner BM (score < or =2) (33 months) (p = 0.010). Markedly thickened BM was associated with increased coincidence of asthma (p = 0.019) and aspirin sensitivity (p = 0.003). No correlation was found between BM thickness and preoperative Lund-MacKay score. There was no statistically significant difference between markedly thickened BM and thinner BM with respect to coincidence of polyps, course of preoperative systemic steroids, estimated blood loss at surgery, and number of prior surgeries. CONCLUSION: Increased BM thickness is correlated with prolonged duration of symptoms and the coincidence of asthma. This may indicate paranasal sinus remodeling akin to that which occurs in the bronchioles of persistent asthmatic sufferers.     

Diabetic changes in the stria vascularis in humans--a study of PAS-stained temporal bone sections

Sensorineural hearing loss can be caused by diabetes mellitus, and diabetic microangiopathy contributes to diabetic complications such as nephropathy. I compared the outer diameter of strial capillaries, the strial atrophy rate, and basement membrane thickening in the strial capillaries of temporal bone sections from 16 diabetics and 16 non-diabetics matched for age and sex and assessed the correlations between these values and age, duration of disease, fasting blood sugar, and glycohemoglobin. In the non-diabetic group, the minimum and maximum outer diameters of the capillary in the cochlear apical turn were larger than in the basal and middle turns. The strial atrophy rate in the apical turn was higher than in the basal and middle turns. There was no significant difference in basement membrane width between the turns. In the diabetic group, there were no significant differences in minimum outer diameter and basement membrane width between the turns. The maximum outer diameter of the middle turn was larger than that of basal turn. The strial atrophy rate in the apical turn was higher than in the basal and middle turn. In the comparison between the diabetic group and the non-diabetic group, the maximum outer diameter of the apical turn in the diabetics was smaller than in the non-diabetics, the basement membrane width in the basal, apical and all three turns as a whole in the diabetics was thicker than in the non-diabetics, the strial atrophy rate in the basal turn and all three turns as a whole in diabetics was higher than in non-diabetics. There were two correlations in the non-diabetics, between age and strial atrophy rate and between age and basement membrane width in the basal turn, and there were positive correlations in the diabetics, between the strial atrophy rate and fasting blood sugar and between strial atrophy rate and glycohemoglobin in the basal turn. Because of basement membrane thickening toward capillary lumen, these results led to the hypothesis that strial atrophy is one factor in diabetic hearing loss.     

鼻咽癌放疗后鼻黏膜组织形态学的研究

目的:研究放疗对鼻咽癌患者鼻黏膜组织形态学的影响.方法:按患者纳入条件和剔除条件选择鼻咽癌患者47例,于放疗前后各取中鼻甲黏膜组织1块,采用常规苏木精-伊红染色及PAS染色,光镜下观察鼻咽癌放疗前后中鼻甲黏膜之上皮层的纤毛和细胞、基底层及固有层的腺体和腺细胞的改变;同时随机抽取6例用扫描电镜和透射电镜观察其上皮层的纤毛及纤毛柱状上皮细胞的变化.结果:放疗前,47例患者鼻黏膜组织形态均正常;放疗后,6例无明显变化,41例出现不同层次和不同程度改变.光学显微镜下见:上皮细胞及纤毛脱落,基底膜增厚,固有层的浆液腺减少,黏液腺增多,血管扩张、充血、增生,血管内皮细胞损伤等;扫描电镜下见:纤毛结构异常,出现脱落、粘连成簇状等现象;透射电镜下见:上皮细胞的细胞核形态不规则、固缩,细胞质出现空泡,细胞器明显减少等.结论:鼻咽癌放疗后鼻黏膜组织形态受到不同程度破坏,这可能是鼻咽癌放疗后并发鼻及鼻窦炎的病理学基础.     

Alterations of the basal membrane in middle ear cholesteatoma

Cholesteatoma epithelium is characterized by a keratinocyte disregulation accompanied by destruction of the ossicles and other bony parts of the temporal bone. Immunohistochemical methods using antibodies to fibronectin, tenascin and metalloproteinases were used to assess the alterations of the instrinsic and extrinsic components of the basement membrane. Spatial orientation of the basement membrane was preserved in histological sections. Collagen type IV, tenascin, fibronectin, basic fibroblastic growth factor (bFGF), and matrix metalloproteinases (MMPs) are related to the matrix, perimatrix of normal or pathological tissues. They were studied immunohistologically in twenty cholesteatomas, eight samples of normal auditory canal skin, and six specimens of normal middle ear mucosa. Cholesteatomas displayed alterations of the basal membrane, with presence of MMPs and a linear immunoreactivity for collagen type IV and laminin, disrupted in areas with intense inflammation. The electronic microscope revealed protrusions, duplications, thickening and disruptions of the lamina densa of the basement membrane. Thus, we conclude, that MMPs and bFGF could play an important role maintaining the proliferative activity and the aggressive behaviour of cholesteatoma in the middle ear.     

Non-insulin-dependent diabetic microangiopathy in the inner ear.

Hearing loss has long been associated with diabetes mellitus. Microangiopathy, associated with thickening of the basement membranes of small vessels, has been implicated as a major source of multiple system organ disease. OBJECTIVE: This study was designed to evaluate changes in basement membrane thickness in the inner ear of laboratory animals suffering from non-insulin-dependent diabetes mellitus (NIDDM) with, and without, exposure to moderate intensity noise exposure in an attempt to extrapolate the same disease process in humans. DESIGN: Spontaneously hypertensive-corpulent non-insulin-dependent rats (SHR/N-cp) were selected as a genetic model for the above study. Both lean and obese rats were used in this study. A genetically similar control group of animals (LA/N-cp) were used as controls. These animals express both the lean and obese phenotypes, but they lack the NIDDM gene. Forty-eight animals in each group were sacrificed at the end of the study. The cochleas were dissected and fixed. The basement membrane of the stria vascularis was examined using transmission electron microscopy. SETTING: This study was a laboratory-based, standard animal study. MAIN OUTCOME: This study was designed to show microangiography of the inner ear as related to NIDDM with, and without, obesity and noise exposure. RESULTS/CONCLUSIONS: NIDDM alone does not cause statistically significant basement membrane thickening; however, NIDDM in combination with obesity and/or noise exposure did show significant thickening and the combination of all three showed the greatest thickening. NIDDM appeared to be the greatest contributing factor.     

Extracellular matrix of Reinke's space in some pathological conditions

OBJECTIVE: Reinke's space (RS) is a highly specific structure in which the majority of vocal fold pathology occurs. The vibratory equivalents of structurally normal RS are regular vocal fold vibrations and normal glottic mucosal waves. Recently, RS has been considered to be composed not only of fibres but also of extracellular matrix (ECM), which is an extremely important component of a normal mucosal wave. As Reinke's oedema (RO) is characterized by excessive ECM in RS, we investigated the cell activity in RO tissue which is possibly responsible for excessive ECM production. MATERIAL AND METHODS: Tissue samples were obtained from 20 RO patients during microlaryngeal surgery. Tissue was analysed histochemically using the AgNOR method and the proliferation activity was assessed immunohistochemically using Ki67 monoclonal antibodies. RESULTS: AgNOR activity was detected in prominent stromal cells in 16 patients. Also, more pronounced activity, compared to the surrounding control tissue, was demonstrated in the epithelial cells of 17 patients using a Ki67 proliferation marker. Electron microscopy showed thickening and decomposition of the basement membrane in all RO tissue samples. CONCLUSIONS: Vocal fold mucosa that has been damaged by smoking and phonotrauma may react by producing excessive ECM, resulting in RO. Both epithelial and stromal cells are in a state of higher metabolic activity, indicating their role in this production.     

布地奈德联合克拉霉素治疗慢性鼻-鼻窦炎疗效观察以及对黏膜组织重塑的影响

目的　探究应用布地奈德联合克拉霉素治疗慢性鼻-鼻窦炎（CRS）疗效观察和对黏膜组织重塑的影响。方法　选取我院收治的90例CRS患者,随机分成布地奈德治疗组、克拉霉素治疗组和布地奈德联合克拉霉素治疗组,比较三组患者治疗前后VAS评分、鼻窦CT评分;比较气道重塑情况和不良反应发生情况等。结果　治疗后,联合治疗组鼻部各症状VAS平均评分、鼻窦CT评分显著优于其他两组（P 均<0.05）;联合治疗组气道损伤程度较轻,基底膜增厚不明显,转化生长因子β1灰度值显著大于其他两组（P <0.05）;患者服药后不良反应发生较少,均经过相关治疗得以转归。结论　采用布地奈德联合克拉霉素能够显著改善CRS患者病况,减轻黏膜组织重塑,值得在临床上广泛推广。     

鼻中隔偏曲伴下鼻甲肥大患者的鼻窦CT分析

目的　通过对鼻中隔偏曲患者鼻窦CT的测量分析,初步评价鼻中隔偏曲程度与下鼻甲肥大的相关性。方法　分析98例鼻中隔偏曲患者鼻窦冠状位CT,将与鼻中隔偏曲方向一致的鼻腔设为对照组,与鼻中隔偏曲方向相反的鼻腔设为实验组。测量并记录鼻中隔偏曲角度,双侧下鼻甲骨、内侧黏膜、外侧黏膜厚度。结果　实验组和对照组下鼻甲内侧黏膜、骨、外侧黏膜厚度差异有统计学意义（P <0.05）。实验组下鼻甲内侧黏膜、骨、外侧黏膜厚度差异有统计学意义（P <0.05）。实验组下鼻甲内侧黏膜、骨、外侧黏膜厚度与鼻中隔偏曲角度的相关性无统计学意义,但相关系数r 提示三者与鼻中隔偏曲角度的相关性：骨＞内侧黏膜＞外侧黏膜。结论　鼻中隔偏曲伴代偿性下鼻甲肥大,不仅由下鼻甲黏膜增厚引起,也可由下鼻甲骨本身增生引起,鼻中隔矫正术术前行鼻窦CT检查,对鼻中隔偏曲伴下鼻甲肥大患者手术方式的选择有一定帮助。     

改良经鼻内镜下泪囊鼻腔造孔术

目的报道经鼻内镜下泪囊鼻腔造孔术的改良及其疗效,就改良手术方法和目的进行探讨。方法采用改良经鼻内镜下泪囊鼻腔造孔术治疗的慢性泪囊炎患者31例(35眼)。男性4例,女性27例。年龄9～70岁,平均31岁。术前行泪囊碘油造影。随访6～20个月。结果31例(35眼)慢性泪囊炎,双眼患者4例;2例(2眼)为鼻内镜手术损伤致泪囊炎。前期泪囊鼻腔激光手术病史4例(5眼),鼻外径路手术2例(2眼)。28例(91.4%,32/35眼)治愈,症状消失,鼻腔造孔通畅。1例术后1周取出膨胀海绵时发生鼻腔黏膜瓣位置移位;2例术后6个月造孔瘢痕闭锁,其中1例再手术后治愈。总有效率97.1%(34/35眼)。结论保留鼻腔黏膜瓣并以此修复裸露骨质,可最大程度避免和减少骨质和瘢痕增生,有助于提高和取得满意的临床泪囊鼻腔造孔治疗效果。