鼻丘及下鼻甲划痕法治疗变应性鼻炎的机制研究

目的 探讨鼻丘、下鼻甲划痕术治疗变应性鼻炎(allergic rhinitis,AR)的机制.方法 对24例持续性AR患者行鼻丘、下鼻甲划痕手术治疗,并于手术前、手术后4周取其下鼻甲鼻黏膜组织各1块,行HE染色、甲苯胺蓝染色及P物质(substance P,SP)免疫组织化学染色.观察鼻黏膜组织的组织形态及以嗜酸性粒细胞浸润为主的炎症病变情况;肥大细胞(MCs)浸润及脱颗粒情况,并计算MCs活化分数;SP免疫组化积分光密度值(IOD )的测定情况.结果 HE染色:手术后以嗜酸性粒细胞浸润为主的炎症病变程度较手术前有一定改善;SP免疫组化积分光密度值测定:手术前后相比,差异具有统计学意义(P<0.05);MCs情况:手术前后MCs浸润数量、脱颗粒情况及活化百分数经两两比较,差异均具有统计学意义(P<0.05).手术前后SP积分光密度值变化与MCs活化分数变化经相关性检验,存在相关关系(R=0.594).结论 鼻丘、下鼻甲划痕通过阻断鼻腔黏膜表面C类阳性感觉神经纤维,进而抑制SP的表达水平,降低其对MCs脱颗粒反应的协同作用,减少炎性介质的释放,进而缓解鼻腔黏膜变应性炎症,改善患者的鼻部症状,且SP含量的变化可在一定程度影响MCs的活化比例.

The Mechanism Study of the Amyxis Surgery of Agger Nasi and Inferior Turbinates in Treating Allergic Rhinitis

Objective To study the mechanism of the amyxis surgery of agger nasi and inferior turbinates in treating allergic rhinitis (AR).Methods The 24 patients with persistent AR received the amyxis surgery of agger nasi and inferior turbinates.The samples of nasal mucosa were collected before operation and 4 weeks after operation respectively and stained via hematoxylin-eosin (HE) staining, toluidine blue staining and SP immunochemistry staining.The organization form of nasal mucosa tissues and the inflammatory lesions of the infiltration of eosinophilic granulocyte were observed, and the infiltration and degranulation of mast cells were detected and the activated fraction was calculated.The integral optical density (IOD) of immunochemistry was determined.Results The results of HE staining showed that the inflammatory lesions of the eosinophils infiltration after operation were better to some extent than before operation.The results of IOD determination showed significant differences between before and after operation (P<0.05).There were also significant differences between before and after operation in the infiltration quantity and degranulation of mast cells and the activated fraction (P<0.05).The results of the correlation test showed that there were strong correlation between the changes of IOD and the activated fraction of mast cells (R=0.594).Conclusion The amyxis surgery of agger nasi and inferior turbinates can alleviate the allergic inflammation of nasal mucosa and improve patients' nasal symptoms by blocking the C positive sensory nerve fibers on the surface of nasal mucosa, inhibiting the expression of SP, and reducing the synergetic effect of the response to MC degranulation and the release of inflammatory mediators.Meanwhile, the content changes of Substance P influence the activated fraction of mast cells to some degree.