IgE、嗜酸性粒细胞在慢性鼻—鼻窦炎疾病中的临床研究

发布时间：2018-06-13 06:59

本文选题：慢性鼻-鼻窦炎 + IgE　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的:探讨变应性因素血清总IgE、血清特异性IgE、血清嗜酸性粒细胞、组织嗜酸性粒细胞与慢性鼻-鼻窦炎之间关系及血清特异性IgE与嗜酸性粒细胞关系。方法:选取2016年6月1日至2017年2月28日在我院耳鼻喉科住院的72例慢性鼻-鼻窦炎(CRS)的手术患者为实验组,选取同一时期在我院住院行鼻中隔矫正术的16例单纯鼻中隔偏曲患者为对照组。将慢性鼻-鼻窦炎组分为慢性鼻-鼻窦炎伴鼻息肉组(CRSwNP)和慢性鼻-鼻窦炎不伴鼻息肉组(CRSsNP)。将慢性鼻-鼻窦炎血清特异性IgE(SIgE)阳性患者分为SIgE阳性组,血清特异性IgE(SIgE)阴性患者分为SIgE阴性组。根据慢性鼻-鼻窦炎患者组织嗜酸性粒细胞浸润情况,分为嗜酸性粒细胞浸润组(ECRS)、非嗜酸性粒细胞浸润组(non-ECRS)。采用德国FOOKE ALLERG-O-LIQ-SYSTEM全自动变态反应体外定量检测系统对患者血清总IgE、血清特异性IgE进行检测,对血清和组织嗜酸细胞进行计数,并对患者进行病史询问、视觉模拟量表(VAS)评分、Lund-Mackay CT系统评分、Lund—Kennedy内镜评分,探讨变应性因素(血清特异性IgE、血总IgE、血清嗜酸性粒细胞、组织嗜酸性粒细胞)与慢性鼻窦炎之间关系,血清特异性IgE、组织嗜酸性粒细胞对慢性鼻窦炎患者症状、体征病变程度评分的影响及血清特异性IgE(SIgE)与嗜酸性粒细胞、血清总IgE之间的关系。结果:1、血清特异性IgE、血清总IgE、血清嗜酸性粒细胞在CRSwNP组与对照组,CRSsNP组与对照组及CRSwNP组与CRSsNP组之间均无统计学差异。2、血清特异性IgE阳性组VAS评分平均为13.6,阴性组VAS评分平均为18.5,阳性组与阴性组VAS评分差异有统计学意义(t=-2.7,p=0.01)。血清特异性IgE阳性组CT评分平均为12.9,阴性组CT评分平均为12.1,差异无统计学意义(t=0.6,p=0.56)。血清特异性IgE阳性组内镜评分平均为7.6,阴性组内镜评分平均为7.4,两组评分差异无统计学意义(t=0.3,p=0.8)。3、在嗜酸性粒浸润组中,CRSwNP有11例,CRSsNP有2例;在非嗜酸性粒细胞浸润组中,CRSwNP有18例,CRSsNP有19例,两组差异有统计学意义(?2=5.1,p=0.02)。嗜酸性粒细胞浸润组VAS评分平均为20.6,非嗜酸性粒细胞浸润组VAS评分平均为15.4,两者之间差异有统计学意义(t=2.1,p=0.04)。嗜酸性粒细胞浸润组CT评分平均为14.5,非嗜酸性粒细胞浸润组CT评分平均为10.7,两者之间差异有统计学意义(t=2.4,p=0.02)。嗜酸性粒细胞浸润组内镜评分平均为9.0,非嗜酸性粒细胞浸润组内镜评分平均为6.8,两者之间差异有统计学意义(t=2.5,p=0.02)。4、特异性IgE阳性组血嗜酸性粒计数平均为0.19,阴性组血嗜酸性粒细胞计数平均为0.18,两组差异无统计学意义(t=0.2,p=0.8)。特异性IgE阳性组患者中组织嗜酸性粒细胞浸润型有4例,非浸润型有10例;特异性IgE阴性组患者中,组织嗜酸性粒细胞浸润型有10例,非浸润型有24例,两组差异无统计血意义(?2=0.003,p=0.96)。特异性IgE阳性组血清总IgE浓度平均为226.3,阴性组血清总IgE浓度平均为87.5,两组差有统计学意义(t=3.2,p=0.002)。结论:1、慢性鼻-鼻窦炎病因复杂,不能以IgE、嗜酸性粒细胞等单一因素作为判断指标。2、当慢性鼻-鼻窦炎患者合并过敏状态时,症状和体征的病变程度不一定加重。3、慢性鼻-鼻窦炎组织嗜酸性粒细胞浸润提示并发鼻息肉概率增加,且症状、体征病变程度加重,嗜酸性粒细胞浸润程度与变态反应无关,可能存在非过敏性嗜酸性粒细胞浸润型慢性鼻-鼻窦炎。
[Abstract]:Objective: To investigate the relationship between serum total IgE, serum specific IgE, serum eosinophil, tissue eosinophil and chronic rhinosinusitis and the relationship between serum specific IgE and eosinophil. Methods: 72 cases of chronic rhinosinusitis (CRS) in the Department of ENT of our hospital from June 1, 2016 to February 28, 2017 were selected. In the experimental group, 16 patients with nasal septum deviation in the same period were selected as the control group. The chronic rhinosinusitis group was divided into chronic rhinosinusitis with nasal polyp group (CRSwNP) and chronic rhinosinusitis without nasal polyp group (CRSsNP). The chronic rhinosinusitis serum specific IgE (SIgE) was used. The positive patients were divided into SIgE positive group, and the serum specific IgE (SIgE) negative patients were divided into SIgE negative group. According to the eosinophil infiltration in the patients with chronic rhinosinusitis, the eosinophil infiltration group (ECRS), the non eosinophilic granulocyte infiltration group (non-ECRS), and the German FOOKE ALLERG-O-LIQ-SYSTEM full automatic allergy body were used. The total IgE and serum specific IgE were detected by the external quantitative detection system. The serum and tissue eosinophils were counted, and the patient was asked for medical history, the visual analogue scale (VAS) score, the Lund-Mackay CT system score, and the Lund Kennedy endoscopy score, to explore the allergic factors (serum specific IgE, blood total IgE, serum eosinophilia). The relationship between granulocyte, eosinophil and chronic sinusitis, serum specific IgE, the influence of eosinophil on the symptoms of chronic sinusitis, the score of the degree of signs, the relationship between serum specific IgE (SIgE) and eosinophils, and the total IgE in serum. Results: 1, serum specific IgE, serum total IgE, serum There was no significant difference in eosinophil between the CRSwNP group and the control group. There was no statistical difference between the CRSsNP group and the control group and the CRSwNP group and the CRSsNP group. The average VAS score of the serum specific IgE positive group was 13.6, the mean VAS score in the negative group was 18.5. The difference of the VAS score between the positive group and the negative group was statistically significant (t=-2.7, p=0.01). The average score of the score was 12.9 and the negative group CT score was 12.1, the difference was not statistically significant (t=0.6, p=0.56). The average endoscopy score of the serum specific IgE positive group was 7.6, the average of the negative group was 7.4, and the two groups had no statistical significance (t=0.3, p=0.8).3. In the eosinophilic infiltration group, there were 11 CRSwNP and 2 cases in CRSsNP; in the non eosinophilic acid group, there were 2 cases in the non eosinophilic group. In the group of granulocyte infiltration, there were 18 cases of CRSwNP and 19 cases in CRSsNP. The difference between the two groups was statistically significant (2=5.1, p=0.02). The average VAS score of eosinophil infiltration group was 20.6 and the average VAS score of non eosinophil infiltration group was 15.4. The difference between the two groups was statistically significant (t=2.1, p=0.04). The average CT score of eosinophil infiltration group was average 14.5, the average CT score of non eosinophil infiltration group was 10.7, the difference between the two groups was statistically significant (t=2.4, p=0.02). The average endoscopy score of eosinophil infiltration group was 9, and the average endoscopy score of non eosinophilic granulocyte infiltration group was 6.8. There was a significant difference between the two groups (t=2.5, p=0.02).4, and the specific IgE positive group blood eosinophilia. The average particle count was 0.19, the mean blood eosinophil count in the negative group was 0.18, and the two groups were not statistically significant (t=0.2, p=0.8). There were 4 cases of tissue eosinophil infiltration in the patients with specific IgE positive group and 10 cases of non infiltrating type. In the specific IgE negative group, there were 10 cases of tissue eosinophil infiltration type and non infiltrating type. There were 24 cases, the two groups had no statistical significance (? 2=0.003, p=0.96). The average serum total IgE concentration in the specific IgE positive group was 226.3, the average serum IgE concentration in the negative group was 87.5, and the two groups were statistically significant (t=3.2, p=0.002). Conclusion: 1, the chronic rhinosinusitis is complicated and can not be judged by the single factor of IgE and eosinophil. Standard.2, when patients with chronic rhinosinusitis are allergic to allergic conditions, the degree of symptoms and signs does not necessarily aggravate.3. The eosinophil infiltration in chronic rhinosinusitis tissues suggests an increase in the probability of nasal polyps, and the symptoms, the severity of the signs, the degree of eosinophil infiltration and the allergic reaction, may be non allergic. Eosinophil infiltrating chronic rhinosinusitis.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765

【参考文献】