上颌窦后鼻孔息肉与普通鼻息肉的组织病理学对照研究

发布时间：2018-05-12 07:53

本文选题：上颌窦后鼻孔息肉 + 鼻息肉　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：目前关于鼻息肉(Nasal polyps,NP)的组织病理学特征有很多研究报道，较为公认的共性特征是组织水肿和炎性细胞的浸润。上颌窦后鼻孔息肉（Antrochoanal polyp,ACP）作为鼻息肉的一种特殊类型，却有其不同于普通鼻息肉的好发部位和预后，这些不同的临床特征可能暗示两组疾病的组织结构有差异。但有关ACP和普通NP组织病理学差异的研究甚少，本研究旨在观察ACP与普通NP的组织病理学特征，重点观察两者的黏膜下腺体分布，嗜酸性粒细胞、中性粒细胞、浆细胞及淋巴细胞的浸润分布与计数，微血管的计数，并对各类炎细胞、微血管之间的相关关系进行分析，探讨两组疾病的组织病理学差异，以及这种差异在临床上的可能意义。方法：选择2011年10月至2013年07月雅安市人民医院耳鼻咽喉科的住院病例，确定纳入与排除标准，对符合标准的病例进行收集。将收集的病例资料分为ACP组与普通NP组，其中ACP组有24例，普通NP组40例。将纳入病例术中取出的病变标本进行组织病理学研究。研究采用的主要方法有：①采用HE染色，观察ACP组和普通NP组的黏膜下腺体分布，炎性细胞（嗜酸性粒细胞、中性粒细胞、浆细胞、淋巴细胞）的分布与计数，并对结果进行统计学分析；②采用免疫组化EnVision法分别计数ACP组和普通NP组中CD34标记阳性的微血管密度，并对结果进行统计学分析。结果：（1）在ACP组中，黏膜下出现腺体例数2例，腺体出现率为8.33%；普通NP组中黏膜下出现腺体例数为38例，腺体出现率为95%，两组疾病粘膜下腺体出现率进行卡方检验，χ2=48.071，P＜0.05，粘膜下腺体出现率差异有统计学意义。（2）ACP组与普通NP组中嗜酸性粒细胞数、中性粒细胞数、浆细胞数、淋巴细胞数以及微血管密度进行两独立样本t检验，t值分别为18.423，9.564，4.823，2.100，2.930，P值均＜0.05，差异均有统计学意义。（3）在ACP组中，，嗜酸性粒细胞同中性粒细胞、淋巴细胞、浆细胞两两间呈正相关（相关系数r分别为0.943，0.751，0.630，且P＜0.01）；微血管密度与嗜酸性粒细胞、中性粒细胞之间呈正相关（相关系数r分别为0.528，0.521，P＜0.01）。（4）普通NP组中，嗜酸性粒细胞同淋巴细胞、浆细胞两两间呈负相关（相关系数r分别为-0.686，-0.713,且P＜0.01）；嗜酸性粒细胞与微血管密度呈正相关（r=0.756，P＜0.01）。结论：(1)ACP组黏膜下腺体出现率显著低于普通NP组；黏膜下浸润细胞类型不同，普通NP组中以嗜酸性粒细胞浸润为主，ACP组中以中性粒细胞及淋巴细胞浸润为主。⑵微血管的增生同鼻息肉的发生、发展关系密切。微血管增生程度不同是导致ACP的结构和预后不同于普通NP的因素之一。⑶通过相关性分析，嗜酸性粒细胞的浸润同微血管增生在两组疾病中均呈正相关，考虑嗜酸性粒细胞可能促进微血管增生。
[Abstract]:Objective: there are many reports on histopathological features of nasal polyp Nasal polypsNPs. The common characteristics are tissue edema and inflammatory cell infiltration. As a special type of nasal polyps, the posterior maxillary sinus polyp Antrochoanal polypypanus (ACPP) is different from the common nasal polyps in its location and prognosis. These different clinical features may indicate that there are differences in the tissue structure between the two groups. However, there are few studies on histopathological differences between ACP and NP. The aim of this study was to observe the histopathological characteristics of ACP and NP, and to observe the distribution of submucosal glands, eosinophils, neutrophils, and neutrophils. The infiltration, distribution and count of plasma cells and lymphocytes, the count of microvessels, and the correlation between inflammatory cells and microvessels were analyzed, and the histopathological differences between the two groups were discussed. And the possible clinical significance of this difference. Methods: the inpatients of Otolaryngology Department of Ya'an people's Hospital from October 2011 to July 2013 were selected, the inclusion and exclusion criteria were determined, and the cases that met the criteria were collected. The data were divided into ACP group and NP group, including 24 cases in ACP group and 40 cases in NP group. Histopathological study was performed on the pathological specimens taken out during the operation. The main methods used in the study were to observe the distribution of submucosal glands, the distribution and count of inflammatory cells (eosinophils, neutrophils, plasma cells, lymphocytes) in ACP group and NP group with HE staining. The results were statistically analyzed and the CD34 positive microvessel density in ACP group and NP group were counted by immunohistochemical EnVision method, and the results were analyzed statistically. Results in ACP group, there were 2 cases of submucosal glands and 8.33 cases of glands, and 38 cases of submucosal glands in NP group. The incidence of submucosal glands in the two groups was tested by chi-square test (蠂 ~ 2 + 48.071) (P < 0.05). There was significant difference in the occurrence rate of submucosal glands between the ACP group and the NP group. The number of eosinophils, neutrophils and plasma cells in the ACP group was significantly different from that in the normal NP group, and there was no significant difference in the number of eosinophils, neutrophils and plasma cells between the two groups. The t values of two independent samples were 18.4239.564 (4.8232.100) 2.930 (P < 0.05). The difference was statistically significant (P < 0.05). In ACP group, eosinophils were the same as neutrophils and lymphocytes. There was a positive correlation between plasma cells (r = 0.943) and eosinophils and neutrophils (r = 0.943, 0.751n, 0.630, P < 0.01), and a positive correlation between microvessel density and eosinophil and neutrophils (r = 0.528, 0.521, P < 0.01, P < 0.01, respectively) in NP group, eosinophil was the same lymphocyte in normal NP group. There was a negative correlation between plasma cells (r = -0.686- 0.713, P < 0.01), and a positive correlation between eosinophil and microvessel density (P < 0.01). Conclusion the incidence of submucosal glands in the ACP group was significantly lower than that in the NP group, and the submucosal infiltrating cells were different in the ACP group. In normal NP group, eosinophilic granulocytes infiltrate mainly. 2 in ACP group, neutrophils and lymphocytes infiltrate mainly. 2 the microvascular hyperplasia is closely related to the occurrence and development of nasal polyps. The degree of microvascular hyperplasia is one of the factors leading to the structure and prognosis of ACP being different from that of NP. 3 through correlation analysis, the infiltration of eosinophils is positively correlated with microvascular hyperplasia in both groups. Consider that eosinophil may promote microvascular proliferation.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R765.25

【参考文献】