翼管神经切断术治疗变应性鼻炎的疗效及分子机制初探

发布时间：2018-06-29 22:27

本文选题：鼻炎 + 变应性　；参考：《中南大学》2010年硕士论文

【摘要】： 目的观察翼管神经切断术治疗变应性鼻炎的临床疗效。方法对49例重度持续性变应性鼻炎患者实施鼻内镜下翼管神经切断术,以“兰州标准[1]”和“过敏性鼻结膜炎生活质量表(RQLQ)[2]”对患者术前及术后的远期(3-5年不等)生活质量进行评估,统计分析其疗效。结果本组49例患者的远期(3-5年不等)疗效,按“兰州标准”进行评价,显效35例(71.4%),有效9例(18.4%),无效5例(10.2%),总有效率为89.8%；按“过敏性鼻结膜炎生活质量表(RQLQ)[2]”进行评价,结果显示,显效45例(91.8%),有效2例(4.1%),无效2例(4.1%),总有效率为95.9%；另外,将本组所有49例患者视为1个整体,将困扰患者的各种症状归纳成7个不同的方面,统计分析整体在接受手术后各个方面的改善情况,结果显示,手术后整体的鼻眼和非鼻眼症状、日常生活及睡眠质量、情感状态都显著改善(P0.01),解决实际问题能力也显著增强(P0.01)。结论翼管神经切断术是治疗重度持续性变应性鼻炎切实可行的方法之一。目的为探讨翼管神经切断术治疗变应性鼻炎的分子机制,本文观察了手术前、后鼻黏膜中与变应性鼻炎高度相关的炎症细胞(嗜酸性粒细胞、Eos)、细胞因子(白介素4、IL-4；白介素5、IL-5)及神经肽(降钙素基因相关肽、CGRP; P物质、SP；血管活性肠肽VIP)的变化。方法收集10例接受鼻内镜下翼管神经切断术治疗的变应性鼻炎患者的术前、术后详细资料,采用“兰州标准”和“过敏性鼻结膜炎生活质量表(RQLQ)”对术前和术后生活质量进行评估。运用病理组织学技术观察术前及术后3个月鼻粘膜中Eos的数量改变,同时应用免疫组织化学技术观察术前及术后3个月的IL-4、IL-5、CGRP、SP、VIP表达水平的变化。结果术后3月时,经“兰州标准”和“过敏性鼻结膜炎生活质量表(RQLQ)”的评定结果显示,显效率达100%,所有患者症状基本消失。细胞计数结果显示：实验组术前鼻黏膜中Eos、IL-5阳性染色细胞、IL-4阳性染色细胞分别为26.8±4.02、361.7±70.84、203.4±33.62,而这些指标在术后分别下降为9.8±4.18、93.3±19.80、70.1±13.37,术前、术后相比较差异均有统计学意义(P0.01)；平均积分光密度(IODM)值测量显示,实验组术前鼻黏膜中CGRP、SP、VIP的光密度值分别为2329.05±272.63、2019.43±236.18、2465.96±358.63,而术后分别下降为1753.32±289.99、1705.82±154.17、1755.74±360.27,术前、术后相比较差异均有统计学意义(P0.01)。结论(1)翼管神经切断术治疗变应性鼻炎的临床有效性可能与鼻黏膜中Eos、IL-5、IL-4、CGRP、SP、VIP的减少有关。 (2)翼管神经切断术治疗变应性鼻炎的临床有效性,不单纯只是与阻断了支配鼻黏膜的绝大部分副交感神经的功能有关,同时也可能与局部鼻粘膜失衡的免疫反应恢复到接近正常有关。
[Abstract]:Objective to observe the clinical effect of pterygotomy on allergic rhinitis. Methods 49 patients with severe persistent allergic rhinitis were treated with endoscopic pterygotomy. Quality of life (QOL) was evaluated by Lanzhou Standard [1] and allergic rhinitis conjunctivitis (RQLQ) [2] before and after operation. Results the long-term (3-5 years) curative effect of 49 cases was evaluated according to Lanzhou Standard, 35 cases (71.4%) were effective, 9 cases (18.4%) were effective, 5 cases (10.2%) were ineffective, the total effective rate was 89.8.The results were evaluated according to the quality of Life Table (RQLQ) [2] of allergic rhinitis conjunctivitis. The results showed that 45 cases (91.8%) showed remarkable effect, 2 cases (4.1%) were effective, 2 cases (4.1%) were ineffective, and the total effective rate was 95.9%. Statistical analysis showed that the overall nasal and non-nasal symptoms, daily life, sleep quality and emotional state were significantly improved after surgery (P0.01), and the ability to solve practical problems was also significantly enhanced (P0.01). Conclusion Pterygotomy is one of the feasible methods for the treatment of severe persistent allergic rhinitis. Objective to investigate the molecular mechanism of pterygotomy in the treatment of allergic rhinitis. The inflammatory cells (eosinophils Eos) and cytokines (IL-4) in the posterior nasal mucosa which were highly related to allergic rhinitis before and after operation were observed. Changes of interleukin-5 IL-5 and neuropeptide (calcitonin gene-related peptide CGRP; substance P SPP; vasoactive intestinal peptide VIP). Methods Ten cases of allergic rhinitis treated by endoscopic neurotomy of pterygotomy were collected before and after operation. The quality of life (QOL) was evaluated by Lanzhou Standard and RQLQ before and after operation. The changes of Eos in nasal mucosa before and 3 months after operation were observed by histopathological technique, and the expression of IL-4 IL-5 CGRPU SPN VIP was observed by immunohistochemical technique before and 3 months after operation. Results at 3 months after operation, the results of Lanzhou Standard and RQLQ showed that the effective rate was 100 and the symptoms of all the patients were basically disappeared. The results of cell count showed that the positive cells of IL-4 in the nasal mucosa of the experimental group were 26.8 卤4.02361.7 卤70.84203.4 卤33.62 before operation and 9.8 卤4.1833.3 卤19.80fen 70.1 卤13.37 before and after the operation, respectively. There were significant differences before and after operation (P0.01). The mean integrated optical density (IODM) value was 2329.05 卤272.63 ~ 2019.43 卤236.1855.96 卤358.63 and 1753.32 卤289.99 ~ 1705.82 卤154.171755.74 卤360.27, respectively. There was significant difference between the two groups before and after operation (P0.01). Conclusion (1) the clinical efficacy of pterygotomy in the treatment of allergic rhinitis may be related to the decrease of Eossil IL-5 IL-4 CGRPU VIP in nasal mucosa. (2) the clinical efficacy of pterygotomy in the treatment of allergic rhinitis. It is not only related to blocking the function of most parasympathetic nerves that innervate the nasal mucosa, but also related to the restoration of the immune response of the local nasal mucosa imbalance to close to normal.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21

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