慢性鼻窦炎嗅觉障碍患者嗅上皮超微结构观察  

Ultrastructure changes of the olfactory epithelium of the patients suffering from dysosmia caused by the chronic sinusitis

作　　者：王娜亚[1] 程靖宁[1] 盛瑞红[2] 何风[3] 张敏[4] 潘子昂[2] 张小伯[1] 王石麟[2] 

机构地区：[1]北京中日友好医院耳鼻咽喉科,100029 [2]北京中日友好医院电镜室 [3]民航总医院耳鼻咽喉科 [4]北京中日友好医院电镜室病理科

出　　处：《中华耳鼻咽喉科杂志》2001年第1期38-41,共4页Chinese Journal of Otorhinolaryngology

基　　金：归国川生医学奖学金科学研究启动基金资助项目! (0 30 )

摘　　要：目的　观察慢性鼻窦炎嗅觉障碍患者嗅上皮的超微结构变化。方法　对 35例住院行鼻内窥镜手术治疗伴有嗅觉缺失鼻窦炎患者的嗅上皮取活体组织 ,光镜下将嗅上皮按病变分为正常、萎缩和呼吸上皮化生组 ,透射电镜分别观察各组超微结构变化。结果　①光镜下正常的嗅上皮细胞表面超微结构出现支持细胞微绒毛消失、嗅泡内微管结构消失或空泡化致嗅泡变形、嗅纤毛变形或减少、少量纤毛化生等改变 ;②萎缩的嗅上皮超微结构改变的特点 :轻、中度萎缩主要为支持细胞上部的细胞器和膜限制性的电子致密囊泡明显减少或消失、空泡化 ,基底细胞退行性变 ;重度萎缩为细胞结构不清 ,多为双层细胞结构 ,细胞核染色质呈斑块状凝聚、核空泡化或核固缩 ;细胞质内均出现内质网扩张 ,线粒体肿胀、嵴排列紊乱、减少或空泡状改变 ;③呼吸上皮化生区域 ,丛状纤毛细胞与支持细胞、嗅泡样结构间隔分布 ,即嗅上皮细胞呈岛状分布。结论　炎症导致嗅上皮细胞由表层及里层各种超微结构异常程度与嗅上皮萎缩程度呈正相关 ;Objective To observe the ultrastructural changes of olfactory epithelium (OE) in patients suffering from dysosmia caused by chronic sinusitis. Methods The specimens of olfactory epithelium were obtained from 35 patients operated for chronic sinusitis accompanied by dysosmia. According to the results of light microscope (LM) examination, the OE was divided into three groups by the types of pathological changes: normal, atrophic and respiratory epithelium metaplasia(REM). Transmission electron microscope was used to observe the ultrastructural changes of each group. Results Under the LM, the surface ultrastructure of the OE showed some abnormal changes: (1) surface microvillus of the supporting cells disappeared; (2) olfactory vesicle changed their shape due to vacuolization; (3) disappearance of canaliculus structure in the olfactory vesicle ; (4) the olfactory cilia changed the shape or reduced; some of the reduced cilia underwent metaplasia. The ultrastructural changes of atrophic OE included: (1) minor and moderate atrophy: the organelles and the membrane limited electron dense vesicles on the upper section of the supporting cells obviously decreased or disappeared, even underwent vacuolization. The basic cell degenerated; (2) serious atrophy: the turbidity of the cell structure, even double cell structure, the nuclei of the cell aggregated as the plaque and vesiculose change or karyopyknosis. As for the cytoplasm, there were the dilation of the ERs, turgidity of the mitochondrion, the disarrangement, diminution and vacuolization. Fasciculate cilia were distributed separately in the REM group. Conclusion There is a positive relationship between the atrophy degree and the degree of the abnormal ultrasrucutural changes of the OE. The ultrastructural changes of OE in patients suffering from dysosmia caused by chronic sinusitis may provide reference for assessment of the treatment of dysosmia.

关 键 词：鼻窦炎 嗅粘膜 嗅觉缺失 电子显微镜扫描检查 超微结构 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]