胃内容物鼻咽部反流与腺样体组织免疫状态的相关性研究  

The association between the nasopharyngeal reflux of gastric contents and the immune status of adenoid tissues

作　　者：张春林[1] 林小燕[2] 李春雷[1] 饶澄[1] 王科[1,3] 刘兆辉[1] 

机构地区：[1]遵义医学院附属医院耳鼻咽喉头颈外科,贵州遵义563003 [2]广东省妇幼保健院耳鼻咽喉科,广州510310 [3]西安医学院第一附属医院耳鼻咽喉头颈外科,710077

出　　处：《重庆医学》2017年第6期760-763,共4页Chongqing medicine

基　　金：贵州省科技厅联合基金资助项目(黔科合J字LKZ[2012]06号)

摘　　要：目的研究腺样体肥大(AH)患儿中胃内容物鼻咽部反流与腺样体免疫状态的相关性。方法收集AH病例,分为AH不伴扁桃体肥大组(A组),AH伴扁桃体肥大组(B组),收集无腺样体和扁桃体肥大的患儿作为对照组。采用酶联免疫吸附(ELISA)法检测鼻咽部分泌物中胃蛋白酶的表达,免疫组织化学法检测腺样体组织中BCL-2、PCNA、CD45Ro、CD20的表达,进一步分析胃蛋白酶水平与BCL-2、PCNA、CD45Ro、CD20的相关性。此外,分析上述指标表达水平与AH程度的相关性。结果 A组和B组中胃蛋白酶平均水平分别为(2.91±1.69)ng/mL,(2.70±1.42)ng/mL,胃蛋白酶阳性率分别为57.1%和54.6%,均高于对照组(P<0.01),而A组和B组的胃蛋白酶平均水平和阳性率差异无统计学意义(P>0.05)。BCL-2、PCNA、CD45Ro、CD20在腺样体组织中的表达,B组有高于A组的趋势,但仅CD20表达差异有统计学意义(P=0.042)。胃蛋白酶与BCL-2、PCNA、CD45Ro,CD20表达呈正相关(均P<0.01),相关系数分别为0.64,0.66,0.63,0.58。此外,在根据AH程度分组的亚组比较中,胃蛋白酶阳性率差异有统计学意义(P=0.022),BCL-2、PCNA、CD45Ro、CD20的表达水平均与腺样体的分度有关(P<0.01)。结论鼻咽部分泌物中胃蛋白酶表达水平与腺样体的免疫反应活跃程度相关,胃内容物鼻咽部反流可能是AH的可能病因。Objective To explore the association between nasopharyngeal reflux of gastric contents and the immune status of adenoid tissues in children with adenoid hypertrophy（AH）.Methods The pediatric AH patients were collected and divided into group A（AH without tonsil hypertrophy）and group B（AH with tonsil hypertrophy）,children without AH and tonsil hypertrophy were collected as control group.ELISA and immunohistochemistry were adopted to detect pepsin in nasopharyngeal secretions and BCL-2,PCNA,CD45 Ro and CD20 in adenoid tissues,respectively.Then,the association between pepsin and levels of BCL-2,PCNA,CD45 Ro and CD20 were analyzed.Moreover,we also explored the relationship between above biomarkers and the degree of AH.Results In group A and group B,the levels of pepsin in nasopharyngeal secretions were（2.91±1.69）ng/mL and（2.70±1.42）ng/mL,meanwhile the positive rates of pepsin in nasopharyngeal secretions were 57.1% and 54.6%,respectively,which all were significantly higher compare with the control group（P〈0.01）,however,no significant differences were found between group A and group B.Compared with group A,there was a tendency of higher levels of all biomarkers in group B,though only the comparison of CD20 reached the statistical significance（P=0.042）.Pepsin level was positively correlated with the levels of BCL-2,PCNA,CD45 Ro and CD20,the correlation coefficient were 0.638,0.661,0.634 and 0.583,respectively.Moreover,the positive rate and levels of BCL-2,PCNA,CD45 Ro and CD20 were related with the adenoid hypertrophic degree（P〈0.01）.Conclusion Some AH patients had nasopharyngeal reflux of gastric contents,and in their adenoid tissues,an active immune status which was positively related with pepsin expression was observed.The nasopharyngeal reflux of gastric contents was a probable etiological factor of AH.

关 键 词：腺样体肥大 胃食管反流 鼻咽反流 胃蛋白酶A 免疫活性 

分 类 号：R766[医药卫生—耳鼻咽喉科]