慢性鼻窦炎与咽喉反流的相关性研究  

A preliminary study on the relationship between laryngopharyngeal reflux and chronic rhinosinusitis

作　　者：李晓云 李进让[2] 张淑君[1] 张永强 齐志伟[1] 纽瑞凤 

机构地区：[1]承德医学院附属医院耳鼻咽喉科,河北承德067000 [2]海军总医院全军耳鼻咽喉头颈外科中心 [3]河北省隆化县医院耳鼻咽喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第23期1828-1832,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:对慢性鼻窦炎(CRS)与咽喉反流的关系进行初步探讨。方法:46例患者中,CRS伴鼻息肉患者25例(CRSwNP组),CRS不伴鼻息肉患者10例(CRSsNP组),11例因鼻腔解剖异常行手术治疗的患者作为对照组,采用免疫组织化学方法对3组标本的胃蛋白酶表达水平进行检测。将胃蛋白酶表达强度与鼻窦CT的Lund-Mackay评分、嗜酸粒细胞、淋巴细胞、单核细胞、嗜碱粒细胞、中性粒细胞进行相关性分析。结果:CRSwNP组胃蛋白酶表达强阳性8例(32%),阳性8例(32%),弱阳性2例(8%),阴性7例(28%)。CRSsNP组胃蛋白酶表达强阳性4例(40%),阳性3例(30%),弱阳性1例(10%),阴性2例(20%)。对照组胃蛋白酶表达强阳性0例,阳性2例(18.2%),弱阳性3例(27.3%),阴性6例(54.5%),CRSwNP组与CRSsNP组胃蛋白酶表达的强度高于对照组(P<0.05),CRSwNP组与CRSsNP组胃蛋白酶表达强度差异无统计学意义(P>0.05)。胃蛋白酶表达强度与Lund-Mackay评分存在正相关(r=0.349,P<0.05),与各种血炎性细胞百分比不存在直线相关关系。结论:咽喉反流与CRS存在相关性,可能是CRS的危险因素,咽喉反流与CRS严重程度呈正相关,咽喉反流引起CRS的炎症反应,并不以某种炎细胞为主。Objective：To study the relationship between laryngopharyngeal reflux and chronic rhinosinusitis.Method：A total of 46 patients were enrolled in this study including 25 cases with chronic rhinosinusitis with nasal polyps,10 cases with chronic rhinosinusitis without nasal polyps and 11 cases underwent surgery due to abnormal nasal anatomy such as nasal septum deviation,bubble in the turbinate,etc.as control group.The expression of pepsin was detected using immunohistochemistry in three groups.The intensity of pepsin expression and CT score of sinus,blood eosinophils percentage,blood neutrophils percentage,blood basohils percentage,blood mononuclear percentage,blood lymphocytes percentage were analyzed.Result：There were 8 strong positive cases（32%,8/25）,positive in 8 cases（32%,8/25）,2 weakly positive cases（8%,2/25）,7 negative cases（28%,7/25）in chronic rhinosinusitis with nasal polyps group.In the chronic rhinosinusitis without nasal polyps group,the expression of pepsin was strong positive in 4 cases（40%,4/10）,positive in 3 cases（30%,3/10）,weakly positive in 1 cases（10%,1/10）,negative in 2 cases（20%,2/10）.There were no strong positive expression in the control group,positive in 2 cases（18.2%,2/11）,weakly positive in 3 cases（27.3%,3/11）,negative in 6 cases（54.5%,6/11）,chronic rhinosinusitis with nasal polyps group and chronic rhinosinusitis without nasal polyps group higher than the control group（P〈0.05）.There was no significant difference in pepsin expression between chronic rhinosinusitis with nasal polyps group and without group（P=0.617）.Spearman correlation analysis indicated that the intensity of pepsin was positively correlated with the score of Lund-Markay（r=0.349,P=0.017）,there was no correlation with the percentage of various inflammatory cells.Conclusion：The positive expression intensity of pepsin in chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps is significantly higher than that in normal control grou

关 键 词：咽喉反流 鼻窦炎 胃蛋白酶 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]