鼻丘、下鼻甲割治法治疗变应性鼻炎的关键技术及其分子机制的研究  

Study on the key technology and molecular mechanism of the treatment of allergic rhinitis by nasal mound and inferior turbinate cutting therapy

作　　者：谢艳[1] 张勤修[1] 蒋路云[1] 刘洋[1] 吴濛潇 Xie Yan;Zhang Qinxiu;Jiang Luyun;Liu Yang;Wu Mengxiao(Department of Otolaryngology,Hospital of Chengdu University of Traditional Chinese Medicine;Clinical Medical College,Chengdu University of Traditional Chinese Medicine)

机构地区：[1]成都中医药大学附属医院耳鼻喉科,成都610072 [2]成都中医药大学临床医学院,成都610072

出　　处：《重庆医科大学学报》2023年第1期48-53,共6页Journal of Chongqing Medical University

基　　金：四川省科技厅重点研发资助项目(编号:2018SZ0400);四川省医学会医学科研课题资助项目(编号:S17022);成都中医药大学“杏林学者”学科人才科研提升计划资助项目(编号:QNXZ2019038)。

摘　　要：目的:探究鼻丘、下鼻甲割治法治疗变应性鼻炎(allergic rhinitis,AR)的关键技术及其分子机制。方法:收集2019年3月2日至2020年5月30日于成都中医药大学附属医院耳鼻喉科接受鼻丘、下鼻甲割治法治疗的85例AR患者临床资料,其中男32例、女53例,年龄(35.74±10.24)岁。采用视觉模拟量表(visual analogue scale,VAS)评分比较不同割治部位、割治方向、割治深度在治疗后1周、4周、8周、12周的疗效。进一步采用ELISA检测治疗前后患者血清中γ干扰素(interferon-gamma,IFN-γ)、免疫球蛋白E(immunoglobulin E,IgE)、白介素-4(interleukin-4,IL-4)的含量,用HE染色和甲苯胺蓝染色检测治疗前后患者的嗜酸性粒细胞和肥大细胞,用Western blot、qPCR检测治疗前后患者降钙素基因相关肽(calcitonin gene related peptide,CGRP)和P物质(substance P,SP)的表达量。采用SPSS 22.0进行统计学分析。结果:鼻丘联合下鼻甲割治疗效明显优于单纯鼻丘割治和单纯下鼻甲割治(P<0.05)。鼻丘割治的3个方向疗效没有差异。下鼻甲割治深度达骨质层,明显优于黏膜和黏膜下;ELISA实验表明治疗后的AR患者IFN-γ(t=6.069,P<0.001)含量明显上升,IgE(t=6.954,P<0.001)和IL-4(t=12.060,P<0.001)含量明显下降。HE染色和甲苯胺蓝染色表明治疗后患者的嗜酸性粒细胞浸润明显减少,肥大细胞的活性明显下降。Western blot实验表明AR患者治疗后的CGRP(t=11.130,P=0.008)和SP(t=11.930,P=0.007)与治疗前相比明显下降。qPCR实验表明AR患者治疗后的CGRP(t=11.640,P=0.007)和SP(t=7.104,P=0.002)与治疗前相比明显下降。结论:割治部位和割治深度是鼻丘、下鼻甲割治法的关键技术参数,该割治法可以减轻鼻腔黏膜炎症,其分子机制可能是降低CGRP和SP表达。Objective:To explore the key techniques and molecular mechanism of the treatment of allergic rhinitis(AR)by nasal mound and inferior turbinate cutting therapy. Methods:From March 2,2019 to May 30,2020,the clinical data of 85 patients with AR in Hospital of Chengdu University of Traditional Chinese Medicine were collected,including 32 males and 53 females,aged 35.74±10.24. A visual analogue scale(VAS)score was used to compare the efficacy of different cutting sites,cutting directions and cutting depth at 1 week,4,8 and 12 weeks after treatment. The levels of interferon-gamma(IFN-γ),immunoglobulin E(IgE) and interleukin-4(IL-4)in serum of patients before and after treatment were further detected by ELISA. Eosinophils and mastocyte of patients before and after treatment were detected by HE staining and toluidine blue staining. The expression levels of Calcitonin gene related peptide(CGRP)and substance P(SP) were detected by Western blot and qPCR. Statistical analysis was performed with SPSS 22.0. Results:The curative effect of nasal mound combined with inferior turbinate was significantly better than that of simple nasal mound turbinate and simple inferior turbinate(P<0.05).There was no significant difference in efficacy among the three directions of nasal mound turbinate. The results of ELISA showed that the levels of IFN-γ(t=6.069,P<0.001)in AR patients after treatment were significantly increased,IgE(t=6.954,P<0.001)and IL-4(t=12.060,P<0.001)were evidently decreased. HE staining and toluidine blue staining indicated a significant decrease in eosinophil infiltration and mastocyte activity in the treated patients. Western blot experiment showed that CGRP(t=11.130,P=0.008)and SP(t=11.930,P=0.007)decreased significantly after treatment in AR patients compared with those before treatment. The qPCR experiment showed that CGRP(t=11.640,P=0.007)and SP(t=7.104,P=0.002)decreased significantly after treatment in AR patients compared with those before treatment. Conclusion:The site and depth of the cutting are the key tec

关 键 词：鼻丘、下鼻甲割治法 变应性鼻炎 割治部位 割治深度 鼻腔黏膜炎症 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]