摘要
目的观察布地奈德对不伴鼻息肉的慢性鼻-鼻窦炎(CRS without nasal polyps,CRSsNP)鼻内镜术后鼻黏膜细胞外基质(extracellular matrix,ECM)及基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)表达的影响。方法 30例行鼻内镜手术的CRSsNP患者术后随机分为两组,布地奈德组20例(术后布地奈德喷鼻3个月),对照组10例(术后未使用糖皮质激素),术后3个月随访时留取筛区黏膜标本,并对患者行视觉模拟量表主观症状评分及Lund-Kennedy法鼻内镜评分,所有标本行Masson三色(MT)胶原染色及苦味酸-天狼星红染色,观察鼻黏膜基底膜区及黏膜内固有层ECM胶原沉积及成分等情况,免疫组化检测MMP-9的表达。结果 1与对照组相比,布地奈德组的VAS评分及鼻内镜评分均明显降低(t=-2.489,P=0.019;t=-3.318,P=0.003)。2布地奈德组鼻黏膜在基底膜区及黏膜内固有层ECM胶原沉积较对照组均明显减少(t=15.242,P=0.000;t=7.179,P=0.000)。3两组ECM沉积的胶原均以Ⅰ型胶原纤维为主,Ⅲ型、Ⅳ型胶原较少。4布地奈德组鼻黏膜内MMP-9的表达较对照组明显减少(t=9.173,P=0.000)。结论布地奈德能减少CRSsNP鼻内镜术后鼻黏膜ECM胶原的沉积,改善鼻内镜术后疗效,降低MMP-9的表达可能是其中机制之一。
OBJECTIVE To explore the effect of budesonide on extracellular matrix and expression of matrix metalloproteinases-9（MMP-9） in nasal mucosa of chronic rhinosinusitis without nasal polyps（CRSsNP） af ter endoscopic sinus su rger y（ESS）. METHODS Thirty patients with CRSsNP were randomly divided into two groups after ESS： Twenty patients in glucocorticoid group were treated with budesonide after ESS; ten patients in control group were not treated with any glucocorticoid. The subjective and objective assessments were achieved by means of VAS and Lund-Kennedy endoscopic scores three months after ESS. Histological specimens from all patients three months after ESS were studied. The paraffin sections were stained with Masson trichrome（MT） and Picric acidSirius red. The deposition of collagen in extracellular matrix（ECM） and the type of collagen were observed respectively. The expression of MMP-9 was determined by means of immunohistochemistry. RESULTS Compared with control group, the VAS scores and the Lund-Kennedy scores of glucocorticoid group were decreased obviously three months after ESS（t=-2.489, P=0.019; t=-3.318, P=0.003）. The collagen deposition both in basement membrane zone and within the nasal mucosa in glucocorticoid group was significantly reduced（t=15.242, P=0.000; t=7.179, P=0.000）. The collagen deposited in ECM was mainly composed of collagen type Ⅰ. Collagen type Ⅲ and collagen type Ⅳ was much less than collagen type Ⅰ. The expression of MMP-9 in glucocorticoid group was lower than in control group（t =9.173, P =0.000）. CONCLUSION The intervention of budesonide can reduce the collagen deposition in ECM of nasal mucosa of CRSsNP and improve the surgical effect after ESS. The effects of budesonide may be made by reducing the expression of MMP-9.
出处
《中国耳鼻咽喉头颈外科》
CSCD
2014年第10期546-549,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
基金
南京军区医学科技创新课题项目(09MA055)
