慢性鼻竇炎併鼻息肉主要為源自篩竇、上頷竇及中鼻甲附近區域的發炎 反應，然其詳細的病因及發生機轉仍不清楚。顯微鏡下可見以嗜酸性球為主 的鼻竇黏膜發炎細胞浸潤，先前研究顯示此一現象受到趨化嗜酸性球的細胞 激素表現所調控，故推測鼻息肉的形成可能與微生物感染、過敏原刺激及宿 主本身的免疫反應有關。 CC 趨化激素 Eotaxin 及 RANTES 已證實可吸引嗜 酸性球至發炎部位，本實驗即試圖了解這些對嗜酸性球有特異性之趨化激素 的蛋白質在慢性鼻竇炎併鼻息肉病人血液中的表現情形其與疾病嚴重度及周 邊血液嗜酸性球濃度的的相關性，以探討 CC 趨化激素在慢性鼻竇炎病鼻息 肉發病過程中所扮演的角色。 20 位即將進行鼻竇內視鏡手術的慢性鼻竇炎病 人為實驗組，取其血清進行研究，並以鼻竇電腦斷層攝影結果，使用 Lund-M acKay 法判斷其臨床嚴重度 ; 另取 20 位正常人之血液樣本為對照組。結果顯 示實驗組血液中 Eotaxin 及 RANTES 的濃度均較對照組為高，呈現有意義的 差異 (p<0.05) 。臨床嚴重度則與 Eotaxin 及 RANTES 濃度均呈正相關，但 E otaxin 的相關性較強。另以實驗組血液中 Eotaxin 及 RANTES 與血液嗜酸性 球比率加以比較，結果 Eotaxin 及 RANTES 均呈現正相關。我們認為對慢性 鼻竇炎病人而言，疾病嚴重度主要與 Eotaxin 之表現有關，暗示其在趨化嗜酸 性球由周邊血液至病灶發炎部位，及疾病的病理生理機轉上扮演較重要的角 色。
慢性鼻竇炎病人趨化激素 RANTES, Eotaxin 與疾 病嚴重度的相關性
Chronic rhinosinusitis and nasal polyps mainly develop in the ethmoid sinus, maxillary sinus and m iddle turbinate area, often in relation to inflammatory and allergic conditions. Their exact etiology a nd pathogenesis are still under debate. Histologically, inflammatory cell infiltrations of nasal mucos a predominated by eosinophils are typical for such disease, and may be due to the chemotactic activ ity of chemokines specific for eosinophils. This findings suggest that nasal polyp is an inflammator y growth that is controlled by the local environment and the immunologic defense mechanism of th e host. The CC-chemokine Eotaxin and RANTES (regulated on activation normal T cell expressed and secreted) have been postulated to be involved in the recruitment of eosinophils toward inflamed tissues. To explore their possible roles in chronic rhinosinusitis, we examined the concentraion of E otaxin and RANTES protein in the serum of patients and correlated these results to the severity of d isease graded by sinus CT imaging. Serum samples were obtained from 20 of patients undergoing e ndoscopic sinus surgery, and blood samples of 20 normal control subjects were also drawn. Enzym e-linked immunosorbent assay(ELISA) for Eotaxin and RANTES protein of serum was performed, and the relationship between these results and the Lund-MacKay rhinosinusitis scoring system and t he percentage of peripheral eosinophil were investigated. In comparison to normal control group, w e found significant elevation of Eotaxin and RANTES protein in the serum of experimental group(p
<0.05). The levels of serum Eotaxin and RANTES in patients were correlated with the severity of th e disease; with Eotaxin showed a more statistical significance. Besides, RANTES and Eotaxin level s were correlated with the percentage of peripheral eosinophil(p<0.05). These data suggest that, in p atients of chronic rhinosinusitis with nasal polyp, disease severity correlates mainly with Eotaxin, a nd that RANTES may play a less important role in the mobilization of eosinophils from the blood i nto inflamed tissues. Further larger experiment was anticipated to validate this correlation.
Levels of RANTES, Eotaxin in the patients with chronic rhinosinusitis and its correlation with
severity of the disease
