慢性鼻竇炎病人趨化激素 RANTES, Eotaxin 與疾病嚴重度的相關性 Levels of RANTES, Eotaxin in the patients with chronic rhinosinusitis and its correlation with severity of the disease
中文摘要
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-MacKay 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 Eotaxin 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。
英文摘要
Chronic rhinosinusitis and nasal polyps mainly develop in the ethmoid sinus, maxillary sinus and middle turbinate area, often in relation to inflammatory and allergic conditions. Their exact etiology and pathogenesis are still under debate.
Histologically, inflammatory cell infiltrations of nasal mucosa predominated by eosinophils are typical for such disease, and may be due to the chemotactic activity of chemokines specific for eosinophils. This findings suggest that nasal polyp is an inflammatory growth that is controlled by the local environment and the immunologic defense mechanism of the 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 Eotaxin and RANTES protein in the serum of patients and correlated these results to the severity of disease graded by sinus CT imaging. Serum samples were obtained from 20 of
patients undergoing endoscopic sinus surgery, and blood samples of 20 normal control subjects were also drawn. Enzyme-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 the percentage of peripheral eosinophil were investigated. In comparison to normal control group, we 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 the disease; with Eotaxin showed a more
statistical significance. Besides, RANTES and Eotaxin levels were correlated with the percentage of peripheral eosinophil(p<0.05). These data suggest that, in patients of chronic rhinosinusitis with nasal polyp, disease severity correlates mainly with Eotaxin, and that RANTES may play a less important role in the mobilization of eosinophils from the blood into inflamed tissues. Further larger experiment was anticipated to validate this correlation.
