| Objective: At present the micro and ultramicro structure of the ostiomeatal complex (OMC) mucosa in chronic sinusitis and nasal polyps (CSNP) have been observed abundantly. But these studies were mostly on the basis of the Chinese classification of CSNP. These observation results proved that the Chinese classification of CSNP had pathological basis, interpresented the occurrence, development and regularity of CSNP. With the increasing recognition of nasal diseases, the mucosal succession of nasal cavity and nasal sinuses has been generally accepted. Rhinitis and sinusitis influenced each other. The traditional name of sinusitis is replaced by the rhinosinusitis now. For the past few years, we have found that there wasn't evident improvement of chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS) and the recurrence was frequent in clinical practise. For this reason, some scholars presented the allergic factor may play a important role in the occurrence and recurrence of CRS. In the present study we observed the distinction between the allergy group and infection group with light and scanning electron microscope. We hope to provid a new idea from the etiology view for the new classification and treatment perscriptions of CRS. Methods: We observed the diference in pathomorphology among the three groups (the control, allergy and infection) with light and scanning electron microscope.1 The choice of subjectsThe patients were randomly enrolled as the case group, who were in our hospital and need ESS in my department during March 2006 to September 2006, besides of the patients who were caused by fungous infection, primarily mucosal cilia structure and unctional disturbance, cystic fibrosis, granulocytosis anallergic rhinitis, general immunity disease, the recurrence after ESS, et al. According to the table 1, we used weight-integration method and divided the patients into three groups. As follows: the infection group was one to six scores, the mixed group was seven to fifteen scores and the allergy group was sixteen to twenty-three scores. The allergy and infection groups were enrolled as the case group, and there were twenty patients in every group. We selected randomly five patients from each group who were observed by SEM. The control group were composed of patients who need nasal septal construction and didn't have other nasal diseases. We also selected randomly five patients from the controls who were observed by SEM.2 The preparation and observation of specimens2.1 Light microscope specimensWe fixed the OMC mucosa with 10% formalin, dehydrate automatically, paraffin imbedding, and sect serial sections three pieces which thickness was 4μm. HE, Van Giesoncs, and alcianblue-periodicacid-schiff (AB-PAS) staining were used to observe the changes of epithelium, goblet cell, basement membrance, mucosal interstitial substance, inflammatory cell and mucous glands, to measure the thickness of basement membrance and the area of mucous glands.2.2 SEM specimensWe took the OMC mucosa during the operation, which were agitated and washed with 4℃normal sodium (NS), fixed with 2.5% glutaraldehyde for 2h quickly, then dehydrated and dried gradiently with alcohol, plated metal membrane. Finally we observed the cilium quantity, desquamation, disorder and disorientation with SEM.3 statistics managementCompletely randomized one-way analysis of variance and Student-Newman-Keuls test were used to analyze the data.α<0.05 was considered as significant difference.Results: The appearance in pathomorphology were different among the three groups. The following were the changes under HE,VG,AB-PAS staining and SEM.1 The changes of OMC mucosal epithelium with HE stainingThe mucosa of healthy controls was smooth and glossy, dominated by ciliated cells mostly. The cilia was neat and erect, the basement membrane was not thickening, the interstitial substance was not hydropsia, and the inflammatory cells were not increasing. There were different changes in the OMC mucosa of the case group, including of the increase of the goblet cell, the thickening of the basement membrane, the infiltration of the inflammatory cells, the hyperplasy of the mucous glands and the epithelial fiber tissue. These changes in allergy group were more obvious than that in infection group.2 The thickness of the basement membrane under VG stainingThe thickness of the basement membrane ( x±s) was (8.574±0.624)μm in control group, (14.552±0.641)μm in allergy group, and (12.561±0.493)μm in infection group. Comparision to the controls, the basement membrane of the case group was thicking, which was observed on the VG stained specimens. The thicking of the basement membrane in allergy group was more significant than that in infection group, which had significant difference (P<0.05).3 The area of the mucous glands under AB-PAS stainingThe area of the mucous glands ( x±s) was (0.082±0.006) mm 2 in control group, (0.184±0.007) mm 2 in allergy group, and (0.137±0.005) mm 2 in infection group. The mucous glands were few in controls. Conversely, the case group showed obviously increased mucous glands, gland alveolus distension, and high secretion. The area of the mucous glands in allergy was larger than that of the infection group, and there was significant difference (P<0.05).4 The observation of the epithelium by SEMThe cilia in the controls was well-distributed, neat, consistent arranged orientation. The epithelium of the case group appeared different pathological characteristics. The cilia in the allergy group was disordered,lodging,clustered and adhered by a large of mucus. But in the infection group we observed the desquamation of cilia in large pieces and replacement of microvilli. Gaps of the cell extended obviously. The remnant cilia was leaned, fractured and in disorder.Conclusion: Through the observation of micro and ultramicro structure of different types CRS, we found there was distinction between the allergy group and infection group. For this reason, the etiological factor was complicated and multiplex. The classification of CRS according to the etiopathogenisis may make for the diagnosis and treatment of CRS. |
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