Immune Mechanisms And Pathological Prognosis Of Nasal Mucosa Inflammation

Rhinitis is the focus of nasal clinic and scientific practice, the etiology of which is complex. There is no precise understanding in pathophysiological mechanisms, and its occurrence, development and prognosis are far from clear.Rhinitis refers to inflammation of the nasal mucosa, some of which are allergic and autoimmune itself, and the others are induced by the allergic and autoimmune diseases as factors in the pathogenesis. So the immune mechanism is important in the inflammatory process, especially in chronic process.It is a major discovery of modern immunology that immune response is controlled by the two subgroups T helper cell, which can be divided into two subtypes according to the secretion of the different cytokines: Th1 cells and Th2 cells. An immune deviation towards the Th1 pattern will lead to chronic inflammation,while the immune deviation towards the Th2 pattern will lead to atopic allergic diseases. Thus, Th1/Th2 balance is one of the important mechanisms in maintaining the health of whole body and local nasal mucosa.In this study, the immune mechanisms and the pathological changes of the nasal mucosa inflammation caused by allergic rhinitis, chronic nasal-sinusitis with nasal polyps, chronic nasal-sinusitis without nasal polyps and nasal septum deviation were compared, which will provide some theoretical basis for the design of a comprehensive treatment plan and the assessment of prognosis.PARTⅠIMMUNE MECHANISMS OF NASAL MUCOSA INFLAMMATIONObjective: Thl/Th2 related cytokines IL-12, IL-4 leves in the peripheral blood of patients with allergic rhinitis, chronic nasal-sinusitis with nasal polyps, chronic nasal-sinusitis without nasal polyps and nasal septum deviation will be detected in order to discuss the similarities and differences of the immune mechanisms in common clinical rhinitis.Methods: The plasma of patients with allergic rhinitis, chronic nasal-sinusitis with nasal polyps, chronic nasal-sinusitis without nasal polyps and the nasal septum deviation in the department of Otorhinolaryngology of the First Affiliated Hospital of Chongqing Medical University were collected from June to December in 2008, and were detected of IL-4, IL-12 levels by enzyme-linked immunosorbent assay (ELISA).Statistical analysis was performed by the SPSS13.0(Statistical Package for Social Sciences, version 13.0) Results: The IL-4 levels of AR group, CRSwNP group, CRSsNPgroup and nasal septum deviation group were significantly higher than the control group(P<0.05), there were no significant differences between the four groups.The IL-12 levels of CRSwNP and CRSsNP groups were significantly higher than the control group, while the IL-12 levels of AR and nasal septum deviation group were not significantly lower than the control group(P>0.05), but both significantly lower than the CRSsNP and CRSwNP groups(P<0.05).Conclusion: The differentiation and mature of Th1 cells are inhibited, and there is an immune deviation towards the Th2 pattern in the patients with AR and NSD. Th1/Th2 cells are both involved in the entire inflammatory process in the patients with CRSwNP and CRSsNP. Therefore, relationship of Th1/Th2 cells is considered playing an important role in the occurrence and development in nasal mucosa inflammation.PARTⅡPATHOLOGICAL PROGNOSIS OF NASAL MUCOSA INFLAMMATIONObjective: The nasal mucosa of the patients with allergic rhinitis, chronic nasal-sinusitis with nasal polyps, chronic nasal-sinusitis without nasal polyps and nasal septum deviation were observed by SEM respectively, a comprehensive comparison of these four rhinitis were made in the similarities and differences of pathological changes.Methods: Four pieces of nasal mucosa with the size of 0.5cm×0.5cm, were gotten by endoscopic from one patient randomly choosed from 4 groups respectively in PARTⅠ, and were observed by SEM.Results: Under the SEM, the cilia loss of columnar epithelial cells in AR patients was obvious, with increased spacing of columnar epithelial cells, and exposure of basement membrane; columnar epithelial cells were integrated into bundles, dumping to different directions; large numbers of short-cilia and microvilli were distributed and staggered with the cilia; many prostrate microvilli were seen on the surface of columnar epithelial cells. In the patients with CRSsNP, there were disorders of cilia arrayes, like the mesh on top of the columnar epithelial cells, cilia were fell off and were replaced by microvilli. The patients with CRSwNP compared with CRSsNP, the nasal mucosa damage was much more obvious, normal cilia almost couldn't be seen, and many columnar epithelial cells were lost, exposing large areas of basement membrane. The morphological changes in the patients with NSD were relatively minor, but there were still cilia integration, lack of direction and loosely connected cells,etc.Conclusion: The results of this study show that there are similarities and differences on the extent and nature of pathological changes of nasal ciliated columnar epithelium in patient with the four types of rhinitis, and suggest that a comprehensive treatment including anti-infective, anti-allergic,exciting cilia as well as nasal surgery to correct deformities should be adopted for these patients, which can effectively prevent the development and expanding of the nasal mucosa inflammation.