目的 分析白细胞介素13(IL-13)及其受体亚型α2(IL-13Rα2)在嗜酸粒细胞性慢性鼻-鼻窦炎伴鼻息肉(ECRSwNP)和非ECRSwNP患者中的表达及其意义.方法 回顾性分析60例接受鼻内镜手术的慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者,依据术后组织病理检查中鼻息肉组织嗜酸粒细胞计数(每高倍视野＞5为ECRSwNP),将病例分为ECRSwNP和非ECRSwNP两组.其中ECRSwNP患者27例,非ECRSwNP患者33例.所有患者术前进行临床症状视觉模拟量表(VAS)评分、鼻内镜检查与鼻息肉病变评分、鼻窦CT检查与病变Lund-Mackay评分、血嗜酸粒细胞计数与百分比和血清总IgE水平测定.术后通过免疫组织化学染色及半定量分析IL-13和IL-13Rα2在鼻息肉组织中的表达.以SPSS 16.0软件进行统计学分析.结果 两组患者平均症状得分、总血清IgE水平差异无统计学意义(t值分别为0.102、0.659,P值均＞0.05).两组患者鼻息肉病变得分分别为(3.6±1.1)、(2.1±0.8)分,差异有统计学意义(t=4.009,P＜0.01);双侧鼻息肉发生率、鼻窦病变CT得分、术前外周血嗜酸粒细胞计数、嗜酸粒细胞百分比、每个高倍镜视野下嗜酸粒细胞计数差异均有统计学意义(x2或t值分别为15.879、4.428、3.148、3.038、5.100,P值均＜0.01).ECRSwNP组患者组织嗜酸粒细胞计数与外周血嗜酸粒细胞计数和百分比之间呈正相关(r值分别为0.683、0.631,P值均＜0.01).ECRSwNP组患者组织IL-13和IL-13Rα2的表达得分分别为(8.1±1.6)、(8.8±1.4)分,较非ECRSwNP组患者的(5.4±1.6)、(4.8±1.6)分,明显增高,差异有统计学意义(t值分别为7.749、8.010,P值均＜0.01).ECRSwNP组患者鼻息肉组织IL-13和IL-13Rα2高表达率、阳性细胞比例、高倍镜视野下阳性细胞计数均较非ECRSwNP明显增强,差异有统计学意义(P值均＜0.01).结论 与非ECRSwNP相比,ECRSwNP组患者鼻息肉与鼻窦病变程度较重,鼻息肉组织IL-13与IL-13Rα2的表达明显增加.对CRSwNP亚型的区分有助于对其发病机制的认识及治疗策略的选择.%Objective To evaluate the expressions of interleukin (IL) 13 and its receptor IL-13Rα2 in eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) and non-ECRSwNP and their clinicopathological implications.Methods A total of 60 consecutive patients with CRSwNP who underwent endoscopic sinus surgery (ESS) were divided into two groups of ECRSwNP (n =27) and non-ECRSwNP (n =33) based on tissue eosinophil count (more than five cells per high power field) with postoperative pathological examination.Before ESS,the severities of symptoms,nasal polyps,and sinonasal diseases on CT were scored,peripheral blood eosinophil count and percentage,and total serum IgE level were measured.IL-13 and IL-13Rα2 expressions in polyp tissues were examined with immunohistochemistry.SPSS 16.0software was used to analyze the data.Results There was no significant differences between ECRSwNP and non-ECRSwNP groups in the mean symptom scores (t =0.102,P ＞ 0.05),but ECRSwNP,compared to nonECRSwNP,demonstrated a higher incidence of bilateral polyps (x2 =15.879,P ＜ 0.01),a higher mean score of nasal polyps (3.6 ± 1.1 vs 2.1 ± 0.8,t =4.009,P ＜ 0.01) or diseases on CT (t =4.428,P ＜0.01).And also a significant difference existed between two groups in mean blood eosinophil count (t =3.148,P ＜ 0.01) or percentage (t =3.038,P ＜ 0.01),but no significant difference in total serum levels of IgE (t =0.659,P ＞ 0.05).There was a closed correlation between tissue eosinophil count and blood eosinophil count (r =0.683,P ＜0.01) or percentage (r =0.631,P ＜0.01) in ECRSwNP,but not in nonECRSwNP.The expressions of both IL-13 and IL-13Rα2 increased significantly in ECRSwNP compared to non-ECRSwNP (scores 8.1 ± 1.6 vs.5.4 ± 1.6; 8.8 ± 1.4 vs.4.8 ± 1.6,t value was 4.749,8.010,P＜ 0.01).Conclusions IL-13 and IL-13Rα2 are associated closely with pathogenesis of ECRSwNP.Subtyping CRSwNP and studying underly mechanism can be helpful to make treatment strategy for CRSwNP.
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