目的 比较类几丁质酶YKL-40及Toll样受体4(TLR4)在慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)与不伴鼻息肉(chronic rhinosinusitis without nasal polyps,CRSsNP)患者鼻窦黏膜中表达的差异及其临床意义.方法 选取在山东大学齐鲁医院住院治疗的CRSwNP患者22例,CRSsNP者17例作为试验组,取其鼻窦黏膜;收集18例鼻中隔偏曲患者的下鼻甲黏膜作为对照组,采用实时荧光定量反转录聚合酶链反应(RT-PCR)检测各组中YKL-40、TLR4及核因子κB(NF-κB) mRNA的相对表达量;免疫组织化学染色检测YKL-40和TLR4蛋白在组织中的表达强度及分布.以SPSS 17.0软件分析各组中相关因子的表达差异及各因子间的相关性.结果 mRNA水平:YKL-40在CRSwNP组中的相对表达量为0.91 ±0.17,高于对照组的0.49±0.09,差异有统计学意义(=2.12 P ＜0.05).TLR4在CRSsNP组、CRSwNP中的相对表达量分别为0.88±0.19、0.67±0.13,均低于对照组的1.48±0.14,差异有统计学意义(t值分别为-4.11、-2.48,P值均＜0.05).NF-κB在CRSsNP组、CRSwNP中的相对表达量分别为0.69 ±0.13、0.72 ±0.14,均低于对照组的1.20 ±0.15,差异有统计学意义(t值分别为2.33、2.27,P值均＜0.05).蛋白质水平:YKL-40在CRSwNP组中的表达高于CRSsNP组和对照组(U值分别为72.5、73,P值均＜0.01);TLR4在CRSwNP和CRSsNP组中的表达低于对照组(U值分别为62、38,P值均＜0.01).CRSwNP组YKL-40与TLR4呈负相关(rmRNA=-0.741,P＜0.01;r蛋白质=-0.46,P＜0.05).结论 YKL-40在CRSwNP鼻窦黏膜组织高表达,且与TLR4呈负相关,提示二者可能存在交互作用,同时参与了CRSwNP的发生发展.%Objective To explore the expression of YKL-40,TLR4 and NF-κB in chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP and CRSsNP),and to investigate their expressional correlation and the potential role in pathogenesis of CRS.Methods The specimens were obtained from sinus mucosa and inferior turbinate mucosa of the patients with informed consent.The different expression of YKL-40,TLR4 and NF-κB among each group was detected by real time RT-PCR and immunohistochemistry(S-P method).SPSS 17.0 software was used to analyze the data.Results mRNA level:The relative expression of YKL-40 in CRSwNP group (0.91 ± 0.17) was higher than those in the control group (0.49 ± 0.09),the difference was significant (t =2.12,P ＜ 0.05).The relative expression of TLR4 in CRSsNP group(0.88 ±0.19) and CRSwNP group(0.67 ± 0.13) were lower than those in control group(1.48 ± 0.14),the differences were significant (t value was-4.11,-2.48,all P ＜ 0.05).The relative expression of NF-κB in CRSsNP group (0.69 ± 0.13) and CRSwNP group (0.72 ± 0.14) were lower than those in control group(1.20 ±0.15),the differences were significant(t value was 2.33,2.27,all P ＜0.05).Protein level:The expression of YKL-40 in CRSwNP group was stronger than that in CRSsNP group and control group (U value was 72.5 and 73,all P ＜0.01).The expression of TLR4 in CRSwNP group and CRSsNP group was weaker than that in control group(U value was 62 and 38,all P ＜ 0.01).There was a negative correlation between YKL-40 and TLR4 (rmRNA =-0.741,P ＜ 0.01 ; rprotein =-0.46,P ＜ 0.05)in CRSwNP group.Conclusions The expression of YKL-40 in pantients with CRSwNP is higher than those in healthy control and CRSsNP patients.There was a negative correlation between YKL-40 and TLR4.Both of them may be involved in the pathogenesis of CRSwNP.
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