Iino Y, Nagamine H, Yabe T, Matsutani S
Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Clin Exp Allergy. 2001 Jul;31(7):1135-43. doi: 10.1046/j.1365-2222.2001.01134.x.
Although patients with intractable otitis media associated with bronchial asthma have extensive accumulation of eosinophils in the middle ear mucosa and middle ear effusion, systematic histological and immunohistochemical studies have not been performed.
To clarify the pathogenesis of middle ear diseases, we carried out immunohistochemical studies on middle ear specimens, particularly focusing on the characteristics of accumulated eosinophils.
Middle ear specimens obtained from eight adult patients and from 17 controls were immunohistochemically stained using monoclonal antibodies against EG1, EG2, mast cell tryptase, IgA and IgE. The concentration of eosinophil cationic protein (ECP) in middle ear effusion samples was also measured.
In the asthmatic patients, severe round-cell infiltration was observed in the submucosa and most of the EG1-positive cells were also EG2-positive. In the control patients, the mucosa showed a fibrotic change with a few inflammatory cells, and EG1- or EG2-positive cells were quite few. The expression of IgE was found not only on the surface of mast cells but also within the plasma cells in the asthmatic patients, and the number of IgE-positive cells was about twice as high as that of mast cells. A significantly higher concentration of ECP was noted in middle ear effusion obtained from the asthmatic patients than that from the control patients.
Most of the eosinophils in the middle ear mucosa and middle ear effusion were activated, resulting in degranulation and release of ECP, and local IgE production occurs in the middle ear mucosa, indicating that the intractable inflammation is closely associated with IgE-mediated late phase response with eosinophil accumulation.
尽管伴有支气管哮喘的难治性中耳炎患者中耳黏膜和中耳积液中有大量嗜酸性粒细胞积聚，但尚未进行系统的组织学和免疫组织化学研究。
为阐明中耳疾病的发病机制，我们对中耳标本进行了免疫组织化学研究，尤其关注积聚的嗜酸性粒细胞的特征。
对8例成年患者和17例对照者的中耳标本使用抗EG1、EG2、肥大细胞类胰蛋白酶、IgA和IgE的单克隆抗体进行免疫组织化学染色。还测量了中耳积液样本中嗜酸性粒细胞阳离子蛋白（ECP）的浓度。
在哮喘患者中，黏膜下层观察到严重的圆形细胞浸润，大多数EG1阳性细胞也是EG2阳性。在对照患者中，黏膜显示纤维化改变，伴有少量炎症细胞，EG1或EG2阳性细胞很少。在哮喘患者中，不仅在肥大细胞表面而且在浆细胞内都发现了IgE的表达，IgE阳性细胞的数量约为肥大细胞的两倍。哮喘患者中耳积液中ECP的浓度明显高于对照患者。
中耳黏膜和中耳积液中的大多数嗜酸性粒细胞被激活，导致脱颗粒和ECP释放，中耳黏膜中发生局部IgE产生，表明难治性炎症与嗜酸性粒细胞积聚的IgE介导的迟发性反应密切相关。
