Katsuta Shinya, Osafune Hirotaka, Takita Rumi, Sugamata Masao
First Department of Otorhinolaryngology, Toho University, School of Medicine, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 2002 Dec;105(12):1189-97. doi: 10.3950/jibiinkoka.105.1189.
To evaluate the therapeutic effect of Roxithromycin (RXM), we studied 56 chronic sinusitis patients with nasal polyps using computed tomography (CT) and electron microscopy in addition to conventional clinical assessment. The paranasal sinus of subjects was observed clinically before and after daily administration of RXM at 300 mg for 3 months all underwent allergy testing for possible complications of allergic rhinitis based on subjective symptoms and objective findings. Improvement after RXM treatment was seen in 50.3% based on subjective symptoms and 59.1% based on objective findings. Overall improvement was seen in 53.6%. In 41 cases (73.2%) of all patients with chronic sinusitis and complications of allergic rhinitis, no significant difference was seen between patients with and without complications (53.7% in those with complications and 53.3% in those without). In CT analysis the paranasal sinus in 51.8% of all posttreated patients showed obvious improvement. In electron microscopy in chronic sinusitis patients with complications of allergic rhinitis, pretreated ethmoidal sinus tissues showed high mucous epithelial cell apoptosis in addition to common histological lesions, while posttreatment patients showed only eosinophil apoptosis in the interstitium and no apoptotic epithelial cells. We divided ethmoidal sinus lesions in patients without complications into 3 types and evaluated them as follows: In type 1, pretreated ethmoidal sinus tissues showed plasma cell infiltration and posttreatment cell apoptosis. In type 2, pretreated tissues showed lymphocyte and plasma cell infiltration and posttreated showed only some lymphocytes and no plasma cells. In type 3, proliferation of fibroblasts, most of which showed apoptosis, was seen in addition to apoptotic epithelial cells before treatment, while after treatment, these lesions remained with some apoptotic bodies phagocytosed by macrophages. In type 3 patients relapsed after surgery. Our findings indicate that RXM treatment had a significant therapeutic effect on chronic sinusitis with nasal polyps with and without complications of allergic rhinitis. We clarify the morphological mechanism of therapeutic effect of RXM on each type of ethmoidal sinus lesion divided by light and electron microscopy.
为评估罗红霉素（RXM）的治疗效果，我们除了进行常规临床评估外，还使用计算机断层扫描（CT）和电子显微镜对56例患有鼻息肉的慢性鼻窦炎患者进行了研究。在每日服用300毫克RXM 3个月前后，对受试者的鼻窦进行了临床观察，并根据主观症状和客观检查结果，对所有患者进行了过敏性鼻炎可能并发症的过敏测试。基于主观症状，RXM治疗后有50.3%的患者病情改善；基于客观检查结果，改善率为59.1%。总体改善率为53.6%。在所有患有慢性鼻窦炎并伴有过敏性鼻炎并发症的患者中，41例（73.2%）有并发症患者与无并发症患者之间无显著差异（有并发症患者为53.7%，无并发症患者为53.3%）。CT分析显示，所有接受治疗后的患者中，51.8%的鼻窦有明显改善。在电子显微镜检查中，患有过敏性鼻炎并发症的慢性鼻窦炎患者，治疗前筛窦组织除常见组织学病变外，黏液上皮细胞凋亡率高，而治疗后患者仅间质中有嗜酸性粒细胞凋亡，无凋亡上皮细胞。我们将无并发症患者的筛窦病变分为3型并进行如下评估：1型，治疗前筛窦组织有浆细胞浸润，治疗后细胞凋亡；2型，治疗前组织有淋巴细胞和浆细胞浸润，治疗后仅见一些淋巴细胞，无浆细胞；3型，治疗前除凋亡上皮细胞外，可见成纤维细胞增殖，多数成纤维细胞显示凋亡，治疗后这些病变仍存在，并有一些被巨噬细胞吞噬的凋亡小体。3型患者术后复发。我们的研究结果表明，RXM治疗对伴有或不伴有过敏性鼻炎并发症的鼻息肉慢性鼻窦炎有显著治疗效果。我们通过光学显微镜和电子显微镜阐明了RXM对各型筛窦病变治疗效果的形态学机制。
