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鼻炎患者鼻气道炎症的客观监测。

Objective monitoring of nasal airway inflammation in rhinitis.

作者信息

Howarth Peter H, Persson Carl G A, Meltzer Eli O, Jacobson Mikila R, Durham Stephen R, Silkoff Philip E

机构信息

IIR Research Division, Mail Point 810, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, United Kingdom.

出版信息

J Allergy Clin Immunol. 2005 Mar;115(3 Suppl 1):S414-41. doi: 10.1016/j.jaci.2004.12.1134.

Abstract

Allergic rhinitis is an inflammatory nasal disorder in which a range of different cells participates. A variety of approaches has been used to monitor nasal inflammation objectively to investigate disease processes and to evaluate the effect of therapeutic intervention. These approaches include nasal lavage, nasal cytology, and nasal biopsy, together with the more recently established measurement of nasal nitric oxide (NO) concentration. Although all provide information about nasal mucosal inflammation, the extent of information that can be obtained by each approach, the ease of sampling, and the complexity of sample handling differ. Such considerations influence the choice of approach when measurement of nasal inflammation is to be an objective outcome parameter in a clinical trial. In addition, the choice of approach is also determined by the questions or hypotheses that are to be addressed. Nasal lavage is simple and rapid to perform, is well tolerated, and provides a sample that can provide information about luminal cell recruitment, cell activation, and plasma protein extravasation. Nasal cytology involves sampling and recovering mucosal surface cells. It is also easy to perform and is well tolerated in general, although some find that the procedure causes a transient unpleasant sensation. A differential cell count from the sample provides information about relative cell populations. Both nasal lavage and nasal cytology are readily applicable to clinical trials. Nasal cytology sample handling is easier, but nasal lavage offers the advantage of providing considerably greater information from the sample. Nasal biopsy is a considerably more invasive procedure and requires expertise not only in tissue sampling but also in biopsy processing. Therefore, it is applicable only in specialist centers. However, nasal biopsy is the only sampling technique that directly informs about tissue cellular events, although these may be implied, in part from the other sampling approaches. Tissue specimens can be used to evaluate both protein and gene expression. Measurement of nasal NO involves expensive equipment but provides an instantaneous result, unlike the other approaches, all of which require sample processing and analysis. Recommendations for standardization of measurement have been made, and measures are considered in part to reflect allergic inflammation within the nasal mucosa. The limitations of nasal NO are that it reflects only a certain aspect of allergic mucosal inflammation, and that because a proportion of nasally measured NO is derived from the sinuses under normal circumstances, nasal NO is not specific for nasal disease. The high contribution from the sinus mucosa limits the discriminatory ability of nasal NO to reflect nasal tissue-specific alterations. The incorporation of measures of nasal inflammation in clinical trials has distinguished anti-inflammatory therapy from symptomatic therapy and has the potential to provide information about the efficacy of novel therapies for allergic rhinitis.

摘要

变应性鼻炎是一种多种不同细胞参与的鼻腔炎症性疾病。已采用多种方法来客观监测鼻腔炎症,以研究疾病过程并评估治疗干预的效果。这些方法包括鼻腔灌洗、鼻细胞学检查和鼻活检,以及最近建立的鼻腔一氧化氮(NO)浓度测量。尽管所有这些方法都能提供有关鼻黏膜炎症的信息,但每种方法可获得的信息量、采样的难易程度以及样本处理的复杂性各不相同。当在临床试验中将鼻腔炎症测量作为一个客观的结局参数时,这些因素会影响方法的选择。此外,方法的选择还取决于要解决的问题或假设。鼻腔灌洗操作简单、快速,耐受性良好,所提供的样本可提供有关管腔细胞募集、细胞活化和血浆蛋白外渗的信息。鼻细胞学检查涉及采样和回收黏膜表面细胞。它通常也易于操作且耐受性良好,尽管有些人觉得该操作会引起短暂的不适感。对样本进行细胞分类计数可提供有关相对细胞群体的信息。鼻腔灌洗和鼻细胞学检查都很容易应用于临床试验。鼻细胞学检查的样本处理更容易,但鼻腔灌洗的优势在于能从样本中提供更多得多的信息。鼻活检是一种侵入性大得多的操作,不仅在组织采样方面需要专业知识,在活检处理方面也需要专业知识。因此,它仅适用于专科中心。然而,鼻活检是唯一能直接告知组织细胞事件的采样技术,尽管这些事件在一定程度上也可从其他采样方法中推断出来。组织标本可用于评估蛋白质和基因表达。鼻腔NO的测量需要昂贵的设备,但能提供即时结果,这与其他方法不同,其他方法都需要样本处理和分析。已针对测量标准化提出了建议,这些测量方法部分被认为可反映鼻黏膜内的变应性炎症。鼻腔NO的局限性在于它仅反映变应性黏膜炎症的某一方面,而且由于在正常情况下经鼻腔测量的NO有一部分来自鼻窦,所以鼻腔NO对鼻腔疾病并不具有特异性。鼻窦黏膜的高贡献率限制了鼻腔NO反映鼻腔组织特异性改变的鉴别能力。在临床试验中纳入鼻腔炎症测量方法,已将抗炎治疗与对症治疗区分开来,并有可能提供有关变应性鼻炎新疗法疗效的信息。

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