Seiberling Kristin A, Conley David B, Tripathi Anju, Grammer Leslie C, Shuh Lydia, Haines G Kenneth, Schleimer Robert, Kern Robert C
Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Chicago, IL 60611, USA.
Laryngoscope. 2005 Sep;115(9):1580-5. doi: 10.1097/01.mlg.0000168111.11802.9c.
OBJECTIVE/HYPOTHESIS: The role of infectious agents in the etiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. Recent studies have provided indirect evidence of exposure to staphylococcal exotoxins in the blood and polyp tissue of patients with CRSwNP. These exotoxins have the capacity to act as superantigens, bypassing normal antigen processing and directly stimulating a massive inflammatory response. The objective of the study was to analyze mucus and polyp tissue samples from patients with CRSwNP for the presence of staphylococcal exotoxins.
Prospective study.
Tissue and mucus samples were obtained from 42 patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and 11 normal control patients. Twenty-nine of 42 patients had chronic rhinosinusitis with bilateral nasal polyposis, 2 had antrochoanal polyps, and 11 had chronic rhinosinusitis without nasal polyps. Eleven patients without chronic rhinosinusitis or polyps served as normal control patients. Specimens were analyzed for the presence of five staphylococcal exotoxins (SEA, SEB, SEC, SED, and toxic shock syndrome toxin type 1 [TSST-1]) using enzyme-linked immunosorbent assay (ELISA). Histological analysis of specimens and mean eosinophil counts were correlated with the presence of toxin.
At least one toxin was detected in 14 of 29 patients with bilateral nasal polyposis. Nine of the 14 patients also had positive findings for additional toxins. The dominant histological pattern in the CRSwNP patient group was polypoid mucosa with edema, which was found in both ELISA-positive and ELISA-negative patients. Mean eosinophil counts tended to be higher in ELISA-positive patients with polyps compared with patients without toxin detection. No toxin was detected in the 11 specimens taken from normal control patients. Only 1 of the 13 patients with CRS without polyps had positive ELISA results for toxin.
The current study demonstrates the presence of superantigen toxins in 14 of 29 patients with CRSwNP, with SEB and TSST-1 being the most common. Further studies are necessary to correlate the presence of toxin with the pathological changes present in polyp tissue.
目的/假设：感染因子在伴鼻息肉的慢性鼻-鼻窦炎（CRSwNP）病因学中的作用仍不明确。近期研究提供了间接证据，表明CRSwNP患者的血液和息肉组织中存在葡萄球菌外毒素暴露。这些外毒素具有作为超抗原的能力，可绕过正常的抗原处理过程，直接刺激大规模炎症反应。本研究的目的是分析CRSwNP患者的黏液和息肉组织样本中是否存在葡萄球菌外毒素。
前瞻性研究。
从42例因慢性鼻-鼻窦炎接受鼻内镜鼻窦手术的患者及11例正常对照患者中获取组织和黏液样本。42例患者中，29例患有双侧鼻息肉的慢性鼻-鼻窦炎，2例患有上颌窦后鼻孔息肉，11例患有无鼻息肉的慢性鼻-鼻窦炎。11例无慢性鼻-鼻窦炎或息肉的患者作为正常对照。使用酶联免疫吸附测定（ELISA）分析样本中五种葡萄球菌外毒素（SEA、SEB、SEC、SED和1型中毒性休克综合征毒素[TSST-1]）的存在情况。对样本进行组织学分析，并将嗜酸性粒细胞平均计数与毒素的存在情况相关联。
29例双侧鼻息肉患者中有14例检测到至少一种毒素。这14例患者中有9例还检测到其他毒素呈阳性。CRSwNP患者组的主要组织学模式为息肉样黏膜伴水肿，ELISA阳性和ELISA阴性患者中均有发现。与未检测到毒素的患者相比，ELISA阳性的息肉患者嗜酸性粒细胞平均计数往往更高。11例正常对照患者的样本中未检测到毒素。13例无息肉的慢性鼻-鼻窦炎患者中只有1例ELISA毒素检测呈阳性。
本研究表明，29例CRSwNP患者中有14例存在超抗原毒素，其中SEB和TSST-1最为常见。有必要进一步研究毒素的存在与息肉组织中病理变化之间的相关性。
