Zhang N, Gevaert P, van Zele T, Perez-Novo C, Patou J, Holtappels G, van Cauwenberge P, Bachert C
ENT-Department, University Hospital Ghent, Upper Airway Research Laboratory, Ghent, Belgium.
Rhinology. 2005 Sep;43(3):162-8.
Nasal polyps in adults, characterized by abundant eosinophils, local overproduction of immunoglobulin E, and often associated with asthma, have been appreciated as an eosinophilic inflammation, potentially of allergic origin, but unrelated to a bacterial impact. Evidence accumulates, however, that Staphylococcus aureus colonizes chronic rhinosinusitis with, but not without polyps, with significantly increased prevalence. The germs release enterotoxins, which act as superantigens and induce a topical multiclonal IgE-formation as well as a severe, possibly steroid-insensitive eosinophilic inflammation. Recently, S. aureus could be demonstrated to reside intraepithelially, and potentially to release superantigens into the tissue from within the epithelial cells. An immune defect, either in the innate or adaptive immunity, might be responsible for this phenomenon. Follicle-like structures and lymphocyte accumulations, specifically binding enterotoxins, can be found within the polyp tissues, giving rise to local IgE formation. The superantigen-induced immune response also leads to a modulation of the severity of the eosinophilic inflammation, and may be linked to lower airway co-morbidity in polyp patients. Interestingly, IgE antibodies to enterotoxins can be found in the majority of aspirin-sensitive polyp tissues, associated with a substantial increase in ECP and IL-5. The possible role of S. aureus enterotoxins in polyp disease in Europe, the US and Asia has meanwhile been supported by several studies, demonstrating the presence of IgE antibodies to enterotoxins and inflammatory consequences in nasal polyp tissue. First studies also point to an involvement of S. aureus derived enterotoxins in lower airway disease, such as severe asthma and exacerbated COPD, clearly suggesting a clinical need for diagnosis and treatment of the germ and its related effects. Therapeutic approaches are so far empirical, and need further study, also serving to proof the clinical relevance of the concept.
成人鼻息肉的特征是嗜酸性粒细胞丰富、局部免疫球蛋白E产生过多，且常与哮喘相关，一直被认为是一种嗜酸性粒细胞炎症，可能起源于过敏，但与细菌影响无关。然而，越来越多的证据表明，金黄色葡萄球菌定植于慢性鼻窦炎伴息肉而非不伴息肉的患者中，其患病率显著增加。这些细菌释放肠毒素，肠毒素作为超抗原，可诱导局部多克隆IgE形成以及严重的、可能对类固醇不敏感的嗜酸性粒细胞炎症。最近发现，金黄色葡萄球菌可在上皮内驻留，并可能从上皮细胞内向组织中释放超抗原。先天性或适应性免疫方面的免疫缺陷可能是导致这一现象的原因。在息肉组织内可发现滤泡样结构和淋巴细胞聚集，它们能特异性结合肠毒素，从而引起局部IgE形成。超抗原诱导的免疫反应还会导致嗜酸性粒细胞炎症严重程度的调节，并且可能与息肉患者下呼吸道合并症有关。有趣的是，在大多数阿司匹林敏感的息肉组织中可发现针对肠毒素的IgE抗体，同时伴有嗜酸性粒细胞阳离子蛋白（ECP）和白细胞介素-5的大量增加。与此同时，多项研究支持了金黄色葡萄球菌肠毒素在欧洲、美国和亚洲息肉病中的可能作用，这些研究证明了鼻息肉组织中存在针对肠毒素的IgE抗体以及炎症后果。初步研究还指出，金黄色葡萄球菌衍生的肠毒素参与了下呼吸道疾病，如重度哮喘和慢性阻塞性肺疾病（COPD）急性加重，这清楚地表明临床上需要对该病菌及其相关影响进行诊断和治疗。目前的治疗方法多为经验性的，需要进一步研究，以证实这一概念的临床相关性。
