Bhattacharyya Neil
Division of Otolaryngology, Brigham and Women's Hospital, Boston Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA.
Am J Rhinol. 2007 Jan-Feb;21(1):1-4. doi: 10.2500/ajr.2007.21.2982.
The aim of this study was to characterize the cellular composition of persisting sinus secretions after endoscopic sinus surgery (ESS).
Consecutive adult patients with persisting abnormal sinus secretions post-ESS were prospectively evaluated. Sinus secretions were aspirated and submitted for cytological analysis. Semiquantitative cell counts were obtained for epithelial cells (graded as present or absent), eosinophils (graded on a 4-point Likert severity scale), and neutrophils (3-point Likert scale). Prior operative histopathology from ESS and Lund CT scores were reviewed. Statistical analyses were conducted to determine the relationships between preoperative Lund score, operative histopathology, and subsequent cellular infiltrate in sinus secretions.
Forty-three patients (mean age, 49 years) were enrolled. Epithelial cells were present in 13 (30.2%) of these individuals. Cytological eosinophilia was rated as absent in 14 (32.6%) cases, mild in 5 (11.6%) cases, moderate in 18 (41.9%) cases, and severe in 6 (14.0%) cases. Neutrophil presence was absent in 24 (55.8%) cases, present/mild in 15 (34.9%) cases, and severe in 4 (9.3%) cases. No significant correlation could be found between the presence of each of these three cell types, the presence or absence of polyps, or preoperative Lund score (all p > 0.05). Sloughed epithelial cell presence was inversely but significantly correlated with original sinus histopathological inflammation (Spearman's rho, -0.348; p = 0.04); eosinophilic cytology tended to increase with prior operative histopathology inflammatory grade but neutrophils did not.
The cytological profile of persisting secretions after ESS is dominated by eosinophils and to a lesser degree neutrophils. The presence of sloughed epithelial cells may signify ongoing mucosal damage from persisting sinonasal inflammation.
本研究的目的是描述内镜鼻窦手术（ESS）后持续存在的鼻窦分泌物的细胞组成。
对ESS术后持续存在异常鼻窦分泌物的成年患者进行前瞻性评估。抽取鼻窦分泌物并进行细胞学分析。获取上皮细胞（分级为存在或不存在）、嗜酸性粒细胞（按4级李克特严重程度量表分级）和中性粒细胞（3级李克特量表）的半定量细胞计数。回顾ESS术前手术组织病理学和Lund CT评分。进行统计分析以确定术前Lund评分、手术组织病理学与随后鼻窦分泌物中细胞浸润之间的关系。
纳入43例患者（平均年龄49岁）。其中13例（30.2%）存在上皮细胞。细胞学嗜酸性粒细胞增多在14例（32.6%）病例中评定为无，5例（11.6%）病例中为轻度，18例（41.9%）病例中为中度，6例（14.0%）病例中为重度。24例（55.8%）病例中无中性粒细胞，15例（34.9%）病例中存在/轻度，4例（9.3%）病例中为重度。这三种细胞类型中的每一种的存在、息肉的存在与否或术前Lund评分之间均未发现显著相关性（所有p>0.05）。脱落上皮细胞的存在与原始鼻窦组织病理学炎症呈负相关但具有显著相关性（斯皮尔曼相关系数，-0.348；p = 0.04）；嗜酸性粒细胞细胞学倾向于随先前手术组织病理学炎症分级增加而增加，但中性粒细胞并非如此。
ESS后持续分泌物的细胞学特征以嗜酸性粒细胞为主，中性粒细胞程度较轻。脱落上皮细胞的存在可能表明鼻窦持续炎症导致黏膜持续损伤。
