Bhattacharyya Neil
Division of Otolaryngology, Brigham and Women's Hospital, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA.
Laryngoscope. 2007 Nov;117(11):2041-4. doi: 10.1097/MLG.0b013e3181379d96.
To determine the cellular composition and influence of microbiology on persistent paranasal sinus secretions after endoscopic sinus surgery (ESS).
Persistent sinus secretions from a consecutive series of patients after ESS were studied with cytopathology and cultures for aerobic, anaerobic, and fungal organisms. A control group consisting of patients without persistent secretions after ESS was also studied. Epithelial, neutrophil, and eosinophil cell presence was semiquantitatively assessed on a 4-point scale and compared between control and diseased groups. Cellular composition was then stratified and analyzed according to the presence of microorganisms.
A total of 50 diseased and 24 control patients were studied. Both diseased and control patients demonstrated sloughed epithelial cells in secretions (53.1% and 66.7%, respectively, P = .131). The diseased group exhibited significantly higher eosinophilic or eosinophilic/neutrophilic cellularity than the controls (P = .048). The average neutrophil infiltration score was 0.82 versus 0.54 for the controls (P = .104). For the diseased group, the mean eosinophil score was 1.56 versus 0.96 in the control group (P = .035). Pathogenic bacteria were identified in 64% of the diseased group patients versus 54.2% in controls (P = .454). Only two fungal cultures were positive (diseased group). Microbiological analysis indicated that in the absence of bacteria, diseased group patients mainly manifested an eosinophilic presence, whereas in the presence of bacteria, the neutrophil response was enhanced in diseased patients and eosinophil response was enhanced in controls.
Persistent sinus secretions after ESS are primarily driven by an eosinophilic presence. Patients without inflammatory exudate after ESS respond to bacteria with increased eosinophilia, whereas hypersecretory patients demonstrate both increased neutrophil and eosinophil presence.
确定鼻内镜鼻窦手术（ESS）后持续性鼻窦分泌物的细胞组成及微生物学影响。
对一系列ESS术后持续性鼻窦分泌物的患者进行细胞病理学检查，并培养需氧菌、厌氧菌和真菌。同时研究了一组ESS术后无持续性分泌物的患者作为对照组。上皮细胞、中性粒细胞和嗜酸性粒细胞的存在情况采用4分制进行半定量评估，并在对照组和患病组之间进行比较。然后根据微生物的存在情况对细胞组成进行分层和分析。
共研究了50例患病患者和24例对照患者。患病组和对照组患者的分泌物中均有脱落的上皮细胞（分别为53.1%和66.7%，P = 0.131）。患病组的嗜酸性粒细胞或嗜酸性粒细胞/中性粒细胞细胞密度显著高于对照组（P = 0.048）。对照组的平均中性粒细胞浸润评分为0.54，患病组为0.82（P = 0.104）。患病组的平均嗜酸性粒细胞评分为1.56，对照组为0.96（P = 0.035）。患病组64%的患者鉴定出病原菌，对照组为54.2%（P = 0.454）。仅2例真菌培养呈阳性（患病组）。微生物学分析表明，在无细菌的情况下，患病组患者主要表现为嗜酸性粒细胞增多，而在有细菌的情况下，患病患者的中性粒细胞反应增强，对照组的嗜酸性粒细胞反应增强。
ESS术后持续性鼻窦分泌物主要由嗜酸性粒细胞增多引起。ESS术后无炎性渗出物的患者对细菌的反应是嗜酸性粒细胞增多，而分泌过多的患者则表现为中性粒细胞和嗜酸性粒细胞均增多。
