Lasisi A O, Olayemi O, Arinola O G, Omilabu S A
Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Nigeria.
J Laryngol Otol. 2009 Oct;123(10):1103-7. doi: 10.1017/S0022215109990600. Epub 2009 Jul 29.
Interferon-gamma has been reported to have an immunoregulatory role in otitis media with effusion. However, such a role remains to be determined in acute suppurative otitis media.
To determine the levels of interferon-gamma in middle-ear secretion in children with acute suppurative otitis media, and to determine the significance of interferon-gamma to the nature of otorrhoea and the outcome of otitis media.
Prospective, longitudinal follow up of patients selected from community and tertiary health centres.
We selected children with acute suppurative otitis media, diagnosed as otorrhoea of less than three months' duration. Middle-ear secretions were collected by pipetting and stored at -80 degrees C. Interferon-gamma was assayed using enzyme-linked immunosorbent assay. The patients were treated and followed up for nine to 12 months, to separate those with resolved acute suppurative otitis media from those with chronic suppurative otitis media.
The study initially included 358 cases of acute suppurative otitis media. Nine-month follow up was achieved in 304 patients (85 percent). Of these patients, acute suppurative otitis media resolved in 187 (61 percent), while chronic suppurative otitis media was evident in 117 (39 percent). The children with completed follow up comprised 173 boys and 131 girls, aged between four months and nine years (mean age 6.6 years; standard deviation 1.32). These children had purulent otorrhoea in 171 cases (56 percent) and mucoid otorrhoea in 133 cases (44 percent). The children's middle-ear secretion interferon-gamma concentrations ranged from 12 to 126 pg/ml. The mean middle-ear secretion interferon-gamma concentration was 27.2 pg/ml (standard deviation 8.8) in patients whose acute suppurative otitis media resolved, and 73.1 pg/ml (standard deviation 9.5) in those progressing to chronic suppurative otitis media. In children with purulent otitis media, the mean middle-ear secretion interferon-gamma concentration was 43.5 pg/ml (standard deviation 15.6); in those with mucoid otitis media, it was 74.3 pg/ml (standard deviation 19.1). Univariate analysis revealed significant differences in middle-ear secretion interferon-gamma concentration, comparing resolved acute suppurative otitis media and chronic suppurative otitis media cases (p = 0.00), and comparing purulent and mucoid otitis media cases (p = 0.00). Pearson correlation testing revealed significant inverse correlation between interferon-gamma concentration and middle-ear secretion immunoglobulin G concentration (p = 0.01), immunoglobulin E concentration (p = 0.03) and immunoglobulin A concentration (p = 0.00).
A high concentration of interferon-gamma in middle-ear secretions promotes chronicity of suppurative otitis media. Further research in this area may lead to the development of agents which assist the control of suppurative otitis media chronicity.
据报道，γ干扰素在分泌性中耳炎中具有免疫调节作用。然而，其在急性化脓性中耳炎中的作用仍有待确定。
测定急性化脓性中耳炎患儿中耳分泌物中γ干扰素的水平，并确定γ干扰素对耳漏性质及中耳炎转归的意义。
对选自社区和三级医疗中心的患者进行前瞻性纵向随访。
我们选取了急性化脓性中耳炎患儿，诊断标准为耳漏持续时间少于3个月。通过移液器收集中耳分泌物，并储存在-80℃。采用酶联免疫吸附测定法检测γ干扰素。对患者进行治疗并随访9至12个月，以区分急性化脓性中耳炎已痊愈的患者和慢性化脓性中耳炎患者。
该研究最初纳入358例急性化脓性中耳炎患者。304例患者（85%）完成了9个月的随访。在这些患者中，187例（61%）急性化脓性中耳炎已痊愈，117例（39%）出现慢性化脓性中耳炎。完成随访的儿童包括173名男孩和131名女孩，年龄在4个月至9岁之间（平均年龄6.6岁；标准差1.32）。这些儿童中，171例（56%）有脓性耳漏，133例（44%）有黏液性耳漏。儿童中耳分泌物γ干扰素浓度范围为12至126 pg/ml。急性化脓性中耳炎已痊愈的患者，中耳分泌物γ干扰素平均浓度为27.2 pg/ml（标准差8.8），进展为慢性化脓性中耳炎的患者为73.1 pg/ml（标准差9.5）。在脓性中耳炎患儿中，中耳分泌物γ干扰素平均浓度为43.5 pg/ml（标准差15.6）；在黏液性中耳炎患儿中，为74.3 pg/ml（标准差19.1）。单因素分析显示，比较急性化脓性中耳炎已痊愈和慢性化脓性中耳炎病例，中耳分泌物γ干扰素浓度存在显著差异（p = 0.00），比较脓性和黏液性中耳炎病例也存在显著差异（p = 0.00）。Pearson相关性检验显示，γ干扰素浓度与中耳分泌物免疫球蛋白G浓度（p = 0.01）、免疫球蛋白E浓度（p = 0.03）和免疫球蛋白A浓度（p = 0.00）之间存在显著负相关。
中耳分泌物中高浓度的γ干扰素会促使化脓性中耳炎迁延不愈。该领域的进一步研究可能会促成有助于控制化脓性中耳炎慢性化的药物的研发。
