Department of Otolaryngology, Head and Neck Surgery, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Am J Rhinol Allergy. 2012 Jul-Aug;26(4):255-9. doi: 10.2500/ajra.2012.26.3772.
We aimed to examine the effect of different therapeutic modalities on levels of fractional concentrations of exhaled nitric oxide (FeNO) in patients with eosinophilic chronic rhinosinusitis (ECRS).
Thirty-six ECRS patients with nasal polyps were treated either medically or surgically. Oral and nasal FeNO levels were measured using an electrochemical NO analyzer initially and at 1 and 6 months. The mRNA expression and localization of nitric oxide synthase (NOS) isoforms in sinus mucosa and nasal polyps were analyzed by real-time polymerase chain reaction (PCR) and immunohistochemistry.
The mean oral FeNO levels in the surgical group had decreased significantly from 50.9 to 36.8 ppb 6 months after endoscopic sinus surgery. All patients in this group showed significantly higher nasal FeNO levels after treatment. The mean nasal FeNO levels were 62.3 ppb at 1 month and 93.6 ppb at 6 months. Mean oral and nasal FeNO levels in the medical group after treatment remained unchanged when compared with the baseline levels. Positive immunoreactivity of inducible NOS (iNOS) was observed in both epithelial cells and submucosal inflammatory cells. Real-time PCR analysis showed significant up-regulation of iNOS and IL-5 mRNA expression.
A combination of oral and nasal FeNO measurements is useful to monitor the extent of inflammation in CRS patients. The increase in nasal FeNO in the surgical group indicates prompt recovery of NO release from healed sinus mucosa through the opened sinus ostia. Reduction of oral FeNO levels may reflect a cessation of the underlying lower airway inflammation that is characteristic of ECRS.
我们旨在研究不同治疗方式对嗜酸性慢性鼻鼻窦炎（ECRS）患者呼出气一氧化氮（FeNO）分数浓度的影响。
36 例鼻息肉 ECRS 患者分别接受药物或手术治疗。使用电化学 NO 分析仪初始和 1 个月、6 个月时测量口腔和鼻腔 FeNO 水平。通过实时聚合酶链反应（PCR）和免疫组织化学分析鼻窦黏膜和鼻息肉中一氧化氮合酶（NOS）同工型的 mRNA 表达和定位。
手术组的口腔 FeNO 水平从内镜鼻窦手术后的 50.9 降至 6 个月后的 36.8 ppb，显著降低。该组所有患者治疗后鼻腔 FeNO 水平明显升高。治疗后 1 个月和 6 个月时，平均鼻腔 FeNO 水平分别为 62.3 ppb 和 93.6 ppb。与基线水平相比，药物组治疗后的口腔和鼻腔 FeNO 水平保持不变。诱导型 NOS（iNOS）的阳性免疫反应在上皮细胞和黏膜下炎症细胞中均可见。实时 PCR 分析显示 iNOS 和 IL-5 mRNA 表达显著上调。
联合口腔和鼻腔 FeNO 测量有助于监测 CRS 患者炎症的严重程度。手术组鼻腔 FeNO 的增加表明，通过开放的窦口，愈合的鼻窦黏膜中 NO 释放迅速恢复。口腔 FeNO 水平的降低可能反映出 ECRS 特征的潜在下呼吸道炎症的停止。
