Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
Int Forum Allergy Rhinol. 2013 May;3(5):364-8. doi: 10.1002/alr.21135. Epub 2013 Feb 8.
Chronic sinonasal inflammation is associated with tissue remodeling, such as osteitis, which may be a marker of refractory disease; however, the pathophysiology of osteitis in chronic rhinosinusitis (CRS) is insufficiently understood.
Ethmoid mucosa and bone samples were obtained from 35 medically refractory CRS patients and 9 control subjects. Quantitative real-time polymerase chain reaction (RT-PCR) was performed separately on bone and mucosa for matrix metalloproteinase 2 and 9 (MMP2, MMP9) and tissue inhibitor of matrix metalloproteinase 1 (TIMP1). Osteitis was classified as mild, moderate, or severe by measuring bone thickness of the maxillary, sphenoid, and ethmoid sinuses on multiplanar computed tomography (CT). Patients were classified based on severity of osteitis and compared to controls.
Nine patients demonstrated radiographic evidence of osteitis (mild = 3, moderate/severe = 6). Bone PCR revealed biologically significant upregulation of MMP9 in all patients with CRS, but the magnitude of the upregulation decreased with severity of osteitis. Mucosa PCR showed upregulation of MMP9 in moderate/severe osteitis only. No significant changes were seen in MMP2 or TIMP1 regulation.
This is the first study to evaluate the role of MMP in the bone and mucosa of patients with sinonasal osteitis. The pattern of expression suggests there may be a time- and tissue-dependent role for MMP9 in the pathophysiology of osteitis. In addition, MMP9 overexpression is seen despite preoperative oral and intranasal steroid use, suggesting that if MMP9 is an important factor in the development of osteitis then steroids may not be the best treatment in prevention of osteitis.
慢性鼻-鼻窦炎炎症与组织重塑有关，如骨炎，这可能是难治性疾病的标志；然而，慢性鼻-鼻窦炎（CRS）中骨炎的病理生理学尚不清楚。
从 35 例药物难治性 CRS 患者和 9 例对照中获取筛窦粘膜和骨样本。分别对骨和粘膜进行基质金属蛋白酶 2 和 9（MMP2、MMP9）和基质金属蛋白酶组织抑制剂 1（TIMP1）的定量实时聚合酶链反应（RT-PCR）。通过多平面计算机断层扫描（CT）测量上颌窦、蝶窦和筛窦的骨厚度，将骨炎分为轻度、中度或重度。根据骨炎的严重程度对患者进行分类，并与对照组进行比较。
9 例患者显示出骨炎的放射学证据（轻度=3，中度/重度=6）。骨 PCR 显示所有 CRS 患者的 MMP9 均有生物学意义的上调，但上调幅度随骨炎的严重程度而降低。只有在中重度骨炎时，粘膜 PCR 显示 MMP9 上调。MMP2 或 TIMP1 的调节未见明显变化。
这是第一项评估 MMP 在鼻-鼻窦骨炎患者的骨和粘膜中的作用的研究。表达模式表明，MMP9 在骨炎的病理生理学中可能具有时间和组织依赖性作用。此外，尽管术前使用口服和鼻内类固醇，但仍观察到 MMP9 过度表达，这表明如果 MMP9 是骨炎发展的重要因素，那么类固醇可能不是预防骨炎的最佳治疗方法。
