Luo Hua-Nan, Ma Si-Jing, Sheng Ying, Yan Jing, Hou Jin, Zhu Kang, Ren Xiao-Yong
Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2250-4. doi: 10.1016/j.ijporl.2014.10.026. Epub 2014 Oct 24.
To investigate the concentrations of pepsin and pepsinogen within the middle ear cavity and determine whether pepsin and pepsinogen affect the prognosis of children with otitis media with effusion (OME).
All middle-ear lavage fluid from patients with OME undergoing myringotomy (M subgroup) or tympanostomy tube insertion (T subgroup) was collected and pepsin and pepsinogen were detected using enzyme-linked immunosorbent assay. After close follow-up over 2 years, the effects of pepsin and pepsinogen on the prognosis of the patients with OME in the M and T subgroups were analyzed.
The average pepsin and pepsinogen concentrations were significantly lower in the M subgroup (n=54; 24.38±16.10mg/mL and 286.49±91.95mg/mL, respectively) than in the T subgroup (n=55; 45.56±16.60mg/mL and 664.92±107.06mg/mL; t=2.484, P=0.018 and t=2.670, P=0.011, respectively). In the M subgroup, the average time to tympanic membrane healing and tympanic pressure restoration to normal was much longer in pepsin(+) patients (17.0±2.0 days and 26.0±2.5 days, respectively) than in pepsin(-) patients (14.0±1.1 days and 22.0±1.0 days; t=3.871, P=0.001 and t=5.734, P=0.000, respectively), and the hearing level of pepsin(+) patients with OME ascended to 13.08±1.19dB, which was much lower than that of pepsin(-) patients (18.29±1.27dB; t=11.001, P=0.000). In the T subgroup, the complication rate including otorrhea and myringosclerosis was much higher in patients with high pepsin concentrations than in those with low pepsin concentrations (P<0.05). Finally, in both subgroups, the recurrence rates of OME in pepsin(+) or patients with high pepsin concentrations (34.6% [9/26] and 28.6% [10/35]) were significantly higher than those in pepsin(-) or low pepsin concentrations (10.7% [3/28] and 5.0% [1/20]; χ(2)=4.456, P=0.035 and χ(2)=4.420, P=0.036). However, pepsinogen had no significant effect on OME prognosis or recurrence.
Pepsin but not pepsinogen could postpone tympanic membrane healing and pressure restoration in children with OME undergoing myringotomy and increase the incidence of recurrence and complications including otorrhea and myringosclerosis for those undergoing tympanostomy tube insertion. Therefore, pepsin could be considered a poor prognostic factor for OME, further emphasizing the important role of pepsin in OME pathogenesis.
研究中耳腔内胃蛋白酶和胃蛋白酶原的浓度，并确定胃蛋白酶和胃蛋白酶原是否影响分泌性中耳炎（OME）患儿的预后。
收集接受鼓膜切开术（M亚组）或鼓膜置管术（T亚组）的OME患者的所有中耳灌洗液，采用酶联免疫吸附测定法检测胃蛋白酶和胃蛋白酶原。经过2年的密切随访，分析胃蛋白酶和胃蛋白酶原对M和T亚组OME患者预后的影响。
M亚组（n = 54；胃蛋白酶平均浓度为24.38±16.10mg/mL，胃蛋白酶原平均浓度为286.49±91.95mg/mL）的胃蛋白酶和胃蛋白酶原平均浓度显著低于T亚组（n = 55；胃蛋白酶平均浓度为45.56±16.60mg/mL，胃蛋白酶原平均浓度为664.92±107.06mg/mL；t分别为2.484，P = 0.018；t为2.670，P = 0.011）。在M亚组中，胃蛋白酶阳性（pepsin(+)）患者的鼓膜愈合平均时间和鼓室压力恢复正常的时间（分别为17.0±2.0天和26.0±2.5天）比胃蛋白酶阴性（pepsin(-)）患者（分别为14.0±1.1天和22.0±1.0天；t分别为3.871，P = 0.001；t为5.734，P = 0.000）长得多，且pepsin(+)的OME患者听力水平升至13.08±1.19dB，远低于pepsin(-)患者（18.29±1.27dB；t = 11.001，P = 0.000）。在T亚组中，胃蛋白酶浓度高的患者耳漏和鼓膜硬化等并发症发生率远高于胃蛋白酶浓度低的患者（P < 0.05）。最后，在两个亚组中，pepsin(+)或胃蛋白酶浓度高的患者OME复发率（分别为34.6% [9/26]和28.6% [10/35]）显著高于pepsin(-)或胃蛋白酶浓度低的患者（分别为10.7% [3/28]和5.0% [1/20]；χ(2)分别为4.456，P = 0.035；χ(2)为4.420，P = 0.036）。然而，胃蛋白酶原对OME预后或复发无显著影响。
胃蛋白酶而非胃蛋白酶原可延缓接受鼓膜切开术的OME患儿的鼓膜愈合和压力恢复，并增加接受鼓膜置管术患儿的复发率及耳漏和鼓膜硬化等并发症的发生率。因此，胃蛋白酶可被视为OME的不良预后因素，进一步强调了胃蛋白酶在OME发病机制中的重要作用。
