de Borja Callejas Francisco, Martínez-Antón Asunción, Picado César, Alobid Isam, Pujols Laura, Valero Antonio, Roca-Ferrer Jordi, Mullol Joaquim
Department of Clinical and Experimental Respiratory Immunoallergy, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Centers for Biomedical Research Network in Respiratory Diseases, Barcelona, Spain.
Laryngoscope. 2015 May;125(5):E158-67. doi: 10.1002/lary.25147. Epub 2015 Jan 13.
OBJECTIVES/HYPOTHESIS: To investigate the effect of oral plus intranasal corticosteroid (CS) treatment on nasal polyp (NP) mucosa remodeling from patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP).
Case series, retrospective study.
Patients (n = 18) with severe CRSwNP were treated with oral prednisone for 2 weeks and intranasal budesonide for 12 weeks. NP biopsies were obtained from patients biopsies before (w0) and after 2 weeks (w2) and 12 weeks (w12) of CS treatment. Matrix metalloprotease 1 (MMP-1), MMP-2, MMP-7, MMP-9, and tissue inhibitor of metalloprotease type 1 (TIMP-1) expression was evaluated by immunohistochemistry in cell and tissue structures. Epithelial damage, eosinophil infiltration, and collagen content were also examined in NP tissues before and after CS treatment.
Compared to w0: 1) oral plus intranasal CS significantly (P < .01) increased presence of submucosal glands at w2, decreased epithelial cell hyperplasia at w12, and decreased tissue eosinophilia at w2 and w12; 2) CS treatment significantly (P < .05) increased immunoreactivity for MMP-1 and MMP-2 in the epithelium at w2, but decreased immunoreactivity for MMP-9 in the epithelium at w2 and w12; 3) at w12, CS significantly (P < .05) reduced MMP-9 immunoreactive positivity and intensity in the extracellular matrix, while increasing total collagen amount in the extracellular matrix; and 4) CS treatment significantly (P < .01) reduced the number of eosinophils and their MMP and TIMP-1 immunoreactive expression.
CS treatment modulates NP mucosa remodeling, particularly by promoting epithelial repair, regulating tissue remodeling markers, increasing total collagen content, and reducing tissue eosinophil infiltration.
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目的/假设：探讨口服加鼻内应用皮质类固醇（CS）治疗对重度慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者鼻息肉（NP）黏膜重塑的影响。
病例系列，回顾性研究。
18例重度CRSwNP患者接受口服泼尼松2周及鼻内布地奈德12周治疗。在CS治疗前（w0）、治疗2周（w2）和12周（w12）时获取NP活检组织。通过免疫组织化学评估细胞和组织结构中基质金属蛋白酶1（MMP-1）、MMP-2、MMP-7、MMP-9和金属蛋白酶组织抑制因子1（TIMP-1）的表达。还检测了CS治疗前后NP组织中的上皮损伤、嗜酸性粒细胞浸润和胶原含量。
与w0相比：1）口服加鼻内CS在w2时显著（P＜0.01）增加了黏膜下腺的存在，在w12时减少了上皮细胞增生，并在w2和w12时减少了组织嗜酸性粒细胞浸润；2）CS治疗在w2时显著（P＜0.05）增加了上皮中MMP-1和MMP-2的免疫反应性，但在w2和w12时降低了上皮中MMP-9的免疫反应性；3）在w12时，CS显著（P＜0.05）降低了细胞外基质中MMP-9的免疫反应阳性率和强度，同时增加了细胞外基质中的总胶原量；4）CS治疗显著（P＜0.01）减少了嗜酸性粒细胞的数量及其MMP和TIMP-1的免疫反应性表达。
CS治疗可调节NP黏膜重塑，特别是通过促进上皮修复、调节组织重塑标志物、增加总胶原含量和减少组织嗜酸性粒细胞浸润。
4级
