Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Int J Pediatr Otorhinolaryngol. 2024 Sep;184:112079. doi: 10.1016/j.ijporl.2024.112079. Epub 2024 Aug 20.
In recent years, the clinical efficacy of medications for adenoid hypertrophy has been demonstrated. Topical nasal steroids have effects to shrink hypertrophic adenoids and improve symptoms of associated diseases. However, the mechanism which topical steroid administrations cause adenoid shrinkage remains unclear, herein, sensitivity for topical steroids in the mucosal epithelium of adenoids was evaluated histologically by comparing with tonsils.
Histological analysis was performed on adenoids and tonsils removed from 32 pediatric patients with adenoid hypertrophy. In hematoxylin-eosin-stained specimens, the morphology of the mucosal epithelium and eosinophil infiltration were evaluated. The expression of the glucocorticoid receptor (GR), interleukin (IL)-4, and IL-25 in the mucosal epithelium was evaluated, and the staining intensity was scored as 0 (none), 1 (weak), and 2 (strong). The number of eosinophils and expression scores of GR, IL-4, and IL-25 were statistically compared between adenoids and tonsils and analyzed correlations with adenoids sizes.
Adenoids were covered with ciliated epithelium, and eosinophils in the mucosal epithelium and submucosal area was higher than tonsils (p < 0.05). GR expression in the most superficial layer of the mucosal epithelium was observed in adenoids, and the expression intensity score was higher than that in tonsils (p < 0.05). IL-4 and IL-25 were more widely expressed in the mucosal epithelium of adenoids than in tonsils, and their expression intensity scores were also higher than in tonsils (p < 0.05). A correlation was found between adenoid size and the intensity of IL-25 expression in the adenoid epithelium (p < 0.05).
Eosinophilic inflammations in adenoids mucosal epithelium could be one of etiology of adenoid hypertrophy, and the GR and eosinophilic inflammation in the adenoids mucosal epithelium might be target of topical nasal steroids to shrink hypertrophic adenoids.
近年来，已证实药物治疗腺样体肥大的临床疗效。局部鼻用皮质类固醇具有使肥大的腺样体缩小和改善相关疾病症状的作用。然而，局部类固醇给药导致腺样体缩小的机制尚不清楚，在此通过与扁桃体比较，评估腺样体粘膜上皮对局部类固醇的敏感性。
对 32 例腺样体肥大患儿切除的腺样体和扁桃体进行组织学分析。在苏木精-伊红染色标本中，评估粘膜上皮形态和嗜酸性粒细胞浸润情况。评估粘膜上皮的糖皮质激素受体（GR）、白细胞介素（IL）-4 和 IL-25 的表达，并对染色强度进行评分（0：无；1：弱；2：强）。对腺样体和扁桃体的嗜酸性粒细胞数量以及 GR、IL-4 和 IL-25 的表达评分进行统计学比较，并分析与腺样体大小的相关性。
腺样体被纤毛上皮覆盖，粘膜上皮和粘膜下区域的嗜酸性粒细胞高于扁桃体（p<0.05）。GR 在腺样体粘膜上皮的最浅层表达，表达强度评分高于扁桃体（p<0.05）。IL-4 和 IL-25 在腺样体粘膜上皮的表达更为广泛，其表达强度评分也高于扁桃体（p<0.05）。腺样体大小与腺样体上皮中 IL-25 表达的强度呈正相关（p<0.05）。
腺样体粘膜上皮的嗜酸性炎症可能是腺样体肥大的病因之一，GR 和腺样体粘膜上皮中的嗜酸性炎症可能是局部鼻用类固醇缩小肥大腺样体的作用靶点。
