Yamamoto K
Department of Otolaryngology, School of Medicine, Kitasato University, Sagamihara.
Nihon Jibiinkoka Gakkai Kaiho. 1996 Apr;99(4):533-43. doi: 10.3950/jibiinkoka.99.533.
An immunohistochemical study was made on the distribution of neuropeptides in 36 surgical specimens of the inferior nasal turbinate mucosa obtained from 32 patients with allergic rhinitis. Eleven patients (15 specimens) of the 32 underwent chemosurgery in which trichloracetic acid (TCA) was used before excision. In these patients a watery nasal discharge remained even after TCA application, although the nasal obstruction decreased. As a control, 6 specimens obtained from 6 patients with non-allergic rhinitis were also studied. In the present study, the distribution of Substance P (SP) was examined as an index of the parasympathetic nervous system. The distribution of nerve fibers showing a positive reaction specific to each of the two types of neuropeptides was examined in the frontal sections of the specimens at distances of 5 and 15 mm from the anterior tip of the inferior turbinate. In particular, the modes of the distribution in the superficial and deep layers of the mucosa were compared. It was found that, in the patients with allergic rhinitis who had not undergone TCA treatment, both SP-positive and VIP-positive fibers were abundant in the anterior portion of the turbinate immediately beneath the basement membrane. In those patients who underwent chemosurgery prior to excision, SP-positive fibers were very scarce in both superficial and deep layers, whereas VIP-positive fibers appeared to exist only in the deep layer around the remaining nasal glands. In the specimens obtained from patients with non-allergic rhinitis, there was no appreciable difference in the pattern of distribution of SP-and VIP-positive fibers among different sites of the specimens. The present study would indicate that chemosurgery using TCA inhibited the appearance of neuropeptides and resulted in improvement in clinical symptoms. However, in those patients having a continuous watery discharge even after TCA treatment, the function of the remaining nasal glands might be responsible for the symptom, although the contribution of VIP to the increase in vasopermeability should also be taken into consideration. Further studies are needed to determine the distribution of neuropeptides around the vessel walls.
对32例变应性鼻炎患者的36份下鼻甲黏膜手术标本进行了神经肽分布的免疫组织化学研究。32例患者中有11例（15份标本）接受了化学外科手术，即在切除前使用了三氯乙酸（TCA）。在这些患者中，尽管鼻阻塞有所减轻，但即使在应用TCA后仍有鼻水样分泌物。作为对照，还研究了6例非变应性鼻炎患者的6份标本。在本研究中，检测了P物质（SP）的分布作为副交感神经系统的指标。在距下鼻甲前端5毫米和15毫米处的标本额切面上，检查了显示对两种神经肽各自呈阳性反应的神经纤维的分布。特别比较了黏膜浅层和深层的分布方式。结果发现，未接受TCA治疗的变应性鼻炎患者中，SP阳性和血管活性肠肽（VIP）阳性纤维在下鼻甲紧邻基底膜的前部均很丰富。在切除前接受化学外科手术的患者中，浅层和深层的SP阳性纤维都非常稀少，而VIP阳性纤维似乎仅存在于剩余鼻腺周围的深层。在非变应性鼻炎患者的标本中，SP和VIP阳性纤维在标本不同部位的分布模式没有明显差异。本研究表明，使用TCA的化学外科手术抑制了神经肽的出现并导致临床症状改善。然而，在那些即使在TCA治疗后仍持续有鼻水样分泌物的患者中，剩余鼻腺的功能可能是导致该症状的原因，尽管也应考虑VIP对血管通透性增加的作用。需要进一步研究以确定血管壁周围神经肽的分布。
