Ishitoya J, Oguchi N, Wang N Y, Toriyama M, Kudo K
Department of Otolaryngology, International Medical Center of Japan, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 1996 May;99(5):675-80. doi: 10.3950/jibiinkoka.99.675.
We determined the clinical characteristics of chronic sinusitis in patients with different lower respiratory tract diseases. Sinusitis was divided into three groups. The first group was sinusitis with bronchial asthma. The second group was sinusitis with chronic bronchitis, bronchiectasis or diffuse panbronchiolitis. This type of sinusitis is generally called sinobronchial syndrome (SBS). The third group was sinusitis without lower respiratory tract disease. Because the pathogenesis of these lower respiratory tract diseases differs with the diseases, the pathogenesis of sinusitis accompanied by these lower respiratory tract diseases also may be different. Clinical and laboratory examinations used in this study were rhinoscopy, X-ray examination of the paranasal sinuses, cytological study of nasal secretion and the saccharin test for the muco-ciliary function of the nasal mucosa. By rhinoscopic examination, no difference was found in the size of the nasal polyp among three groups. The results of other examinations were as follows. X-ray examination: Involvement of the ethmoid sinuses was greater than that of the maxillary sinuses in the patients with sinusitis with bronchial asthma. In contrast, involvement of the maxillary sinuses in SBS patients was greater than that of the ethmoid sinuses. Cytology of nasal secretion: Dominant inflammatory cells in the patients with sinusitis with bronchial asthma were eosinophils, while neutrophil were more frequently found in the SBS patients. Saccharin test: Most of the patients with bronchial asthma showed normal responses. In the SBS patients, however, only a few patients showed a normal response and the others showed prolonged responses. Clinical characteristics of the patients with sinusitis without lower respiratory diseases were more similar to those of the SBS patients. In conclusion, there were distinct differences in these clinical characteristics between sinusitis with bronchial asthma and SBS. These results suggest that the pathogenesis or the inflammatory process of sinusitis is heterogeneous and whether the inflammation is allergic or not may be important.
我们确定了患有不同下呼吸道疾病的慢性鼻窦炎患者的临床特征。鼻窦炎分为三组。第一组是合并支气管哮喘的鼻窦炎。第二组是合并慢性支气管炎、支气管扩张或弥漫性泛细支气管炎的鼻窦炎。这类鼻窦炎通常称为鼻支气管综合征（SBS）。第三组是无下呼吸道疾病的鼻窦炎。由于这些下呼吸道疾病的发病机制因疾病而异，因此伴有这些下呼吸道疾病的鼻窦炎的发病机制也可能不同。本研究中使用的临床和实验室检查包括鼻镜检查、鼻窦X线检查、鼻分泌物细胞学研究以及鼻黏膜黏液纤毛功能的糖精试验。通过鼻镜检查，三组之间鼻息肉大小未发现差异。其他检查结果如下。X线检查：合并支气管哮喘的鼻窦炎患者筛窦受累程度大于上颌窦。相比之下，SBS患者上颌窦受累程度大于筛窦。鼻分泌物细胞学检查：合并支气管哮喘的鼻窦炎患者中主要炎症细胞为嗜酸性粒细胞，而SBS患者中中性粒细胞更为常见。糖精试验：大多数支气管哮喘患者反应正常。然而，在SBS患者中，只有少数患者反应正常，其他患者反应延长。无下呼吸道疾病的鼻窦炎患者的临床特征与SBS患者更为相似。总之，合并支气管哮喘的鼻窦炎和SBS在这些临床特征上存在明显差异。这些结果表明，鼻窦炎的发病机制或炎症过程是异质性的，炎症是否为过敏性可能很重要。
