摘要目的 探讨术前应用糖皮质激素对慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者组织转化生长因子-β1(TGF-β1)、缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)表达的影响.方法 选择2012年1月-2016年3月于我院择期接受鼻内镜手术治疗的82例CRSwNP患者,分为对照组与观察组各41例,对照组术前无药物干预,观察组术前1周采用糖皮质激素类药物治疗,同时选择同期行鼻中隔偏离矫正术的30例患者作为正常组,术前无糖皮质激素干预,术中取三组鼻息肉或鼻甲组织,采用免疫组化法测定三组TGF-β1、HIF-1α、VEGF表达,比较观察组、对照组治疗效果及术腔恢复情况.结果 术后正常组TGF-β1(0.121±0.011)、HIF-1α(0.154±0.012)、VEGF(0.154±0.012)表达均低于对照组[(0.261±0.051)、(0.236±0.032)、(0.211±0.042)]与观察组[(0.164±0.024)、(0.184±0.026)、(0.164±0.015)](均P<0.05),观察组上述指标均低于对照组(P<0.05);观察组治疗总有效率高于对照组(78.05%vs 95.12%,P<0.05);术后观察组息肉[(0.98±0.12)分vs(0.36±0.11)分]、黏膜水肿[(0.67±0.15)分vs(0.25±0.21)分]、鼻漏[(0.84±0.11)分vs(0.21±0.16)分]、瘢痕[(0.71±0.26)分vs(0.15±0.11)分]、结痂[(0.98±0.11)分vs(0.31±0.12)分]等评分均低于对照组(P<0.05).结论 术前应用糖皮质激素可下调CRSwNP患者鼻息肉组织TGF-β1、HIF-1α、VEGF表达,促进术腔恢复.

abstractsObjective To investigate the effects of glucocorticoid on the expression of transforming growth factor-β1(TGF-β1),hypoxia-inducible factor-1α(HIF-1α)and vascular endothelial growth factor (VEGF) in patients with chronic rhinosinusitis and nasal polyps (CRSwNP). Methods A total of 82 patients with CRSwNP,who underwent endoscopic sinus surgery between January 2012 and March 2016 in our hospital,were included in the study. All patients were divided into the control group and the study group (n=41 each). The control group received no drug intervention before the operation,and the study group was treated with glucocorticoid for 1 week before the operation. At the same time,a contemporary cohort of 30 patients underwent nasal septum deviation correction was included as the normal group,and was not given glucocorticoid intervention before the operation. The nasal polyps or turbinate tissues were collected during the operation. The expressions of TGF-β1,HIF-1α and VEGF were determined by immunohistochemistry. The therapeutic effect and recovery of the cavity were compared between the study group and the control group. Results The postoperative expressions of TGF-β1,HIF-1αand VEGF in the normal group[(0.121± 0.011),(0.154 ± 0.012),(0.154 ± 0.012)]were lower than those in the control group[(0.261 ± 0.051),(0.236±0.032),(0.211±0.042)]and the study group[(0.164±0.024),(0.184±0.026),(0.164±0.015)], respectively(P<0.05),and the above indexes in the study group were lower than those in the control group (P<0.05). The total effective rate in the study group was higher than that in the control group (78.05% vs 95.12%)(P<0.05). The postoperative scores of polyps,mucosal edema,rhinorrhea,scar and scab in the study group were lower than those in the control group[(0.98±0.12)vs(0.36±0.11),(0.67±0.15)vs(0.25± 0.21),(0.84 ± 0.11) vs (0.21 ± 0.16,(0.71 ± 0.26) vs (0.15 ± 0.11),(0.98 ± 0.11) vs (0.31 ± 0.12)], respectively(P<0.05). Conclusion Preoperative use of glucocorticoids can down-regulate the expression of TGF-β1,HIF-1αand VEGF in nasal polyps of patients with CRSwNP,and promote the recovery of the cavity.