鼻息肉患者嗜酸性粒细胞及肥大细胞脱颗粒电镜观察

目的:为了解活化的嗜酸性粒细胞及肥大细胞的脱颗粒情况,应用透射电镜观察嗜酸性粒细胞及肥大细胞的形态变化、颗粒情况及脱颗粒类型,借此探讨嗜酸性粒细胞及肥大细胞在鼻息肉发病机制中的作用,找到一种预防鼻息肉的好方法.方法:鼻息肉组10例,鼻息肉组织来自2001年我科住院做鼻内窥镜手术的多发性鼻息肉病人,男6例,女4例.正常对照组5例,选取同期因鼻外伤住院病人,男4例,女1例.所有组织均在鼻内窥镜下采取,病变组取息肉组织,对照组取下鼻甲组织,标本迅速放入10%甲醛液及4%戊二醛液固定,分别供光镜及电镜检查备检,HE染色及常规电镜制片.结果:光镜下可见大量炎性细胞浸润,以嗜酸性粒细胞为主,主要位于黏膜下,小血管周围;正常对照组炎细胞较少,统计学分析鼻息肉组嗜酸性粒细胞数目明显高于正常对照组,且有显著性差异(P＜0.05).肥大细胞的超微结构特点:正常对照组多为正常肥大细胞,大小基本一致,胞浆内多为高电子密度颗粒,表面可见微绒毛,无空泡形成;鼻息肉组:绝大多数为脱颗粒肥大细胞,表现为颗粒变大、电子密度减低、颗粒间相互融合、颗粒与胞膜融合、空泡形成.另外在息肉组织内可见浆细胞存在,有一较大的核,核内异染色质呈斑块状,分布在核周围,胞浆内充满膨大的粗面内质网,说明蛋白合成旺盛.结论:经研究我们发现鼻息肉组织中有大量的炎性细胞浸润,其中以嗜酸性粒细胞最多,而且大部分是活化状态,嗜酸性粒细胞及肥大细胞脱颗粒后释放炎性介质、细胞毒性蛋白及细胞因子等生物活性物质,引起上皮脱落、组织水肿、血管增生,最终导致鼻息肉的发生和发展,鼻腔局部应用皮质类固醇激素可以抑制炎性细胞的聚集和活化,减轻组织中的炎性反应,从而达到控制鼻息肉的目的.

Degranulation Patterns of Eosinophils and Mast Cells in the Nasal Polyps

Objective: Nasal polyps usually contained many inflammatory cells such as, eosinophils, plasma cells, mast cells, neutrophils and lymphocytes. The eosinophils and mast cells were most common. Degranulation of eosinophils in target tissues is considered a key pathogenic event in major chroniceosinophilic diseases. However, because of a lack of appropriate methods, littleis known about degranulation of eosinophils in nasal polyps. With the application of transmission electron microscopic analysis, a novel approach was devised and validated to quantify eosinophil and mast cell degranulation in human tissues, by observing degranulation of eosinophils and eosinophils and mast cell.Methods: Biopsy specimens from cases with nasal polyposis (6 male and 4 female) and normal nasal mucosa (4 male and 1 female) from cases with nasal injury were evaluated. Biopsies taken from the nasal polyps of the cases and the inferiorturbinate of cases of nasal injury were studied with the light and transmission electron microscope.Results: The most conspicuous feature ofeosinopils is the presence of a large number of eosinophilic granules havingcrystalloid material in an equatorial position. Two conditions display a varyingdegree of local tissue eosinophilias and mast cells, with great differencebeing observed in eosinophil numbers in the nasal polyps cases turbinate. The degranulation of the eosinophils and mast cells were observed only in the eosinophils and mast celles were observed only in the nasal polyps. The eosinophil subtypes were intact and resting in the normal nasal mucosa, however in the nasalpolyps, the eosinophils were intact but degranulating (piecemeal deguanulation).Eosinophils cytolytic or fegs were not observed in the patient groups. Thecontent of the crystalloid core disappeared in many granules of the eosinophilswere also observed. More mast cells were found in the base of nasal polyps andand most of them showed varying degrees of degranulation. Conclusion: Polyps contained significantly more eosinophils than nasal mucosa. When eosinophils and mast cells degranulated, their cytoxic granule proteins would release. This condition resulted in cell injury, tissues edema and progressive eosinophils infiltration. This findings suggested that active inflammation was associated with eosinophils and mast infiltration had a close relation with edema formation, which resulted in the growth of nasal polyps. The study revealed that degranulation eosinophils and mast cells in nasal polyps played an important role in the formationand growth of nasal polyps.