| Objective: Chronic rhinosinusitis (CRS) is a kind of common disease in the otolaryngolory, the treatment of chronic rhinosinusitis and nasal polyps usually takes surgery as the major method, but it is essential to improve the cure rate to the cooperation treatment of antibiotic and glucocorticoid (GC) the period of Preoperative and post operation, application of partial GC is an important component,and it also plays an important role to treat and prevent function in controlling the nasal polyps development. The premise that GC inhibits inflammatory response is GC combined with glucocorticoid receptor(GR). The complexes of GC and GR combined with the specific site of nuclear membrane DNA-glucocorticoid response elements (GRE), thus it reduce the transcription of inflammatory cytokine and medium,and it cause various biological effects finally.GR was divided into two kinds of hypotype-GRαand GRβ. Some studies showed that GRβwas anti-factor of inside GC effect potentially and related with GC-resistant, it is called anti-factor inside in GC-resistant patients, whether two kinds of receptors exist and abnormal expression separately; why some patients demonstrate are not insensitivity and even invalid to GC treatment in clinical practice? These problems become hotsport recently in related researches. In order to explore the mechanism, the domestic and international researchers had done lots of work. Scholars had put forward the concept of glucocorticoid-resistant, which used for describing some patients respond lower or reactionless to large dose of GC. In recent years, it had been reported that TNF-αcan increase expression of GRβ, which may be one of the mechanisms of glucocorticoid resistance induced by inflammation cytokine. From January to July in 2007,in this study the CRS patients in hospital was divided into two groups- the type I and type II according to the standard of Haikou(1997 year).The aim of this study is to explore the relationship of TNF-αand GRβexpression. We hope that it can offer the new thinking for clinical treatment in GC-resistant chronic rhinosinusitis and nasal polyps.Method: We observed the difference in expression of the TNF-αand GRβamong three groups (control group, type I CRS and type II CRS)with the immunohistochemical SP method: 1 The choice of subjects40 hospitalized patients of CRS were selected in this study from January 2007 to July 2007, according to tha standard of Haikou(1997 year),the patients were divided into two groups- type I group(12 case)and type II group(18 case), we had observed 40 patients by immunohistochemical SP method and calculator picture analytical system, all the selected cases never be accepted partial or system glucocorticoid treatment in past two month, the specimens of type II group were proved to be nasal polyps by pathology, the recurred cases after endoscopic sinus surgery (ESS) were eliminated in this study. Patients were divided into two groups according to the standard of Haikou: type II CRS group (type II 1-3) were 18 cases (male 13, female 5), 17-66 years old, the median is 49 years old; The case history is 2.5-10 years, mean 10.25 years. type I CRS group (type I 1-3) were 12 cases(male 7,female 5), 19-68 years old, the median is 36 years old, the case history is 3-20 years, mean 10.7 years. In the meantime, 10 wounded patients who need to accept operations of nasal septal construction were selected to be the control group and they had not CRS and allergic diseases history,a piece of the mucosa of middle nasal concha were cut off as the specimens, 7 male among them, 3 female among them, 20-40 years old, the median is 35 years old, 3-12 days of medical history, average 7.8 days.2 The creation of the specimensWe fixed the specimens with 10% formalin immediately, dehydrated automatically, paraffin imbedded, and sect serial sections three pieces which thickness was 4μm. HE staining, TNF-αand GRβimmunohistochemical staining were taken separately, then we observed the expression of TNF-αand GRβin different kinds of CRS.3 Statistics managementCompletely randomizd one-way analysis of variance and Student-Newman-Keuls test were used to analyze the data with the significant difference ofα=0.05. In the mean time TNF-α and GRβwere correlation analysis.Result: The expression of TNF-αand GRβwere different among three groups.The following were the changes under HE and TNF-αand GRβstainning:1 The TNF-αimmunohistochemistry staining showed that the different type of chronic rhinosinusitis had the different expression of TNF-α.The TNF-α( x±s) was (4.35±2.08) in control group, (6.85±1.21) in type I CRS group, (8.35±2.15) in type II CRS group. Comparision to the controls, TNF-αof all the CRS patients were higher and type II CRS group were high remarkbly, the result showed: there were significant difference of the expression between type I chronic rhinosinusitis and control groups(P<0.05), there were very different between type I chronic rhinosinusitis and control groups(P<0.05).2 The GRβimmunohistochemistry showed that different types CRS expressed difference.The GRβ( x±s) was (10.56±1.08)in control group, (17.85±1.31)in type I CRS, (30.35±3.12) in type II CRS . Comparision to the controls, GRβof all the the CRS patients were higher and type II CRS group were high remarkbly, the result showed: there were significant difference of the expression between type I chronic rhinosinusitis and control groups(P<0.05), there were very different between type I chronic rhinosinusitis and control groups(P<0.05).3 The TNF-αurged the GRβhigh expression and they had an obvious relationship.TNF-αand GRβwere high expression in CRS type II and CRS type I, TNF-αshowed positive correlation with GRβbetween them, and the correlation coefficient was r=0.7983 in CRS type I, and the correlation coefficient was r=0.8125 in CRS type II, and there was statistic significance(P<0.05).Conclusion: TNF-αand GRβwere high expression in CRS type II and CRS type I, TNF-αshowed positive correlation with GRβbetween them. GRβmay play a role to the development of the CRS.The more TNF-αand GRβare high expression, the more state of illness become severe. They contribute to guidance prognosis and treatment protocols by examination TNF-αand GRβ. |
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