Chronic Nose - Sinusitis, Sinus Mucosal Bacterial Biofilms, And Treg/th17 Cell Function Loss Of Balance And Experimental Research

ObjectiveTo observe the morphological characteristics of the biofilms using confocal scanning laser microscopy(CSLM) in patients with chronic rhinosinusitis(CRS),to study the correlation of the CT scores before the surgery,symptom scores,medicine therapy, nasal polyps or polyposis,allergic rhinitis,the course of the disease,the history of nasal surgery and the bacterial biofilm(BBF).MethodsTwenty-seven patients with chronic rhinosinusitis,two with Juverile nasopharyngeal angiofibroma,one with cerebrospinal rhinorrhea and one with simple maxillary cyst underwent endoscopic sinus surgery,their mucosal samples were obtained for the observation of the morphological characteristics of the biofilms,and the elaborate information about the patients,including the main symptoms,medicine therapy,nasal polyps or polyposis,allergic rhinitis,the course of the disease,the history of nasal surgery and so on,were collected.CT scans were graded according to the Lund-Mackay system,patient symptom scores were recorded from the SNOT-20 inventory.The correlation of the medicine therapy,nasal polyps or polyposis,allergic rhinitis,the history of nasal surgery and the bacterial biofilm were assessed by Chi-Square Test;The correlation of the CT scores before the surgery,symptom scores, the course of the disease and the bacterial biofilm scores were assessed by Pearson correlation coefficient(P).ResultsUsing CSLM criteria,bacterial biofilms were found in 16(59.26%) of the 27 CRS patients.No biofilm structures were evident in any of the non-CRS patients.No correlation between the medicine therapy,nasal polyps or polyposis,allergic rhinitis, the history of nasal surgery and the bacterial biofilm were observed.The correlation between the CT scores before the surgery,symptom scores,the course of the disease and the biofilms scores were significant.ConclusionThe CSLM detection of biofilms in CRS patients and their absence in non-CRS patients further supports the hypothesis that biofilms may play a role in the pathogenesis of CRS.The CRS patients who have more CT scores,longer course of the disease,or more severe symptoms may have more possibility of having bacterial biofilms.ObjectiveRecently,Treg cells and Th17 cells have been described as two distinct subsets from Thl and Th2 cells and have the opposite effects on autoimmunity.Th17/Treg balance controls inflammation and may be important in the pathogenesis of CRS.The purpose of our study was to assess whether this balance was broken by bacterial biofilms in patients with CRS.MethodsWe detected Treg and Th17 functions on key transcription factors and related cytokine in the patients with the Part One.Foxp3 mRNA,RORγt mRNA,IL-17 mRNA were estimated with RT-PCR.The difference between the BBF(+) and the BBF(-) were assessed by Student's t test,and the correlation between the BBF scores and the levels of Foxp3 mRNA,RORγt mRNA,IL-17 mRNA were assessed respectively by Spearman correlation coefficient(P).Results There was no significant difference of the levels of Foxp3 mRNA,RORγt mRNA, IL-17 mRNA between the CRS patients and the non-CRS patients,or between the patients with the BBF(+) and the BBF(-).The coefficients(P)between the BBF scores and the levels of Foxp3 mRNA,RORγt mRNA,IL-17 mRNA were 0.156,0.163 and 0.948 respectively.ConclusionTreg/Th17 functional imbalance does not exists in the patients with CRS,or in the patients who have BBF,and the results may also indicate that the existence of BBF is not affected by trhe function of the Treg cells or the Th17 cells.