Basic Science
了解慢性鼻孔炎和过敏真菌鼻塞炎
医学博士Amber Luong
Chronic rhinosinusitis (CRS) is the most prevalent chronic disease affecting over 33 million Americans annually, according to the Centers for Disease Control and Prevention. The socioeconomic impact translates into over $5.8 billion dollars spent for the treatment of sinusitis and on average four work days missed a year per affected person. Despite its prevalence and socioeconomic impact, we have little understanding about the pathophysiology and hence a poor appreciation of the effective means of treating this disease.
Allergic fungal rhinosinusitis (AFRS) represents one severe type of CRS characterized by nasal polyps and a thick, mucin debris filling the sinuses. Its geographic distribution, more prevalent in warm humid environments, places Houston with a large population of AFRS sufferers. This disease is often recalcitrant to our current medical therapy and therefore patients are often faced with multiple surgeries.
尽管它的名称，但对这种疾病的病理生理知之甚少。该疾病被称为过敏真菌性鼻 - 鼻 - 鼻炎，因为它与肺部疾病的临床相似性也具有浓厚的粘液碎屑。来自我们实验室的初始数据支持真菌抗原在AFR激活中的作用。3此外，我们发现AFRS患者的真菌抗原引发了与过敏性炎症反应一致的某些分子的释放。综上所述，这是第一个直接支持AFRS病理生理中真菌抗原的过敏反应的数据。
Our our goal is to elucidate the molecular pathways leading to this allergic immune response in AFRS. Thymic stromal lymphopoietin is released from respiratory cells and directs immune cells to trigger an allergic immune response. This molecule is the link between the epithelial cells that are bombarded by antigens and the subsequent allergic inflammatory response. We believe that the TSLP pathway may also play a role in AFRS.
我们希望使用AFR作为理解CRS和鼻腔鼻窦内的免疫反应的模型，我们希望鉴定出更具体的药理疗法可以靶向的分子。
光学隆隆法和鼻挑衅测试
Schematic representation of the Rhinolux
鼻挑衅测试（NPT）代表评估鼻末端器官对可疑吸入过敏原的反应的直接手段。将抗原引入鼻腔中，并根据鼻粘膜肿胀进行反应。在超敏反应的阳性反应中，减少了静脉血液流入的鼻粘膜肿胀和鼻气道的横截面区域。在大多数欧洲国家，NPT是标准化的，并将其纳入吸入过敏的临床评估中。相反，过敏的诊断主要依赖于病史和皮肤测试或血清过敏原特异性IgE水平的测量。
吸入过敏首先是由过敏症状的临床史提出的，例如鼻漏，打喷嚏，水/发痒的眼睛和鼻腔充血。为了确认和鉴定煽动过敏原，患者接受了皮肤或血液测试（改良的放射性剂测试（MRAST））。一些研究人员认为，除非在患有过敏性鼻炎症状的患者中与血清IgE水平相结合，否则皮肤测试结果与鼻腔挑战有不可靠的相关性。图给定皮肤测试的局限性和MRAST以诊断为临床相关的吸入过敏，是一种替代性诊断性诊断性诊断性诊断。吸入过敏的工具。
佩戴犀牛的病人
《不扩散核武器条约》的响应is typically assessed by acoustic rhinometry or anterior rhinomanometry. Acoustic rhinometry transforms the analysis of a sound pulse within the nasal cavity to an area-distance plot. However, this technique involves placement of a tube within the anterior aspect of the nasal cavity and malpositioning of the nasal tube can lead to distortion. Anterior rhinomanometry measures the pressure difference between the nasopharynx and the naris and unilateral air flow to calculate the nasal resistance to airflow. Although well standardized, it is not valid in subjects with septal perforations or unilateral complete obstruction.
Optical rhinometry has recently been introduced as a means of assessing nasal airway patency. A wavelength light emitter and an optical sensor are placed across the nasal bridge. One of the 3 wavelengths emitted, 800-nm, corresponds to the isobestic point of hemoglobin. Consequently, changes in hemoglobin within the nasal tissue is measured independent of its oxygenation state. Hemoglobin levels within the nasal tissue provide a means of assessing nasal congestion. Rhinolux (Rhios GmbH, Germany), one such optical rhinometer, assesses nasal airway patency by detecting changes in blood flow into the nasal mucosa.
This image depicts the optical rhinometer. A) Schematics of the optical sensor which consists of an optical emitter and detector that resides in the nasal pieces of a spectacles-like frame B) Optical sensor is placed across the nasal bridge during measurements. This is a graphic representation of readings from the optical rhinometer in allergic subject undergoing nasal challenge with histamine and then oxymetazoline in one nasal cavity followed by histamine challenge in the contralateral nasal cavity.
Graph
参考
- Malm, L., R. Gerth van Wijk, and C. Bachert,有关鼻通畅，气流和气流阻力的方面的鼻挑衅指南。国际鼻气道的国际客观评估委员会，国际宗教学会。Rhinology, 2000. 38(1): p. 1-6.
- Gergen, P.J. and P.C. Turkeltaub,在国家样本中，单个过敏原反应与呼吸道疾病的关联：第二次国家健康和营养检查调查的数据，1976 - 80年（NHANES II）。J Allergy Clin Immunol, 1992. 90(4 Pt 1): p. 579-88.
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