免疫蛍光抗体法による慢性副鼻腔炎の研究

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Chronic sinusitis is one of the most prevalent nasal illnesses in Japan, but the pathogenesis of chronic sinusitis has not been fully understood yet. Recent advances in immunology have provide convincing evidence that secretory immunoglobulins may have an important role in mucosal defense mechanism.Fifty six specimens of maxillay mucosae and 17 of nasal mucosae were obtained by surgery from the patients with chronic sinusitis and studied in order to obtain information about the local immune mechanism. Immunofluorescent microscopic studies were undertaken to determine the presence and distribution of different immunoglobulins (IgA, IgM, IgG and IgE) and secretory component (SC) in nasal and maxillary mucosae. Additionally, the relationship between the histopathological types of chronic sinusitis and local immunoglobulins were studied.Following results were obtained.1) There was no difference in the location or production of immunoglobulin bearing cells and extracellular immunoglobulins between the infiltrative and edematous mucosae in histopathological type. In fibrotic type, fluorescent activity could not be established.2) IgA and IgM bearing cells were demonstrated in the surface lamina propria and around the grandular tissue of maxillary mucosa. In the nasal mucosa, IgA and IgM bearing cells were localized around the grandular tissue. A small number of IgG bearing cells weae noted in lamina propria in maxillary and nasal mucosae. No IgE was noted.3) Extracellular IgA and IgM were mostly localized in intercellular space of the mucosal epithelial cells, subepithelial interstitium and around the glands. In maxillary and nasal grandular cells, IgA and SC were localized in the apical portion of glandular cells and intercellular space of the grandular epithelia. IgG was predominantly distributed in the interstitium of most specimens, especially in the surface lamina propria but not seen in the grandular cells.4) As inflammation became severer in the maxillary mucosae, IgA and IgM bearing cells were increased considerably, and especially, extracellular IgG was seen more brilliantly.5) Although SC was detected in 82% of nasal mucosa examined, it was detected in 30% of the examined maxillary mucosae. These results indicated that there is immunological dissociation between nasal and maxillary mucosae.The results suggested that the increase of IgA and IgM bearing cells could be due to an acceleration of local immune response, and the bulk of IgG derived from serum. The production of SC and polymeric IgA were lost in some infected maxillary mucosae. In these SC defficiency and/or decreased secretory IgA production and combined with IgG local immune reactions may contribute to enhancement and perpetuation of inflammation in the naso-maxillary system.
社団法人日本耳鼻咽喉科学会の論文

著者

由井誠一郎
三重大学医学部耳鼻咽喉科教室

免疫蛍光抗体法による慢性副鼻腔炎の研究

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