CAJ | 학술논문

目的观察慢性鼻窦炎嗅觉障碍患者嗅上皮的超微结构变化。方法对35例住院行鼻内窥镜手术治疗伴有嗅觉缺失鼻窦炎患者的嗅上皮取活体组织，光镜下将嗅上皮按病变分为正常、萎缩和呼吸上皮化生组，透射电镜分别观察各组超微结构变化。结果①光镜下正常的嗅上皮细胞表面超微结构出现支持细胞微绒毛消失、嗅泡内微管结构消失或空泡化致嗅泡变形、嗅纤毛变形或减少、少量纤毛化生等改变；②萎缩的嗅上皮超微结构改变的特点：轻、中度萎缩主要为支持细胞上部的细胞器和膜限制性的电子致密囊泡明显减少或消失、空泡化，基底细胞退行性变；重度萎缩为细胞结构不清，多为双层细胞结构，细胞核染色质呈斑块状凝聚、核空泡化或核固缩；细胞质内均出现内质网扩张，线粒体肿胀、嵴排列紊乱、减少或空泡状改变；③呼吸上皮化生区域，丛状纤毛细胞与支持细胞、嗅泡样结构间隔分布，即嗅上皮细胞呈岛状分布。结论炎症导致嗅上皮细胞由表层及里层各种超微结构异常程度与嗅上皮萎缩程度呈正相关；慢性鼻窦炎嗅觉障碍患者嗅上皮超微结构变化与分型分期无关。
목적관찰만성비두염후각장애환자후상피적초미결구변화。방법대35례주원행비내규경수술치료반유후각결실비두염환자적후상피취활체조직，광경하장후상피안병변분위정상、위축화호흡상피화생조，투사전경분별관찰각조초미결구변화。결과①광경하정상적후상피세포표면초미결구출현지지세포미융모소실、후포내미관결구소실혹공포화치후포변형、후섬모변형혹감소、소량섬모화생등개변；②위축적후상피초미결구개변적특점：경、중도위축주요위지지세포상부적세포기화막한제성적전자치밀낭포명현감소혹소실、공포화，기저세포퇴행성변；중도위축위세포결구불청，다위쌍층세포결구，세포핵염색질정반괴상응취、핵공포화혹핵고축；세포질내균출현내질망확장，선립체종창、척배렬문란、감소혹공포상개변；③호흡상피화생구역，총상섬모세포여지지세포、후포양결구간격분포，즉후상피세포정도상분포。결론염증도치후상피세포유표층급리층각충초미결구이상정도여후상피위축정도정정상관；만성비두염후각장애환자후상피초미결구변화여분형분기무관。
Objective　To observe the ultrastructural changes of olfactory epithelium (OE) in patients suffering from dysosmia caused by chronic sinusitis. Methods　The specimens of olfactory epithelium were obtained from 35 patients operated for chronic sinusitis accompanied by dysosmia. According to the results of light microscope (LM) examination, the OE was divided into three groups by the types of pathological changes: normal, atrophic and respiratory epithelium metaplasia(REM). Transmission electron microscope was used to observe the ultrastructural changes of each group. Results　Under the LM, the surface ultrastructure of the OE showed some abnormal changes: (1) surface microvillus of the supporting cells disappeared; (2) olfactory vesicle changed their shape due to vacuolization; (3) disappearance of canaliculus structure in the olfactory vesicle ; (4) the olfactory cilia changed the shape or reduced; some of the reduced cilia underwent metaplasia. The ultrastructural changes of atrophic OE included: (1) minor and moderate atrophy: the organelles and the membrane-limited electron dense vesicles on the upper section of the supporting cells obviously decreased or disappeared, even underwent vacuolization. The basic cell degenerated; (2) serious atrophy: the turbidity of the cell structure, even double cell structure, the nuclei of the cell aggregated as the plaque and vesiculose change or karyopyknosis. As for the cytoplasm, there were the dilation of the ERs, turgidity of the mitochondrion, the disarrangement, diminution and vacuolization. Fasciculate cilia were distributed separately in the REM group. Conclusion　There is a positive relationship between the atrophy degree and the degree of the abnormal ultrasrucutural changes of the OE. The ultrastructural changes of OE in patients suffering from dysosmia caused by chronic sinusitis may provide reference for assessment of the treatment of dysosmia.