健康和疾病中的鼻腔粘膜纤毛清除,Annals of Otology, Rhinology & Laryngology

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健康和疾病中的鼻腔粘膜纤毛清除
Annals of Otology, Rhinology & Laryngology ( IF 1.3 ) Pub Date : 2006-09-01 , DOI: 10.1177/00034894061150s904
Noam A Cohen ₁

Affiliation

尽管在过去的 170 年里已经阐明了关于纤毛功能在健康或患病人类呼吸系统中的精确机制，但仍然存在重大问题。对纤毛作用的首次描述归功于 Sharpey 于 1835 年。然而，直到 Hilding 对术后犬鼻窦的研究证明瘢痕形成和黏膜纤毛清除受到破坏时，黏膜功能的重要性才显现出来。随后，报道了几种用于暴露骨骼的粘膜覆盖的技术，最著名的是 Sewall 和 Boyden。随着 Messerklinger 对鼻腔黏膜纤毛流动模式的描述，解释黏膜重要性的潜在生理学和黏膜保存的概念变得明显。从而恢复自然的鼻窦生理机能，即，粘膜纤毛清除，成为鼻窦炎性疾病内科和外科治疗的目标。粘液中良性和病理性物质的清除受跳动纤毛的推进力和上覆粘液的物理特性控制。呼吸纤毛以协调的方式持续跳动，并且在压力时（例如，运动、感染或发烧）纤毛跳动频率增加以加速粘液清除。因此，上呼吸道纤毛运动处于动态调节之下。多项研究无可争议地表明，慢性鼻-鼻窦炎患者的鼻窦黏液纤毛清除率显着降低。这一发现的可能解释是 1) 基底纤毛搏动频率降低，2) 气道分泌物的粘弹性改变，和/或 3) 鼻窦纤毛对环境刺激的动态反应迟钝。对前两种解释的研究产生了相互矛盾的结果，迄今为止，第三种可能性仍未得到研究。综述了目前对呼吸道纤毛活动的细胞调节及其对慢性鼻鼻窦炎的影响的理解。

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Sinonasal Mucociliary Clearance in Health and Disease

Although much has been elucidated in the past 170 years concerning the precise mechanism of ciliary function in the healthy or diseased human respiratory system, significant questions remain. The first description of ciliary action is credited to Sharpey in 1835. However, the importance of mucosal function was not apparent until Hilding's investigations of the postsurgical canine sinus demonstrated scar formation and disruption of mucociliary clearance. Subsequently, several techniques for mucosal coverage of exposed bone, most notably by Sewall and Boyden, were reported. The underlying physiology explaining the importance of the mucosa and the concept of mucosal preservation became apparent with the description of the sinonasal mucociliary flow patterns by Messerklinger; and thus the restoration of natural sinus physiology, ie, mucociliary clearance, became the goal of both medical and surgical treatment of sinonasal inflammatory disease. Clearance of benign and pathological substances in the mucus is governed by the propulsive force of the beating cilia and the physical characteristics of the overlying mucus. The respiratory cilia continually beat in a coordinated fashion, and in times of stress (eg, exercise, infection, or fever) ciliary beat frequency increases to accelerate mucus clearance. Thus, upper airway ciliary motility is under dynamic modulation. Multiple investigations incontrovertibly demonstrate a marked decrease in sinonasal mucociliary clearance in patients with chronic rhinosinusitis. Possible explanations for this finding are 1) a reduced basal ciliary beat frequency, 2) an alteration of the viscoelastic properties of airway secretions, and/or 3) a blunted dynamic response of sinonasal cilia to environmental stimuli. Studies of the first two explanations yield conflicting results, and to date, the third possibility remains uninvestigated. A review of the current understanding of the cellular regulation of respiratory ciliary activity and its contribution to chronic rhinosinusitis is presented.

更新日期：2006-09-01

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