慢性副鼻腔炎鼻汁の成因と対策 Pathogenesis of Nasal Mucus Hypersecretion in Chronic Sinusitis

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Nasal mucus hypersecretion is a feature of chronic sinusitis (CS). Bacterial infection, which initiates neutrophil accumulation in the nose and sinuses is an initial cause of CS. The specific neutrophil products to stimulate mucus glycoprotein (MGP) secretion are neutrophil elastase, cathepsin G and platelet-activating factor. Eicoanoids are a group of lipids derived from arachidonic acid that is released from the cell membranes of inflammatory and epithelial cells, and also contribute to MGP production. Bacterial products, such as lipopolysaccharide and elastase from some bacteria, are potent secretagogues. Such products derived from inflammatory cells and bacterias are retained in sinuses for a long time because of obstruction of the sinus ostium and mucociliary dysfunction of the nose and sinuses. Submucosal gland cells are hyperplastic and hypertrophic but goblet cells are not, and the major source of MGP hypersecretion is submucosal gland cells rather than goblet cells. The role of neural innervation of submucosal glands on MGP overproduction has not yet to be elucidated.<br>The rheologic properties of nasal mucus from CS patients are much higher than the optimal viscoelasticity for mucociliary transport. Since MGP mainly determines the high viscosity and the high elasticity of nasal mucus, a control of MGP production could contribute to the normalization of abnormal viscoelasticity, and result in the improvement of mucociliary clearance. This is accomplished by removing the sinus retention that contains many secretagogues. Although current pharmacological approaches to airway mucus production are limited, glucocorticoid appears to be the most effective among the few useful drugs. The effect of 14-membered macrolide antibiotics on MGP production is still controversial. Some mucolytic agents change the conformations of MGP and lead to the reduction of viscoelasticity when they are administered topically or systemically.<br>The mechanisms of nasal mucus hypersecretion are also discussed in relation to the etiology of CS.

収録刊行物

  • 耳鼻咽喉科臨床

    耳鼻咽喉科臨床 94(5), 393-401, 2001-05-01

    The Society of Practical Otolaryngology

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各種コード

  • NII論文ID(NAID)
    10008096318
  • NII書誌ID(NCID)
    AN00107089
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00326313
  • NDL 記事登録ID
    5753163
  • NDL 雑誌分類
    ZS43(科学技術--医学--耳鼻咽喉科学)
  • NDL 請求記号
    Z19-421
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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