赵兴泉 钟渠 刘柯 顾珊珊 何武斌 王春艳

[摘要] 目的 探討地塞米松鼓室内注射对分泌性中耳炎外周血和中耳积液中辅助性T细胞（CD4+T细胞）、细胞毒性T细胞（CD8+T细胞）、白细胞介素2（IL-2）、白细胞介素4（IL-4）水平的影响。 方法 选取2018年4月至2020年6月在川北医学院附属第二医院就诊的分泌性中耳炎患者作为研究对象，其中急性患者作为研究A组60例，慢性患者作为研究B组60例，以同期正常体检的体检者60名作为对照组。A组、B组患者均给予地塞米松鼓室内注射进行治疗。记录并比较三组研究对象听力外周血和中耳积液中CD4+、CD8+T细胞、IL-2、IL-4水平。 结果治疗前，A、B两组患者CD4+、CD4+/CD8+及听力水平比较，差异无统计学意义（P>0.05）;但CD4+、CD4+/CD8+均明显低于对照组（P<0.05）。治疗后，A、B两组均明显提高（P<0.05），但CD4+、CD4+/CD8+仍明显低于对照组（P<0.05），CD8+指标在治疗前后均明显高于对照组（P<0.05）;治疗前，A组患者血清IL-2、IL-4水平明显高于B组（P<0.05），且均明显高于对照组（P<0.05）;治疗后，A、B两组均明显降低，但仍明显高于对照组（P<0.05）。 结论 分泌性中耳炎采用鼓室内注射地塞米松治疗，能明显改善患者的免疫力和听力水平，通过比较患者外周血和中耳积液中IL-2、IL-4水平差异，可作为诊断急性及慢性中耳炎的临床依据。

[关键词] 地塞米松;分泌性中耳炎;白细胞介素-2;白细胞介素-4;辅助性T细胞;细胞毒性T细胞

[中图分类号] R764.21          [文献标识码] A          [文章编号] 1673-9701（2021）36-0013-04

Effect of intratympanic injection of dexamethasone on levels of CD4+ T cells， CD8+ T cells， IL-2 and IL-4 in peripheral blood and middle ear effusion of secretory otitis media

ZHAO Xingquan1   ZHONG Qu1   LIU Ke2   GU Shanshan2   HE Wubin1   WANG Chunyan1

1.Department of Otorhinolaryngology， Sichuan Mianyang 404 Hospital， Mianyang   621000， China; 2.Department of Otorhinolaryngology， the Second Affiliated Hospital of North Sichuan Medical College， Nanchong   621000

[Abstract] Objective To explore the effect of intratympanic injection of dexamethasone on levels of CD4+ T cells， CD8+ T cells， IL-2 and IL-4 in peripheral blood and middle ear effusion of secretory otitis media. Methods Patients with secretory otitis media who were treated in the Second Affiliated Hospital of North Sichuan Medical College from April 2018 to June 2020 were selected as the research subjects， and outpatients with secretory otitis media who were treated in the Department of Otorolaryngology were selected as the research subjects. Acute patients were included in the study group A （60 cases）， chronic patients were included in the study group B （60 cases）， and normal physical examination subjects were included in the control group （60 cases）. Patients in group A and group B were treated with intratympanic injection of dexamethasone. The levels of CD4+ T cells， CD8+ T cells， IL-2 and IL-4 in peripheral blood and middle ear effusions of the three groups were recorded and compared. Results Before treatment， no significant differences were observed in CD4+， CD4+/CD8+ and hearing levels between group A and B（P>0.05）， but their CD4+ and CD4+/CD8+ were significantly lower than those in the control group（P<0.05）. After treatment， CD4+ and CD4+/CD8+ in group A and B were significantly lower than those in the control group（P<0.05）. The CD8+ index was significantly higher than that of the control group before and after treatment（P<0.05）， and significantly decreased after treatment， but still significantly higher than that of the control group. Serum IL-2 and IL-4 levels in group A were significantly higher than those in group B， and both of them were significantly higher than those in the control group（P<0.05）. After treatment， serum IL-2 and IL-4 levels in group A and group B were significantly decreased， but still significantly higher than those in the control group （P<0.05）. Conclusion The treatment of secretory otitis media with intratympanic injection of dexamethasone can significantly improve the patients' immunity and hearing level. By comparing the levels of IL-2 and IL-4 in peripheral blood and middle ear effusion of patients， it can be used as the clinical basis for the diagnosis of acute and chronic otitis media.

[Key words] Dexamethasone; Secretory otitis media; IL-2; IL-4; Th cell; Cytotoxic T cell

分泌性中耳炎（Secretory otitis media，SOM）是耳鼻喉科多见的中耳非化脓性疾病，临床表现主要有听力下降、耳闷胀感、鼓室积液及耳鸣等症状[1]。其可分为两种类型为急性和慢性，易发于成年人和儿童[2]。……