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1 KISEP 비용과 비용양점막에서 Neuropeptides의 분포 Abstract 고필준 나기상 박찬일 Distribution of Neuropeptides in Nasal Polyp and Polypoid Mucosa Pil Jun Ko, M.D., Ki Sang Rha, M.D., Chan Il Park, M.D. Department of Otolaryngology, College of Medicine, Chungnam National University, Daejeon, Korea BackgroundThe pathogenesis of nasal polyp is not well understood, however the common pathway of nasal polyp formation is tissue edema. Factors that are known to predispose tissue edema include histamine, arachidonic acid metabolites, serotonin and peptidergic neurotransmitters. ObjectivesTo elucidate the pathophysiological roles of peptidergic neurotransmitters on the polyp formation, we investigated the distribution of several immunoreactive nerve fibers. Materials and MethodsWe obtained normal middle turbinate mucosa, edematous middle turbinate mucosa, polypoid middle turbinate mucosa and nasal polyp tissue from 5 patients at the time of surgery and we determined the distribution of substance PSP immunoreactive, vasoactive intestinal peptidevip immunoreactive and neuropeptideynpy immunoreactive nerve fibers in the above tissues using avidinbiotin complexabc immunohistochemical method. ResultsFine varicose peptidergic nerve fibers were found numerously in normal mucosa and they were decreased in number in the edematous mucosa. However the peptidergic nerve fibers were hardly found in the polypoid mucosa and the pedicle of polyp, and no nerve fibers were found in the apex of polyp except VIPimmunoreactive nerve fibers. ConclusionDecreasing tendency of distribution of these peptidergic nerve fibers in the order of edematous mucosa, polypoid mucosa, and polyp may indicate the denervation of autonomic nervous system. These phenomenon suggests the important role of peptidergic neurotransmitters in the early stage of polyp formation. However, once the polyp has been formed, contribution of the peptidergic neurotransmitters is considered to be negligible. Korean J Otolaryngol 405, 1997 KEY WORDSNeuropeptides Nasal polyp Avidinbiotin complexabc method. 657

2 서 론 대상 및 방법 658

3 Korean J Otolaryngol 40 5, May 1997 만 관찰된 경우 few, 일부 예에서 한두 시야에서만 관 에서는 정상점막이나 부종점막에 비해 적지만 모든 예에 찰된 경우 trace, 전혀 신경섬유가 관찰되지 않은 경우 서 기질층과 점막하분비선 주위에 VIP 양성신경섬유가 absent, 그리고 numerous와 few중간정도의 분포를 보 분포하고 있음이 관찰되었으며 비용의 기저부의 기질층 인 경우 moderate라 정의하였다. 에서는 모든 예에서, 분비선 주위에서는 일부 예에서 관 결 과 정상비점막과 부종점막에서 SP 양성신경섬유는 상피 층과 기질층에 많이 분포하고 있었으나 혈관 근처와 점 막하분비선 주위에서는 약간의 신경섬유만이 관찰되었 으나 비용양점막이나 비용의 기저부에서는 일부 예에서 만 기질층에서 관찰되었고(Fig. 1), 비용의 첨부에서는 전혀 관찰되지 않았다(Table 1). 정상비점막과 부종점막에서 VIP 양성신경섬유는 점막 서도 약간의 신경섬유가 관찰되었다(Fig. 2). 비용양점막 Fig. 2. Immunostaining of the VIP in the edematous middle turbinate mucosa around the submucosal gland (arrow)( 400). Fig. 1. Immunostaining of the substancep in the pedicle part of nasal polyp(arrow)( 400). Fig. 3. Immunostaining of the VIP in the apex part of nasal polyp(arrow)( 400). 하분비선과 기질층에 많이 분포하고 있었으며 혈관주위에 Table 1. Distribution of SPimmunoreactive nerve fibers NM Epithelium Lamina propria EM PM Table 2. Distribution of VIPimmunoreactive nerve fibers Polyp NM Stalk Apex Epithelium EM PM Polyp Stalk Apex Lamina propria Arteriol Arteriol Venule or sinusoid Venule or sinusoid Glands NM Normal mucosa, EM edematous middle turbinate mucosa, PM polypoid middle turbinate mucosa, numerous, moderate, few, trace, absent Glands NM Normal mucosa, EM edematous middle turbinate mucosa, PM polypoid middle turbinate mucosa, numerous, moderate, few, trace, absent 659

에서는 모든 예에서, 분비선 주위에서는 일부 예에서 관 결 과 정상비점막과 부종점막에서 SP 양성신경섬유는 상피 층과 기질층에 많이 분포하고 있었으나 혈관 근처와 점 막하분비선 주위에서는 약간의 신경섬유만이 관찰되었 으나 비용양점막이나 비용의 기저부에서는 일부 예에서 만 기질층에서 관찰되었고(Fig.

4 Fig. 4. Immunostaining of the NPY in the normal middle turbinate mucosa around the vesselsarrow 400. Fig. 5. Immunostaining of the NPY in the pedicle part of nasal polyparrow400. Table 3. Distribution of NPYimmunoreactive nerve fibers NM EM PM Polyp Stalk Apex Epithelium Lamina propria Arteriol Venule or sinusoid Glands NMNormal mucosa, EMedematous middle turbinate mucosa, PMpolypoid middle turbinate mucosa, numerous, moderate, few, trace, absent 고 찰 660

Distribution of NPYimmunoreactive nerve fibers NM EM PM Polyp Stalk Apex Epithelium Lamina propria Arteriol Venule

5 Korean J Otolaryngol 405, May 1997 결 론 661

6 References 1) Larsen PL, Tos M:Polyp formation by experimental tubal occlusion in the rat. Acta Otolaryngol (Stockh). 1991;111: ) Cauna N, Hinderer KH, Manzetti GW, Swanson EW:Fine structure of nasal polyps. Ann Otol ;81:4158 3) Hiraide F, Kakoi H:Histochemical study on innervation of glands and blood vessels in nasal polyps. Acta Otolaryngol(Stockh). 1986;430: 511 4) Fang SY, Shen CL, Ohyama M:Presences of neuropeptides in human nasal polyp. Acta Otolaryngol(Stockh). 1994;114: ) Hajek M:Uber die pathologischen veranderungen der siebbeinknochen im gefolge der entzundlichen schleimhauthyperthrophie und der nasenpolypen. Arch Laryngol Rhinol. 1898;4:277 6) Jenkins J:Blockade theory of polyp formation. Laryngoscope. 1932;42: ) Krajina Z:A contribution to the etiopathogenesis of nasal polyps. Pract OtoRhinoLaryngol. 1938;25: ) Tos M:The pathogenetic theories in formation of nasal polyps. Am J Rhinol. 1990;4:5156 9) Baraniuk JN, Lundgren JD, Okayama M, et al: Substance P and neurokinin A in human nasal mucosa. Am J Respir Cell Mol Biol. 1991;4: ) Kronberger CH, Hacker GW, Muss W, Saria A, Albegger K:Autonomic and peptidergic innervation of human nasal polyp. Acta Otolaryngol (Stockh). 1993;113: ) Baraniuk JN, Castellino S, Lundgren JD, et al: Neuropeptide Y(NPY) in human nasal mucosa. Am J Respir Cell Mol Biol. 1990;3: ) Barnes PJ, Baraniuk JN, Gelvisi MG:Neuropeptides in the respiratory tract. Am Rev Respir Dis II. 1991;144: ) Baraniuk JN, Lundgren JD, Okayama M, et al: Vasoactive intestinal peptide in human nasal mucosa. J Clin Invest. 1990;86: ) Barnes PJ, Baraniuk JN, Gelvisi MG:Neuropeptides in the respiratory tract. Am Rev Respir Dis I. 1991;144: ) Uddman R, Malm L, Fahrenkrug J, Sundler F: VIP increases in nasal blood during stimulation of the vidian nerve. Acta Otolaryngol. 1981; 91:

1 972;81:4158 3) Hiraide F, Kakoi H:Histochemical study on innervation of glands and blood vessels in nasal polyps. Acta Otolaryngol(Stockh).

Fig. 1. Laryngoscopic findings according to Yonekawa Fig. 2. possible etiologic factors. 2A Smoking, 2B Gastroesophageal reflux symptom, 2C Skin

Fig. 1. Laryngoscopic findings according to Yonekawa Fig. 2. possible etiologic factors. 2A Smoking, 2B Gastroesophageal reflux symptom, 2C Skin KISEP Head and Neck Korean J Otolaryngol 2000;43:873-7 라인케부종의원인및음성학적고찰 안중호 남순열 Possible Etiology and Voice Analysis of Reinke s Edema Joong Ho Ahn, MD and Soon-Yuhl Nam, MD Department of Otolaryngology,