鼻・副鼻腔疾患における免疫学的検討—特に末梢血T細胞機能を中心に

IMMUNOLOGICAL STUDY IN DISEASE OF THE NASAL AND PARANASAL SINUSES: WITH EMPHASIS ON THEFUNCTION OF T-CELLS IN PERIPHERAL BLOOD

　I．はじめに

　鼻・副鼻腔疾患の代表的なものである鼻アレルギー，慢性副鼻腔炎における成因・病態に関する研究報告は枚挙にいとまがないほど多くみられる。鼻アレルギーの研究は，IgEの発見以来急速に発展し，現在ではin vitroの段階で論議するまでに至っている。しかし，慢性副鼻腔炎の病態研究では，病理組織学，生理学，生化学，細菌学等の立場からの研究報告が主であり，免疫・アレルギー学の立場からの研究はきわめて少ない。さらに慢性副鼻腔炎は広義の意味で免疫機能低下とする考えもあり，その立場からすれば，リンパ球，特にT細胞機能の検討はその病態解明に役立つと思われる。筆者は慢性副鼻腔炎の病像の解明の一手段として生体の免疫防御機構の角度，特に末梢血T細胞の機能について検討したので報告する。

　Disease of the nasal and paranasal sinuses (localized infection in 20 cases, edematous polyp in 50 cases, diffuse catarrh in 18 cases) were investigated by immunological examinations (serum-immunoglobulin level, T-cell, T-cell with a receptor for Fc portion of IgG, in vitro examination of the helper and suppressor effects of T-cells on differentiation of B-cells into immunoglobulin-producing cells). The following results were obtained:

　1) Serum Immunoglobulin (IgA) was low in 33% of diffuse catarrh cases, while IgG was high in 20% of edematous polyp cases and low in 50% of diffuse catarrh cases.

　2) T-cell counts were within normal range in every type of the disease.

　3) T-cells with a receptor for Fc portion of IgG molecule were significantly increased in 50% of diffuse catarrh cases.

　4) Analysis of the helper effect of T-cells disclosed that the function of T-cells were accelereted in 20% of edematous polyp cases and diminished in 60% of diffuse catarrh cases. The suppressor effect of T-cells showed that the function was significantly accelereted in 40% of diffuse catarrh cases.

　It is clear from the above findings that decrease in cell-mediated immunity, especially quantitative and qualitative disturbance of the function of T-cells, is present in diffuse catarrh type of chronic sinusitis.

　This suggests that the functional insufficiency of the cells in charge of immune response, which controls the immune mechanism, is an important factor in development or etiology of the diseases.