慢性真菌性鼻-鼻窦炎病原学分析  

Etiological analysis of chronic fungal rhinosinusitis

作　　者：隋文君[1] 胡旭辰 刘向祎[1] SUI Wenjun;HU Xuchen;LIU Xiangyi(Department of Laboratory Medicine,Beijing Tongren Hospital,Beijing 100730,China;2017 Grade,Medical Laboratory Technology Major,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京同仁医院检验科,北京100730 [2]首都医科大学,北京100069

出　　处：《国际检验医学杂志》2022年第7期786-790,共5页International Journal of Laboratory Medicine

基　　金：首都医科大学科研培育基金(校自然)项目(PYZ20097);国家科技重大专项(2018ZX10102001)。

摘　　要：目的分析慢性真菌性鼻-鼻窦炎(CFRS)患者的临床特征和病原学数据,为CFRS的病因学研究提供依据。方法将2016年至2020年于北京同仁医院确诊为慢性鼻-鼻窦炎(CRS)的756例门诊及住院患者纳入研究。对CFRS患者临床特征进行分析,对真菌球型鼻窦炎(FB)和变应性真菌性鼻-鼻窦炎(AFRS)患者的临床特征进行比较。对CFRS患者的真菌、细菌病原学分布以及真菌、细菌混合感染情况进行分析。对FB与AFRS患者的真菌培养结果进行比较。对CFRS与非真菌性CRS的细菌病原学分布进行比较。结果纳入研究的CRS患者中,CFRS患者占56.3%(426/756),非真菌性CRS患者占43.7%(330/756)。CFRS多见于成年人、女性,上颌窦发病所占比例最高。426例CFRS均为CNIFRS,其中FB占56.1%(239/426),AFRS占43.9%(187/426),两者性别构成、累及部位比较差异均有统计学意义(P<0.05)。CFRS病原学分析显示其主要致病真菌为曲霉菌,其中以黄曲霉最为多见;细菌、真菌混合感染比例为49.3%,混合1种细菌感染占19.5%,混合2种细菌感染占29.8%;细菌、真菌混合感染中,感染的革兰阳性菌以葡萄球菌(30.0%)、链球菌(4.8%)为主;革兰阴性菌以肠杆菌目细菌(32.9%)和铜绿假单胞菌(9.0%)为主。FB和AFRS患者真菌培养阳性率比较,差异有统计学意义(P<0.05)。CFRS和非真菌CRS的细菌病原学分布较为接近,差异无统计学意义(P>0.05)。结论临床上CFRS以FB和AFRS最为常见,以病原培养为基础的CFRS病原学分析显示真菌混合细菌感染比例较高,并且真菌培养阳性率低,提示CFRS的病原学信息尚不完善,需要进一步研究,这对阐明CFRS的发病机制有重要意义。Objective To analyze the clinical characteristics and etiological data of patients with chronic fungal rhinosinusitis(CFRS)and provide evidence for the etiology of CFRS.Methods A total of 756 outpatients and inpatients diagnosed with chronic rhinosinusitis(CRS)in Beijing Tongren Hospital from 2016 to 2020 were enrolled in the study.The clinical characteristics of CFRS patients were analyzed,and the clinical characteristics of fungal ball(FB)and allergic fungal rhinosinusitis(AFRS)patients were compared.The distribution of fungal and bacterial pathogens and the mixed infection of fungi and bacteria in CFRS patients were analyzed.The fungal culture results of FB and AFRS patients were compared.The bacterial etiological distribution of CFRS and non-fungal CRS was compared.Results Among the CRS patients enrolled in the study,CFRS patients accounted for 56.3%(426/756),and non-fungal CRS patients accounted for 43.7%(330/756).CFRS is more common in adults,females,and the illness at maxillary sinus accounted for the highest proportion.The 426 cases of CFRS were all CNIFRS,of which FB accounted for 56.1%(239/426)and AFRS accounted for 43.9%(187/426).The etiological analysis of CFRS showed that the main pathogenic fungus was Aspergillus,among which Aspergillus flavus was most common;the proportion of bacterial and fungal mixed infection was as 49.3%,19.5%was mixed with one bacterial infection,and 29.8%was mixed with two bacterial infections;in the mixed fungal infection,the gram-positive bacteria were mainly Staphylococcus(30.0%)and Streptococcus(4.8%);the Gram-negative bacteria were mainly Enterobacteriaceae(32.9%)and Pseudomonas aeruginosa(9.0%).There was a statistically significant difference in the positive rate of fungal culture between FB and AFRS patients(P<0.05).The bacterial etiological distribution of CFRS and non-fungal CRS was similar,and the difference was not statistically significant(P>0.05).Conclusion FB and AFRS are the major types of CFRS.Culture-based CFRS etiological analysis shows that the proportion o

关 键 词：真菌性鼻-鼻窦炎 曲霉菌 病原学 临床特征 

分 类 号：R446.5[医药卫生—诊断学]