窦源性颅内曲霉菌病与鼻-眶-脑毛霉菌病的临床及实验室检查特点比较  

Clinical and laboratory features of sinus-originated intracranial aspergillosis and rhino-orbito-cerebral mucormy‑cosis:a comparative analysis

作　　者：蒋玙姝 李玮 庞瑞 代淑华 秦灵芝 张弥兰 刘慧勤 王晓娟 李可 张杰文 JIANG Yushu;LI Wei;PANG Rui(Department of Neurology,The People's Hospi-tal of Zhengzhou University&Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)神经内科,河南郑州450003 [2]周口市中心医院神经内科,河南周口466000 [3]叶县人民医院神经内科,河南平顶山467200

出　　处：《中风与神经疾病杂志》2024年第2期108-115,F0002,共9页Journal of Apoplexy and Nervous Diseases

基　　金：河南省中青年卫生健康科技创新人才培养项目(CY20200060)。

摘　　要：目的比较窦源性颅内曲霉菌病(ICA)和鼻-眶-脑毛霉菌病(ROCM)的临床特征和辅助检查结果。方法回顾性分析河南省人民医院2018年1月—2023年1月诊治的7例窦源性ICA和6例ROCM患者的临床资料。结果100%ROCM和57.1%窦源性ICA患者存在CNS真菌感染致病因素。ROCM患者更易出现眼部症状和体征,包括眼球突出、眶周肿胀和眼内炎,且易出现发热、面部肿胀和面神经麻痹等非眼部症状和体征。ROCM患者血糖、血沉、C反应蛋白和降钙素原升高更明显。头颅MRI显示窦源性ICA患者常见受累部位为鼻窦‑眶尖‑眶后‑海绵窦,ROCM患者易出现鼻窦炎症、骨质破坏和毛霉菌侵及脑血管表现。50%ROCM和42.9%窦源性ICA患者接受单纯抗真菌药物治疗,50%ROCM和57.1%窦源性ICA患者接受药物+手术联合治疗。随访至2023年9月,共50%ROCM和28.6%窦源性ICA患者治疗无效死亡。结论窦源性ICA和ROCM病情进展迅速,伴有糖尿病的ROCM幸存者更易遗留残疾。及时诊断和启动抗真菌药物治疗,纠正潜在的诱发因素,以及积极的手术清创,是更好地治疗CNS真菌感染的基础。Objective To compare the clinical features and auxiliary examination results of sinus-originated intra‑cranial aspergillosis(ICA)and rhino-orbito-cerebral mucormycosis(ROCM).Methods A retrospective analysis was performed for the clinical data of seven patients with sinus-originated ICA and six patients with ROCM who were diagnosed and treated in our hospital from January 2018 to January 2023.Results The pathogenic factor of CNS fungal infection was observed in all patients with ROCM and 57.1%of the patients with sinus-originated ICA.Compared with the patients with sinus-originated ICA,the patients with ROCM were more likely to develop ocular symptoms and signs such as exoph‑thalmos,periorbital swelling,and intraocular inflammation,as well as non-ocular symptoms and signs including fever,fa‑cial swelling,and facial nerve palsy.Compared with the patients with sinus-originated ICA,the patients with ROCM had significantly greater increases in blood glucose,erythrocyte sedimentation rate,C-reactive protein,and procalcitonin.Cra‑nial magnetic resonance imaging showed that sinus-originated ICA often affected the paranasal sinuses,orbital apices,retro-orbital regions,and cavernous sinuses,while the patients with ROCM were more likely to have sinusitis,bone de‑struction,and mucormycosis invading cerebral vessels.As for treatment,50%of the patients with ROCM and 42.9%of the patients with sinus-originated ICA received antifungal therapy alone,while 50%of the patients with ROCM and 57.1%of the patients with sinus-originated ICA received a combination of medication and surgery.By follow-up to September 2023,50%of the patients with ROCM and 28.6%of the patients with sinus-originated ICA had no response to treatment and died.Conclusion Both sinus-originated ICA and ROCM have rapid progression,and ROCM survivors with diabetes are more likely to experience disabilities.Timely diagnosis and initiation of antifungal therapy,correction of underlying predisposing factors,and active surgical debridement are essential for the

关 键 词：中枢神经系统 真菌感染 曲霉菌 毛霉菌 

分 类 号：R515[医药卫生—内科学]