免疫组织化学法在鼻窦真菌球诊断中的价值

Immunohistochemical diagnosis of fungus ball in paranasal sinuses

目的 研究鼻窦真菌球的主要致病菌种 ,探索组织切片中快速鉴定主要条件致病真菌的组织病理学方法。方法 2 5例鼻窦真菌球患者接受鼻窦病变清除术 ,对其组织病理标本分别进行了碘酸雪夫染色 (paraaminosalicylic ,PAS)和免疫组织化学染色 ,并比较两种方法的敏感性。 结果鼻窦真菌球以上颌窦发病率最高 ,其次是蝶窦。致病真菌检测 :曲霉菌感染 2 3例 (92 % ) ,白色念珠菌感染2例 (8% )。鼠抗曲霉单克隆抗体、兔抗白色念珠菌多克隆抗体可以分别鉴定组织中的曲霉菌和白色念珠菌。免疫组化和PAS染色的敏感性差异无显著性 (χ2 =0 2 72 ,P >0 0 5 )。结论鼻窦真菌球感染以曲霉菌属多见 ,免疫组化技术具有抗原特异性强、诊断快速的特点 。

Objective To study the pathogens of fungus balls in paranasal sinuses and establish an immunohistochemical test by which the main opportunistic fungi could be identified. Methods Twenty-five patients with fungal balls were treated by surgical removal of the fungus ball in the infected sinuses. The pathogenic fungi on the specimens were identified by means of routine PAS and immunohistochemical staining methods, and the sensitivity of the two methods were compared. Results The most commonly infected sinus was the maxillary sinus, followed by sphenoid sinus. Pathogens of fungal balls were found to be aspergillus (92%, 23/25) and candida 2 cases(8%). Aspergillus and candida albicans in infected sinuses could be specifically identified by immunostainning. There was no statistically significant differences of sensitivity between immunostainning and PAS stain. Conclusions The main pathogen of the fungus ball was aspergillus. Immunostainning was a rapid and reliable method to identify fungi in infected tissues of paranasal sinuses. It should be widely used in the diagnosis of fungal sinusitis.