鼻腔鼻窦真菌病的真菌学和临床诊疗研究(附51例报告)

Study of mycology from nasal and paranasal sinus mycosis and their clinical management

目的 :研究鼻腔、鼻窦真菌病的菌种鉴定、药敏检测和临床诊疗。方法 :对 51例鼻腔、鼻窦真菌病作如下研究 :1进行菌种鉴定 ;2用 E test法以含酮康唑 (KE) ,伊曲康唑 (IT) ,氟康唑 (FC) ,氟胞嘧啶 (FL)及二性霉素 B(AP)的药敏试条进行药敏检测 ;3病人以手术及抗霉菌药治疗。结果 :1致病菌主要为曲霉菌 ,占 87.5% ,其次为桔青霉菌 ,卡氏支孢霉菌及链格孢子菌较少见 ;2曲霉菌对 IT、FC、KE敏感 ,对 FL、AP有耐药性 ;桔青霉菌对 AP、FC、KE、IT敏感 ,对 FL有耐药性 ;卡氏支孢霉菌对 IT、KE敏感 ,对 FC,FL耐药 ;3本组治愈率为 (4 9/51) 96 .1% ,2例侵袭型者因合并有肝炎、糖尿病未愈。结论 :1鼻腔、鼻窦真菌病的致病真菌主要为曲霉菌 ,其次为桔青霉菌 ;2大多数致病真菌对 IT及 KE敏感 ,E test法药敏测试具有操作简便 ,定值准确 ,重复性好的优点 ;3本病的诊断主要根据其临床特征、影像学、真菌学及病理学所见作出。绝大多数患者全身情况良好 ,极少数有基础疾病 ;

Objective:To study the pathogenic fungi,test anti fungal susceptibility of nasal and paramasal sinus mycosis (NSM) and their clinical management.Method:① Culture and identification of pathogenic fungi.② Anti fungal susceptibilities of Ketoconajole(KE),Itraconazole(IT),Fluconazole(FC),Fluorocytosine(FL) and Amphotericinum B(AP)were tested with E test strip.③ Forty eight cases of NSM were treated with surgery and anti fungi agents.Result:① Pathogenic fungus of NSM was mainly Aspergilus(87 5%,42/48),followed with P.citrinum and C.arrionii,A.alternaria were rare.② Anti fungal susceptibility showed aspergilus was sensitive to IT,FC,KE,resistant to FL and AP.P.citrinum was sensitive to AP,FC,KE and IT,resistant to FL.③ Cure rate of this group was 96 1%(49/51).Four cases of recurrent maxillary sinus mycosis were cured by second time surgery combined with revised medication.Two cases of maxillary sinus and sphenoid sinus mycosis lost the opportunity of treatment because of hepatitis and diabetes.Conclusion:① Main pathogenic fungus of NSM was aspergillus.② Final diagnosis of NSM relied on results [WT5,5”BZ]of clinical features,radiology,mycology and histopathology.Most of the patients with NSM had no system disease.③ E test of anti fungal susceptibility was handy,accurate and repeatable.④ Treatment of NSM was surgery combined with medication which was based on anti fungal susceptibility. [Chinese Arch Otolaryngol Head Neck Surg,2000;7(1):3~8 From the Department of Otorhinolaryngology,First Affiliated Hospital of Guangxi Medical University.Nanning,530021 (Dr.Nong Huitu)]