真菌性鼻窦炎的临床特点与菌群分析

The clinical features and bacterial analysis of fungal rhinosinusitis

目的 研究真菌性鼻窦炎的临床特点及病原菌,及其指导临床治疗的意义。方法 收集2010年1月-2014年12月由首都医科大学附属北京同仁医院收治的疑似真菌性鼻窦炎患者的鼻腔组织标本315例,进行直接显微镜检查和培养鉴定,并收集患者性别、年龄、取材部位等资料。分析真菌性鼻窦炎患者性别年龄分布情况,培养阳性标本取材部位与菌群和直接镜检与培养结果。结果 在315例患者中女性171例（54.29%）,男性144例（45.71%）;0-15岁患者为12例（3.81%）,〉15-30岁患者为29例（9.21%）,〉30-60岁患者为241例（76.51%）,〉60岁患者为33例（10.47%）;315例标本有287例直接镜检阳性,207例真菌培养阳性,202例直接镜检与培养均阳性,23例直接镜检与培养均阴性;在培养阳性的207例标本中,上颌窦的标本156例（75.36%）,来源于蝶窦的标本26例（12.56%）,来源于筛窦的标本21例（10.15%）,来源于额窦的标本4例（1.93%）;真菌性鼻窦炎主要致病菌为黄曲霉菌77例（37.20%）,烟曲霉菌68例（32.85%）,尖端赛多孢子菌11例（5.31%）。结论 真菌性鼻窦炎发病人群主要为青壮年,女性多于男性,发病部位主要为上颌窦,致病真菌主要为曲霉菌属。

Objective To research the clinical characteristics and pathogens of fungal rhinosinusitis（FRS）,and guide the clinical treatment. Methods 315 cases of nasal tissue samples were collected from patients who were admitted to Beijing Tongren Hospital and suspected fungal rhinosinusitis from January 2010 to December 2014. These cases were identified by direct microscopic examination and culture,and their genders,age,sites and other materials were collected. Results 315 patients were studied,of which 171（54.29%） were female patients and 144（45.71%） male.In all the patients,12（3.81%） were from 0 to 15 years old,followed by 〉15-30 years,〉30-60 years,and over 60 years（9.21%,76.51%,and 10.47%,respectively）. In all the 315 samples,287 were positive for microscopic examination,207 were positive by culture,202 were positive for both methodologies,23 were negative for both methodologies.In all the207 samples who were positive by culture,of which 156（75.36%） samples were from maxillary sinus,followed by the sphenoidal,ethmoidal,and frontal sinuses（12.56%,10.15% and 1.93%,respectively）. Aspergillus flavus（37.20%）,Aspergillus fumigatus（32.85%）and Scedosporium apiospermum（5.31%） were the main pathogens of fungal rhinosinusitis. Conclusion The main patients of fungal rhinosinusitis are young adults,and most of them are female.The main pathological changes are maxillary sinus and main pathogens are Aspergillus.