体外特异性免疫指标检测与非侵袭性真菌性鼻窦炎发生的相关性研究

Correlation studies of specific immune indexes in vitro testing and noninvasive fungalsinusitis

目的:通过体外特异性免疫球蛋白检测结合嗜酸细胞百分比的测定,探讨各免疫指标与非侵袭性真菌性鼻窦炎(NIFS)的关系,为其发病机制、亚型分型判定标准及围手术期治疗提供理论支持。方法:回顾性分析33例NIFS,根据术后病理结果判断其嗜酸细胞浸润是否阳性进一步分为真菌球型(FB)16例,变应性真菌性鼻窦炎(AFS)17例。行血清特异性sIgE、sIgG、总IgE、外周血嗜酸粒细胞计数检测并进行比较分析。结果:1FB和AFS两组患者外周血嗜酸粒细胞阳性率差异有统计学意义(χ2=4.661,P<0.05),血清总IgE阳性率有显著性差异(χ2=7.127,P<0.01);2FB组患者总IgE分级主要在1级(占81.25%),AFS组主要在2级(占41.18%),2组差异有统计学意义(Z=-3.189,P<0.01);3FB组患者血清sIgE分级主要在0级(占50%),AFS组主要在2级(占47.06%),2组差异无统计学意义(Z=-0.655,P>0.05);4FB组患者血清sIgG分级主要在0级(占56.25%),AFS组主要在1、3级(各占29.41%),2组差异无统计学意义(Z=-1.377,P>0.05)。结论:1NIFS发病机制是多方面的,不能简单以真菌感染为发病原因,特异性变应性体质在NIFS发病及病情演变过程中起到重要作用;2NIFS在不同特异性变应性体质发病过程中,其病情演变过程不同。可分为FB鼻窦炎和ARS两种亚型;3sIgE、sIgG、总IgE及嗜酸细胞的检测对NIFS临床治疗方案的制定有着重要的指导意义。

Objective：Through the vitro testing of the specific immune globulin, exploring the relationship be- tween the immune index and noninvasive fungal sinusitis, to provide theoretical support for its pathogenesis, sub- type classification criterion and perioperative treatment. Method.. After retrospectively analyzed 33 patients of NIFS, including FB 16 cases,and AFS 17cases, we got test and analysis of serum specific row of IgE and IgG, to- tal IgE and count of blood eosinophils. Result：（1）Two groups of patients with eosinophilia positive rate and serum total IgE positive rate have significant differences（x2 =4. 661, P〈0.05 and x2 = 7. 127,P〈0.01, respectively）; （2）Total IgE for patients of FB classified mainly in lever 1 （81.25 % ）and patients of AFS classified mainly in level 2 （41.18% ）, the difference was statistically significant（Z= - 3. 189, P〈0.01 ） ; （3） Patients of FB with serum slgE classified mainly in lever 0 （50%）, and patients of AFS mainly in level 2 （47.06%）, there was no statistically signif- icant difference between them（Z= -0.655, P〉0.05） ;（4） Patients of FB with serum slgG classified mainly in lever 0 （56.25 % ）, while patients of AFS mainly at level 1 and 3 （the same 29.41% ）, there was no statistically significant difference between the two （Z = - 1. 377, P 〉 0.05 ）. Conclusion.. （1） NIFS pathogenesis is various, not simple for fungal infection causes. Specific allergic constitution NIFS plays an important role in development of pathogenesis; （2）In different specific allergic constitution in development of pathogenesis, pathogenic processes of NIFS are dif- ferent, divided into： FB and AFS subtypes;（3）Detection of slgE, sIgG, total IgE, acidophil in the process of si- nusitis and nasal polyps can be used as an auxiliary examination, to provide guidance for clinical treatment.