侵袭性真菌性鼻窦炎致神经系统损害7例临床分析

Clinical analysis of 7 cases of nervous system damage caused by invasive fungal sinusitis

目的 探究侵袭性真菌性鼻窦炎（FRS）致神经系统损害的临床诊断和治疗.方法 选取真菌性鼻窦炎患者7例,对7例患者临床资料,进行影像学、病理学等回顾性分析.患者实验室检查均使用腰穿脑脊液检查（CSF）;影像学使用CT检查或MRI检查.结果 7例患者的既往史中,均无鼻窦炎记录;其中5例免疫力功能低下,2例无特殊病史.患者入院后,均在神经科确诊神经系统被损害;在镜下,检测出曲霉菌4例、毛霉菌2例、隐球菌1例;影像学检查中,患者均有鼻窦病变,4例出现颅底骨质破坏;应用外科手术干预和内科药物干预进行治疗,6例患者好转,1例患者死亡.结论 长期使用抗生素、糖皮质激素或患有糖尿病、肿瘤等的消耗性疾病的患者,其真菌性鼻窦炎的发病率高,并常损害神经系统,是导致患者死亡重要原因之一.

Objective To explore the clinical diagnosis and treatment of nervous system damage caused by invasive fungi nasosinusitis.Methods 7 patients with nervous system damage caused by invasive fungi nasosinusitis were selected,and the clinical,imaging and pathological data of the patients were reviewed retrospectively.Laboratory tests were used in patients with cerebrospinal fluid （CSF）.Imaging used CT or MRI examination.Results In the past history of the patients,no one with nasosinusitis.5 patients immunocompromised and 2 cases had no special medical history.All patients were diagnosed with neurological damage after admission.Under the microscope,fungal cultures showed Aspergillus in 4 cases,Mucor in 2 cases,Cryptococcus in 1 case.In the imaging,all patients had sinus lesions,base of skull destruction in 4 cases.Used surgical interventions and drug for 7 patients,6 cases recovered and 1 case died.Conclusion Using antibiotics and glucocorticoid for a long time or suffered from diabetes and tumour may have higher incidence of invasive fungi nasosinusitis and damage the nervous.It is one of the leading causes of patients with immune deficiencies deaths.