变应性真菌性鼻-鼻窦炎病原菌分布及炎症因子表达

Distribution of pathogenic bacteria and expression of inflammatory factors in allergic fungal rhinosinusitis

目的 探讨变应性真菌性鼻-鼻窦炎病原菌分布特征、炎症因子表达。方法 选取2017年10月-2020年10月于绵阳四○四医院耳鼻喉科就诊的变应性真菌性鼻-鼻窦炎患者98例,在初入院未使用抗生素时采集鼻分泌物标本与血液标本,检测病原菌类型,检测血液中白细胞(WBC)、淋巴细胞(LYM)、中性粒细胞(NE),检测血液降钙素原(PCT)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)因子水平。结果 根据视觉模拟法(VAS)评分、Lund-Kennedy评分将98例患者疾病程度分为轻度、中度、重度3级,分别为46例、35例、17例;病原体分布中曲霉菌感染者比例为39.80%,毛霉菌为22.45%,白假丝酵母为16.33%,酵母样真菌为11.22%,梭霉菌为3.06%,鼻孢子菌为7.14%;研究组的WBC、LYM、NE高于对照组(P<0.001);研究组的PCT、CRP、TNF-α、IL-1β水平高于对照组(P<0.001)。结论 在不同真菌感染引起的鼻窦炎患者中炎症细胞与炎症因子升高明显,PCT、CRP、TNF-α的高表达,激发相关炎症因子的释放,引起严重病理损伤。

OBJECTIVE To investigate the distribution characteristics of pathogens of allergic fungal rhinosinusitis(AFRS) and inflammatory factors expression. METHODS A total of 98 patients with allergic fungal rhinosinusitis who were treated in the Department of Otolaryngology in No. 404 Hospital of Mianyang from Oct 2017 to Oct 2020 were enrolled. Nasal secretion and blood samples were collected on admission before antibiotics were administered. The types of pathogenic bacteria, WBC, LYM, NE, EOS and BAS in blood were detected, and the levels of PCT, CRP, TNF-α, and IL-1β factors in blood were also analyzed. RESULTS According to the VAS score and Lund-Kennedy score, the disease severity in 98 patients was divided into three grades, including mild, moderate and severe disease degrees, with 46 cases, 35 cases and 17 cases in them, respectively. In the distribution of pathogens, the proportion of Aspergillus infection was 39.80%, Mucor was 22.45%, Candida albicans was 16.33%, yeast-like fungi was 11.22%, Clostridium was 3.06% and Rhinospora was 7.14%. Levels of WBC, LYM and NE in the study group were significantly higher than those in the control group(P<0.001). The levels of PCT, CRP, TNF-α and IL-1β in the study group were significantly higher than those in the control group(P<0.001). CONCLUSION In sinusitis patients with different fungi infection, inflammatory cells and inflammatory factors increased significantly, and the high expression of PCT, CRP and TNF-α stimulated the release of relevant inflammatory factors, causing severe pathological damage.