Hafidh Maky, Harney Michael, Kane Robin, Donnelly Martin, Landers Robert, Smyth David
Department of Otolaryngology, Waterford Regional Hospital, Waterford, Ireland.
Auris Nasus Larynx. 2007 Jun;34(2):185-9. doi: 10.1016/j.anl.2006.07.007. Epub 2006 Oct 27.
Allergic fungal sinusitis (AFS) may represent an endpoint in a spectrum of sinonasal disease. Patients fulfilling criteria for a diagnosis of AFS have a poor prognosis often requiring multiple surgeries. The detection of 'allergic mucin' with mucus containing clusters of eosinophils and the detection of fungi by histological examination or culture is key criteria necessary for diagnosis. This study was performed to assess the strength of the association of the presence of fungi with the presence of eosinophils in a group of patients with chronic rhinosinusitis and controls.
Thirty patients with a clinical diagnosis of chronic rhinosinusitis and 10 individuals as control group were selected for the study. Total serum IgE level testing, nasal mucus cytology and fungal culture were performed in all subjects.
Fungal spores were present in the nasal mucus in 14 patients with rhinosinusitis, and in 7 controls. The detection of eosinophils on cytology correlated significantly both with a clinical diagnosis of chronic rhinosinusitis (95% confidence intervals (CI) 0.34-0.81) and with the presence of fungal elements on cytology (p=0.02). The average serum IgE level was higher in patients with fungal spores (p=0.039).
In certain susceptible individuals inhaled fungi may provoke an eosinophilic response. This response varies from simple eosinophilic inflammation to classic allergic fungal sinusitis.
变应性真菌性鼻窦炎（AFS）可能是鼻窦疾病谱中的一个终点。符合AFS诊断标准的患者预后较差，常需多次手术。检测含有嗜酸性粒细胞簇的黏液中的“变应性黏液”以及通过组织学检查或培养检测真菌是诊断的关键标准。本研究旨在评估一组慢性鼻窦炎患者和对照组中真菌的存在与嗜酸性粒细胞的存在之间关联的强度。
选取30例临床诊断为慢性鼻窦炎的患者和10例个体作为对照组进行研究。对所有受试者进行血清总IgE水平检测、鼻黏液细胞学检查和真菌培养。
14例鼻窦炎患者的鼻黏液中存在真菌孢子，7例对照组中也有。细胞学检查中嗜酸性粒细胞的检测与慢性鼻窦炎的临床诊断（95%置信区间（CI）0.34 - 0.81）以及细胞学检查中真菌成分的存在均显著相关（p = 0.02）。有真菌孢子的患者血清IgE平均水平较高（p = 0.039）。
在某些易感个体中，吸入真菌可能引发嗜酸性粒细胞反应。这种反应从单纯的嗜酸性粒细胞炎症到典型的变应性真菌性鼻窦炎各不相同。
