Department of Otorhinolaryngology, Menoufia University Hospital, Shebin El-Kom, Egypt.
Am J Rhinol Allergy. 2013 May-Jun;27(3):168-76. doi: 10.2500/ajra.2013.27.3882.
Diagnosis of allergic fungal rhinosinusitis (AFRS) is complicated because of the presence of fungi on mucosal surfaces of sinonasal passages. The objectives of this study were to define, using immunohistochemistry, lymphocyte populations associated with noninvasive fungal-related chronic rhinosinusitis (CRS; AFRS and FBs [FB]) relative to CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP) as a means of diagnosing different forms of CRS.
Sinus CT scans, nasal endoscopy scores, and the presence of eosinophilic fungal mucin or FBs were used to prospectively define patient groups with CRS who had failed medical treatment and were undergoing endoscopic sinus surgery. Four patient groups were identified: AFRS, FB, CRSwNP, and CRSsNP. Tissue specimens were studied and graded for histopathological changes. Immunophenotyping of mucosal lymphocytes was performed using anti-CD3, -CD20, -CD4, -CD8, -CD56, and -perforin antibodies.
Nasal polyposis scores were similar between AFRS and CRSwNP. Radiological changes associated with AFRS can also be present in CRSwNP, e.g., heterogenicity in 9/30 (30%), expansion in 25/30 (83%), and bony attenuation of the ethmoid trabeculae in 19/30 (63%). Different grades of basement membrane thickness, edema, and fibrosis were observed. In both types of noninvasive fungal rhinosinusitis, CD3+ T lymphocytes were most commonly identified. In cases of AFRS, most T cells were CD8+ (p < 0.001). In FB cases, CD4+ lymphocytes were dominant (p < 0.001). In nonfungal CRS cases, CD20+ lymphocytes (B lymphocytes) predominated (p < 0.001).
Although CT scans and histological examination can assist the diagnosis of rhinosinusitis, tissue immunophenotyping can be used in defining different types of fungal and nonfungal CRS cases.
由于真菌存在于鼻旁窦腔的黏膜表面，变应性真菌性鼻旁窦炎（AFRS）的诊断较为复杂。本研究的目的是通过免疫组织化学方法，定义与非侵袭性真菌相关的慢性鼻旁窦炎（CRS；AFRS 和 FB [FB]）相关的淋巴细胞群体，相对于伴有鼻息肉的 CRS（CRSwNP）和不伴有鼻息肉的 CRS（CRSsNP），以作为诊断不同类型 CRS 的方法。
鼻窦 CT 扫描、鼻内镜评分以及嗜酸性真菌黏液或 FB 的存在被用于前瞻性定义经药物治疗失败且正在接受内镜鼻窦手术的 CRS 患者组。确定了 4 个患者组：AFRS、FB、CRSwNP 和 CRSsNP。对组织标本进行研究并进行组织病理学改变分级。使用抗 CD3、-CD20、-CD4、-CD8、-CD56 和 -穿孔素抗体对黏膜淋巴细胞进行免疫表型分析。
AFRS 与 CRSwNP 的鼻息肉评分相似。与 AFRS 相关的放射学改变也可能存在于 CRSwNP 中，例如，30 例中的 9 例（30%）存在异质性，25 例中的 25 例（83%）存在扩张，30 例中的 19 例（63%）存在筛骨小梁骨衰减。观察到不同程度的基底膜厚度、水肿和纤维化。在这两种非侵袭性真菌性鼻旁窦炎中，最常见的是 CD3+T 淋巴细胞。在 AFRS 病例中，大多数 T 细胞为 CD8+（p < 0.001）。在 FB 病例中，CD4+淋巴细胞占优势（p < 0.001）。在非真菌性 CRS 病例中，CD20+淋巴细胞（B 淋巴细胞）占主导地位（p < 0.001）。
尽管 CT 扫描和组织学检查有助于诊断鼻旁窦炎，但组织免疫表型分析可用于定义不同类型的真菌性和非真菌性 CRS 病例。
