变应性真菌性鼻鼻窦炎和嗜酸性粒细胞性黏蛋白慢性鼻鼻窦炎：基于 STROBE 方法的鉴别诊断标准。一项两中心比较研究。
Allergic fungal rhinosinusitis and eosinophilic mucin chronic rhinosinusitis: Differential diagnostic criteria. A two-center comparative study following STROBE methodology.
机构信息
Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; Service d'ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France.
Service d'ORL pédiatrique et chirurgie cervico-faciale, hôpital Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France.
出版信息
Eur Ann Otorhinolaryngol Head Neck Dis. 2023 Nov;140(6):267-270. doi: 10.1016/j.anorl.2023.10.007. Epub 2023 Oct 11.
OBJECTIVES
Allergic fungal rhinosinusitis (AFRS) and eosinophilic mucin chronic rhinosinusitis (EMRS) are two forms of chronic sinusitis distinguished by the presence (AFRS) or absence (EMRS) of fungal elements in sinus mucin. Detection of the fungal elements, however, is complex and it is difficult to say whether EMRS is in fact an entity distinct from AFRS. The aim of the present study, based on a retrospective series of AFRS and EMRS, was to identify the specific clinical and radiological elements distinguishing between the two.
MATERIALS AND METHODS
A 2-center retrospective observational study following STROBE guidelines included patients managed for AFRS or EMRS between 2009 and 2022. Clinical, mycological, pathologic and radiological data were collected. Type of treatment and disease progression were also analyzed. Intergroup comparison used Student's test for mean values of quantitative variables, with calculation of P-values, and Pearson's Chi test or Fisher's exact test for categoric variables, with calculation of relative risk and 95% confidence intervals.
RESULTS
The AFRS group comprised 41 patients and the EMRS group 34. Demographic data were comparable between groups. EMRS showed a higher rate of asthma (79.4 vs. 31.4%; P<0.001), more severe nasal symptomatology (rhinorrhea, P=0.01; nasal obstruction, P=0.001), and more frequent bilateral involvement (85.3 vs. 58.5%; P=0.021). AFRS showed more frequent complications (19 vs. 0%; P=0.006). Radiologically, mucin accumulation was greater in AFRS, filling the sinus in 84.2% of cases, versus 26.3% (P<0.001), with more frequent sinus wall erosion (19 vs. 5.8%; P=0.073). The recurrence rate was higher in EMRS: 38.2 vs.21.9% (P=0.087).
CONCLUSION
The present retrospective study found a difference in clinical and radiological presentation between AFRS and EMRS, with EMRS more resembling the presentation of severe nasal polyposis.
目的
变应性真菌性鼻鼻窦炎（AFRS）和嗜酸性黏蛋白慢性鼻鼻窦炎（EMRS）是两种慢性鼻旁窦炎的形式，其特征是鼻窦黏液中存在（AFRS）或不存在（EMRS）真菌成分。然而，真菌成分的检测很复杂，很难说 EMRS 是否实际上是一种与 AFRS 不同的实体。本研究基于 AFRS 和 EMRS 的回顾性系列，旨在确定区分两者的具体临床和影像学特征。
材料和方法
遵循 STROBE 指南的 2 中心回顾性观察性研究纳入了 2009 年至 2022 年间因 AFRS 或 EMRS 接受治疗的患者。收集了临床、真菌学、病理学和影像学数据。还分析了治疗类型和疾病进展。使用 Student's t 检验比较定量变量的均值，计算 P 值，使用 Pearson's Chi 检验或 Fisher's 确切检验比较分类变量，计算相对风险和 95%置信区间。
结果
AFRS 组 41 例，EMRS 组 34 例。两组患者的人口统计学数据无差异。EMRS 组哮喘发生率更高（79.4% vs. 31.4%；P<0.001），鼻部症状更严重（流涕，P=0.01；鼻塞，P=0.001），双侧受累更常见（85.3% vs. 58.5%；P=0.021）。AFRS 组并发症更常见（19 例 vs. 0 例；P=0.006）。影像学上，AFRS 组黏液积聚更多，84.2%的病例填满窦腔，而 EMRS 组仅 26.3%（P<0.001），鼻窦壁侵蚀更常见（19 例 vs. 5.8%；P=0.073）。EMRS 组的复发率更高：38.2% vs. 21.9%（P=0.087）。
结论
本回顾性研究发现 AFRS 和 EMRS 的临床和影像学表现存在差异，EMRS 更类似于严重鼻息肉的表现。
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