Savolainen S, Jousimies-Somer H, Karjalainen J, Ylikoski J
Department of Otolaryngology, Central Military Hospital, Helsinki, Finland.
Acta Otolaryngol Suppl. 1997;529:144-7. doi: 10.3109/00016489709124107.
The aim of the present study was to evaluate whether the results of such simple hematologic tests as erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and C-reactive protein (CRP) could give any useful information about the causative agents in 176 patients with acute maxillary sinusitis (AMS). The great majority of tests (82%) showed values which were within normal limits. This may be due to the fact that 22% of AMS cases were culture negative for bacteria and about 60% of culture positive cases had Haemophilus influenzae as the etiologic agent. Significantly raised test values were seen in connection with Streptococcus pyogenes in the majority of cases, less frequently with Streptococcus pneumoniae and rarely with Haemophilus influenzae. We conclude that none of the evaluated routine blood tests are particularly sensitive indicators of the specific etiology of AMS in general. However, elevated CRP values (> 40 mg/l) associated with AMS should alert the physician to the suspicion of Streptococcus pyogenes or Streptococcus pneumoniae in etiology, since both, if left untreated, may lead to sinus empyema. With CRP or other evaluated tests Haemophilus influenzae- or Branhamella catarrhalis-positive AMS cannot be distinguished from a purely viral disease.
本研究的目的是评估诸如红细胞沉降率（ESR）、白细胞计数（WBC）和C反应蛋白（CRP）等简单血液学检查结果能否为176例急性上颌窦炎（AMS）患者的病原体提供有用信息。绝大多数检查（82%）结果显示在正常范围内。这可能是因为22%的AMS病例细菌培养为阴性，且约60%培养阳性病例的病原体为流感嗜血杆菌。在大多数病例中，与化脓性链球菌相关的检查值显著升高，与肺炎链球菌相关的情况较少，与流感嗜血杆菌相关的则很少见。我们得出结论，一般而言，所评估的常规血液检查均不是AMS特定病因的特别敏感指标。然而，与AMS相关的CRP值升高（>40mg/l）应提醒医生怀疑病因是化脓性链球菌或肺炎链球菌，因为如果这两种病原体不治疗，都可能导致鼻窦积脓。通过CRP或其他评估检查，无法区分流感嗜血杆菌或卡他莫拉菌阳性的AMS与单纯病毒性疾病。
