Puhakka T, Mäkelä M J, Alanen A, Kallio T, Korsoff L, Arstila P, Leinonen M, Pulkkinen M, Suonpää J, Mertsola J, Ruuskanen O
Department of Pediatrics, Turku University Hospital, Finland.
J Allergy Clin Immunol. 1998 Sep;102(3):403-8. doi: 10.1016/s0091-6749(98)70127-7.
Acute community-acquired sinusitis is considered a bacterial complication of the common cold. Radiologic abnormalities in sinuses occur, however, in most patients with upper respiratory virus infections.
Assessment of the occurrence, clinical profile, laboratory findings, and outcome of radiologically confirmed sinusitis was carried out as part of a common cold study in young adults.
Clinical examinations and radiography of the paranasal sinuses were carried out on days 1, 7, and 21 in 197 patients with the common cold. The symptoms were recorded on diary cards on days 1 to 20. Ten viruses and 5 bacteria were studied as etiologic agents of common cold as reported earlier. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and total white blood cell counts with differentials were determined in 40 randomized subjects on day 7. The effect of 6 days of intranasal fluticasone propionate treatment of the common cold in the prevention of sinusitis was analyzed.
On day 7, 39% of patients with the common cold in the placebo group (n = 98) had sinusitis, which we would prefer to call viral sinusitis. The symptoms of patients with sinusitis and those without it were not clinically distinguishable. Viral infection was detected in 81.6% of patients with sinusitis. No significantly increased levels of antibodies to bacteria were detected. Serum C reactive protein concentrations, erythrocyte sedimentation rates, and white blood cell counts were low in patients with sinusitis. All patients made a clinical recovery within 21 days without antibiotic treatment. Fluticasone propionate treatment tended to prevent paranasal sinusitis, especially in rhinovirus-positive subjects.
Viral sinusitis frequently occurs in the early days of the common cold, but it is a self-limited illness. The sinuses should not be imaged in patients with the common cold if the signs and symptoms of illness gradually become less severe and no specific signs suggestive of bacterial sinusitis occur.
急性社区获得性鼻窦炎被认为是普通感冒的一种细菌性并发症。然而，大多数上呼吸道病毒感染患者的鼻窦会出现放射学异常。
作为一项针对年轻人普通感冒的研究的一部分，对经放射学确诊的鼻窦炎的发生率、临床特征、实验室检查结果及转归进行评估。
对197例普通感冒患者在第1天、第7天和第21天进行临床检查及鼻窦X线摄影。在第1天至第20天，症状记录在日记卡上。如先前报道，对10种病毒和5种细菌作为普通感冒的病原体进行研究。在第7天，对40例随机选取的受试者测定血清C反应蛋白浓度、红细胞沉降率及不同分类的白细胞总数。分析丙酸氟替卡松鼻内治疗普通感冒6天对预防鼻窦炎的效果。
在第7天，安慰剂组（n = 98）中39%的普通感冒患者患有鼻窦炎，我们更倾向于称之为病毒性鼻窦炎。患有鼻窦炎和未患鼻窦炎的患者症状在临床上无法区分。在81.6%的鼻窦炎患者中检测到病毒感染。未检测到细菌抗体水平显著升高。鼻窦炎患者血清C反应蛋白浓度、红细胞沉降率及白细胞计数较低。所有患者在21天内未经抗生素治疗即临床康复。丙酸氟替卡松治疗倾向于预防鼻旁窦炎，尤其是在鼻病毒阳性的受试者中。
病毒性鼻窦炎在普通感冒早期频繁发生，但它是一种自限性疾病。如果普通感冒患者的症状逐渐减轻且未出现提示细菌性鼻窦炎的特定体征，则不应进行鼻窦影像学检查。
