变应性真菌性鼻窦炎的CT影像学特征分析

目的 探讨变应性真菌性鼻窦炎(AFRS)的CT影像学特征。方法 回顾性分析2008年1月—2018年1月海军军医大学附属长征医院、龙海市第一医院及解放军联勤保障部队第九○九医院耳鼻咽喉头颈外科收治的共52例AFRS患者的临床资料,其中男30例、女22例,年龄13～69岁、平均43岁。52例患者均有单侧或双侧鼻塞、脓涕症状,病程1个月～10年,平均29个月;鼻内镜检查可见中鼻道息肉样物及脓性分泌物,皮肤变应原点刺试验提示真菌变应原阳性。52例均行鼻内镜下鼻窦开放术治疗,术前均行鼻窦CT扫描;总结其CT影像学特征,并于术中重点观察CT显示病变部位组织结构的临床病理与组织学改变特点。结果 52例患者术前CT检查显示:单侧鼻窦病变33例(63.5%),双侧鼻窦病变19例(36.5%);各组鼻窦中,筛窦病变最常见,共48例(92.3%);病变鼻窦腔为低密度软组织影充填(CT值23～50 HU,平均34 HU),其内散在条索状或斑片状高密度影(CT值82 ～107 HU,平均96 HU),呈特征性的毛玻璃样改变,在软组织窗中尤为明显,与周围软组织影分界清晰。术中探查该区域病变为脓性或豆渣样黏稠分泌物,术后组织病理学检查提示该病变为变应性黏蛋白结构。57.7%(30/52)的患者CT可显示筛窦外侧壁、蝶筛隔板或蝶窦间隔等部位的骨质侵蚀表现;术中鼻内镜下见该处窦腔扩大,骨质菲薄或缺如。术后随访6～12个月,全部患者病情均达完全控制或部分控制。结论 AFRS特征性的CT影像学表现为以筛窦受累为主的窦腔实变、膨胀,伴有弥漫、散在的条状或云雾状高密度影,多数患者合并有骨质侵蚀;病变部位CT值对本病的诊断有参考价值。     

常年性鼻炎的病理生理进展

本文就鼻腔血管和神经分布及其在常年性鼻炎发病中的意义、有关的化学介质或传统的神经递质、神经肽、细胞活素和细胞、“反射亢进性鼻炎”、变应原与机体相互作用等诸多方面进行了系统的综述。     

真菌性鼻窦炎50例临床分析

目的 探讨真菌性鼻窦炎的诊断要点和治疗方法.方法 50例患者术前均作鼻窦 CT扫描.其中非侵袭性真菌性鼻窦炎22例,上颌窦受累16例(双侧均受累2例),蝶窦6 例,筛窦6例.鼻内镜下传统上颌窦根治术及钓突切除术23例,经鼻内钓突切除、前筛开放、上颌窦自然口扩大及经下鼻道钻孔上颌窦冲洗术21例,Wigland术式行蝶窦开放及病灶清除术6例.50例中同期行鼻中隔矫正术 11 例.术后定期清理及鼻窦冲洗,部分患者应用抗真菌药物及类固醇激素治疗.结果 术后病理报告50例均见真菌菌丝,部分病例见到孢子.随访2个月至5年,3例复发,48例治愈.结论 CT对本病的诊断有重要价值,应注意其与慢性化脓性上颌窦炎及上颌窦恶性肿瘤的区别;手术彻底清除病灶、通畅引流是其治疗的主要手段.     

非侵袭型真菌性鼻-鼻窦炎28例报告

真菌性鼻窦炎已经逐渐为临床所认识，临床类型从病理学角度分为两大类型：非侵袭型真菌性鼻-鼻窦炎和侵袭型真菌性鼻-鼻窦炎，前者又依据其不同病理改变分为真菌球和变应性真菌性鼻-鼻窦炎。本文总结我科近5年来收治的28例非侵袭型真菌性鼻-鼻窦炎患者的临床资料，报告如下：     

脱敏疗法治疗常年性变应性鼻炎的疗效观察

本文对76例常年性变应性鼻炎患者,分二组进行脱敏治疗,甲组用粉尘螨注射液,乙组用吸入物抗原。甲、乙两组在治疗前及治疗半年后记分别测定血清IgG、IgE。结果表明,甲、乙两组治疗前后记分比较均有非常显著性差异(P均<0.01)。两组间有效率无显著性差异(P>0.05)。两组在治疗前后血清IgG均有非常显著差异(P<0.01)。血清IgE也有显著差异(P<0.05)。血清IgG上升与IgE下降与临床症状好转相一致。甲组具有治疗方便,疗程短等优点。     

常年性变应性鼻炎的病因和临床分析

于１９９．４～１９９５．７间对本科门诊千余例具有典型症状的可疑变应性鼻炎患者应用的１９９０年＂变应性鼻炎诊断标准＂进行评分，对其中符合ＰＡＲ诊断标准的３５０例患者进行分析，就ＰＡＲ的诊断进行了探讨。     

鼻窦内窥镜手术治疗真菌性鼻窦炎17例分析

目的:探讨鼻窦内窥镜手术治疗真菌性鼻窦炎的疗效.方法:17例真菌性鼻窦炎患者,均采用鼻窦内窥镜下手术治疗,彻底清除病灶,充分开放引流.术后对其临床疗效观察分析.结果:17例患者术后随访1～3 a,复查窦腔均无真菌和炎症,全部治愈,无复发.结论:采用鼻窦内窥镜手术治疗真菌性鼻窦炎,创伤小,术中可以尽可能保留鼻腔鼻窦黏膜,治愈率高,复发率低,疗效确切,是较理想的治疗方法.     

常年变应性鼻炎黏膜中水通道蛋白1的表达及意义

水通道蛋白(aquaporin,AQP)是一组与水转运有关的细胞膜转运蛋白,广泛分布于机体组织细胞,尤其与液体分泌和吸收有关的上皮细胞和内皮细胞中含量丰富,参与水的分泌、吸收及细胞内外水的平衡.本实验通过免疫组化技术检测AQP1蛋白在常年变应性鼻炎鼻黏膜组织的表达及分布,探讨其与常年变应性鼻炎临床病理特征之间的关系.     

鼻内镜手术治疗真菌性鼻窦炎35例

目的：探讨真菌性鼻窦炎的发病原因及鼻内镜手术治疗真菌性鼻窦炎的临床疗效。方法：采用鼻内镜手术治疗真菌性鼻窦炎35例,回顾性分析其临床表现、鼻内镜检查和鼻窦CT扫描的病变特征及手术疗效。结果：35例患者鼻内镜检查及鼻窦CT扫描显示,鼻腔均有不同程度解剖异常、窦腔内有不均匀不透光的钙化斑,全部病例术后病理学检查均发现真菌丝。术后随访6个月至2年,治愈31例（89．66％）,显效3例（8．57％）,无效1例（2．86％）。结论：鼻腔局部解剖结构异常及病变与真菌性鼻窦炎关系密切;鼻窦CT扫描结合鼻内镜检查是诊断真菌性鼻窦炎的重要方法;经鼻内镜充分开放病变鼻窦窦口,彻底清除病灶,保持窦口引流通畅,是治疗和预防复发的重要手段。     

真菌性鼻鼻窦炎发病的解剖学因素与临床研究

真菌性鼻鼻窦炎(FRS)由于不同的病理、生理改变,可以表现出不同的临床类型,而其诊断及预后也不尽相同。为使基层临床工作者对FRS有一个全面了解,本文就FRS的解剖学因素、发病原因、流行病学研究、病菌菌种分析、影像学表现、临床分类、各种类型的临床特征及治疗方法进行较为全面的论述。     

Perennial allergic rhinitis and chronic sinusitis: correlation with rhinologic risk factors

BACKGROUND: The reported association of allergy and sinusitis varies greatly between study, and the exact role of allergy in predisposing to sinusitis is not clear. We attempted to determine whether patients with perennial allergic rhinitis are at greater risk of developing sinusitis with respect to a control group, and to determine whether there is a correlation between rhinomanometry, endoscopy, and nasal swab, and computed tomography (CT) findings. METHODS: Forty adult patients with perennial allergic rhinitis underwent CT scans of the paranasal sinuses, and the results were then compared to CTs of the paranasal sinuses of 30 control subjects. All allergic patients underwent nasal endoscopy, nasal swab, and active anterior rhinomanometry, and the results were studied in relation to the CT findings. RESULTS: We found sinusitis in 67.5% of the allergic patients and in 33.4% of the controls, with a statistically significant difference between the two groups (P = 0.017). Twenty-three patients had a positive nasal swab; 22 showed increased nasal resistance on rhinomanometry, and 36 had positive endoscopy, but the association of CT findings with endoscopy, rhinomanometry, or nasal swab was not statistically significant (P = 0.583, P = 1.00, P = 0.506, respectively). CONCLUSIONS: Allergic rhinitis is often associated with sinusitis, but the underlying mechanism has yet to be determined. Evidently, factors other than classical pathogen growth and mechanical factors, such as the association of the various factors and immunologic mechanisms, may contribute to the pathogenesis of chronic sinusitis in allergic patients.     

Unusual aspects of allergic bronchopulmonary fungal disease: Report of two cases due to Curularia organisms associated with allergic fungal sinusitis

We report two cases of allergic bronchopulmonary fungal disease (ABPFD) caused by Curvularia sp and associated with allergic fungal sinusitis (AFS). Curvularia lunata was cultured in one case and Curvularia senegalensis was cultured in the other. Based on these cases and a review of the literature, we discuss unusual clinical and pathologic features that can occur in ABPFD. Unusual clinical aspects of ABPFD include associated AFS, absence of asthma, progression to Churg-Strauss angiitis and granulomatosis, concomitant hypersensitivity pneumonitis, and underlying cystic fibrosis. Atypical pathologic features that may occur in ABPFD include follicular bronchiolitis, xanthomatous bronchiolitis, limited tissue invasion, fungus balls, and association with unusual fungi. Prominent follicular bronchiolitis and xanthomatous bronchiolitis were misleading histologic features in one of our cases and led to a delay in recognition of the diagnosis. Both patients presented primarily with AFS; ABPFD was detected subsequently. This suggests that a small subset of patients with AFS may be at risk for ABPFD. The goal of this review is to increase awareness of unusual clinical and pathologic manifestations of ABPFD. It is hoped that this will result in accurate diagnosis and proper therapy, especially for patients who present with atypical features. Unusual fungal species should be considered in patients who have clinical findings compatible with ABPFD but who do not demonstrate immunologic reactivity to Aspergillus sp, especially Aspergillus fumigatus. In addition, ABPFD should be considered in patients with AFS who develop new pulmonary lesions.     

卡介苗多糖核酸对支气管哮喘合并鼻炎患儿治疗的研究

目的 探讨卡介苗多糖核酸(BCG-PSN)对支气管哮喘合并鼻炎患儿Th1/Th2功能及肺通气功能的影响.方法 37例哮喘患儿随机分为治疗组和对照组两组.按照分级治疗的标准给与相应的糖皮质激素吸入治疗,治疗组加用BCG-PSN,随访6个月,比较治疗前和治疗后血清IFN-γ、IL-4的浓度及IFN-γ/IL-4比值、血浆总IgE、肺功能、鼻炎积分、哮喘发作需急诊就诊的次数、呼吸道感染的次数.结果治疗后治疗组,IL-4、IgE明显下降,IFN-γ及IFN-γ/IL-4比值明显升高;差异有统计学意义(P＜0.05),而对照组无明显改变,差异无统计学意义(P＜0.05).两组肺功能均明显改善,差异有统计学意义(P＜0.05).治疗组哮喘发作需急诊就诊的次数为(0.81±0.20)次,对照组为(1.72±0.80)次,差异有统计学意义,(t=4.15,P＜0.05);治疗组呼吸道感染(1.15±0.55)次,对照组(3.21±0.73)次,差异有统计学意义,(t=3.98,P＜0.05);治疗组鼻炎发作(1.31±0.42)次、对照组(1.11±0.39)次,差异无统计学意义,(t=2.31,P＜0.05).结论 BCG-PSN具有纠正Th1/Th2失衡,减轻气道炎症,改善肺通气功能,提高免疫力的作用.对于哮喘合并过敏性鼻炎的患儿,除针对气道慢性炎症使用糖皮质激素进行抗炎治疗外,同时应重视免疫调节治疗.     

Fexofenadine reduces nasal congestion in perennial allergic rhinitis

BACKGROUND: Nasal congestion is the predominant symptom in perennial allergic rhinitis (PAR), and it seems to be mainly related to the late-phase inflammatory events. The present pilot study aimed to evaluate the therapeutic effect exerted by fexofenadine in patients with PAR due to mite allergy. METHODS: This study was a parallel, double-blind, randomized, three-arm (1:1:1), placebo-controlled study. Thirty-one subjects with PAR were enrolled and received double-blind medication: fexofenadine 120 or 180 mg, or placebo, once a day for 28 days. RESULTS: The total symptom score was reduced by fexofenadine (both dosages) at V2 (P=0.007), whereas placebo did not modify it. Nasal congestion decreased after 1 week of treatment with fexofenadine 120 (P=0.027) and 180 (P=0.01), but not with placebo (P=NS). At V3, fexofenadine (both dosages) significantly reduced nasal congestion (P=0.011 and P=0.007, respectively), by placebo did not show any significant effect. CONCLUSIONS: This pilot study represents the first evidence of the efficacy of fexofenadine in PAR, and also the control of the nasal congestion. We suggest performing larger trials to confirm these preliminary findings.     

首诊眼科的真菌性鼻窦炎的影像解剖学特点

目的　分析以眼部症状为主的真菌性鼻窦炎的影像解剖学特征及临床表现。 方法　选取2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的真菌性鼻窦炎患者285例中首诊于眼科的20例患者的临床资料,分析其特征及临床误诊的原因。 结果　该20例首诊于眼科的病例其病变主要位于筛窦3例,蝶窦2例,上颌窦合并筛窦3例,筛窦合并蝶窦8例,上颌窦合并筛窦、蝶窦4例,眼部症状主要为单侧眼胀痛、视力下降、视野改变、面部疼痛及头痛。 结论　以单侧眼部胀痛及视力改变就诊于眼科的患者,应考虑真菌性鼻窦炎的可能,及时给予鼻窦CT检查后转耳鼻咽喉科进行治疗。     

Clinical advantages of dual activity in allergic rhinitis

Symptoms of allergic rhinitis include sneezing; itching of the eyes, nose, and throat; nasal obstruction; and rhinorrhoea; they may be seasonal or perennial, depending on the causative allergen. The major symptom of perennial allergic rhinitis is nasal obstruction. Sneezing and rhinorrhoea are often present, but are less troublesome than in seasonal allergic rhinitis. Symptom relief is a priority in allergic rhinitis because patients have a severely impaired quality of life. The nasal vascular system is complex. Histamine acts on postcapillary venules during both the immediate and late phase of reactivity and causes plasma extravasation. Other inflammatory mediators can also induce this reaction. Thus, histamine antagonists that also have some additional antiallergic properties have advantages in the treatment of allergic rhinitis. Mizolastine is a second-generation antihistamine that has been shown, in experimental studies, to possess 5-lipoxygenase inhibitory properties in addition to its H₁-receptor antagonistic activity. In the treatment of seasonal allergic rhinitis, mizolastine 10 mg/day has been shown to be effective in reducing nasal and ocular symptoms. It has been shown to be significantly more effective than placebo with a greater percentage of responders. Another study has shown that symptoms of seasonal allergic rhinitis in mizolastine-treated patients were reduced more significantly than in cetirizine-treated patients on the second and third days of treatment. In perennial allergic rhinitis, mizolastine significantly improved symptoms of nasal obstruction compared with placebo and also significantly reduced nasal membrane colour, nasal secretions, and mucosal swelling as shown by rhinoscopy. These effects were maintained over a 5-month treatment period. Mizolastine has also been shown to be at least as effective as loratadine, and in one trial even superior in the treatment of perennial allergic rhinitis.     

Medical treatment of allergic fungal sinusitis.

LEARNING OBJECTIVES: This review of allergic fungal sinusitis (AFS) will enable the reader to (1) differentiate AFS from the other forms of fungal sinusitis, (2) understand AFS pathophysiology, (3) recognize AFS clinical presentation, (4) prepare an effective treatment and follow-up strategy, and (5) avoid diagnostic and treatment pitfalls. DATA SOURCES: All English language MEDLINE articles that cross-referenced allergy, fungal, and sinusitis from 1983-present. Other MESH words referenced included: antibodies, fungal; fungus diseases; IgE; spores, fungal; rhinosinusitis. Additional referenced articles, published abstracts, and conference proceedings were also utilized. STUDY SELECTION: All case reports, studies, and review articles. RESULTS: Allergic fungal sinusitis is a distinct form of non-invasive fungal sinusitis. It is under-diagnosed, and incidence varies by region. Dematiaceous fungi predominate. In the southwestern United States, Bipolaris spicifera is the most common cause. Patients present with nasal polyps, rhinosinusitis, and occasionally proptosis. CT scans show hypertrophic sinusitis and often hyperattenuating allergic mucin within the sinus cavities. Extra-sinus extension of disease is common. Surgical histopathology shows eosinophilic-lymphocytic mucosal inflammation and inspissated allergic mucin containing non-invasive fungal hyphae. All patients are atopic and have positive allergy skin tests to the AFS organism. Total serum IgE levels are usually elevated. AFS immunopathophysiology is analogous to allergic bronchopulmonary aspergillosis. Treatment requires surgery, postoperative oral corticosteroids (OCS), and aggressive allergy management including allergen immunotherapy. Oral corticosteroids reduce disease activity and forestall the need for recurrent sinus surgery. Postoperative changes in total serum IgE mirror the clinical status and may predict disease recurrence. Patients should be cooperatively followed by the medical specialist and surgeon because early sinus surgery for recurrence, together with aggressive medical management, gives the best outcome. CONCLUSIONS: Allergic fungal sinusitis is a new allergic disorder with recognizable clinical and histopathologic findings. Treatment requires aggressive allergy management, postoperative OCS, monitoring of total serum IgE, and medical/surgical co-management.     

Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis: a review of an uncommon association*

BACKGROUND: Although thought to have common immunopathological processes, concomitant occurrence of allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) appears to be rarely reported as to date only five detailed case reports are available. OBJECTIVE: To present a review of seven cases of concomitant ABPA and AAS, three of whom were earlier reported for their unusual presentations. METHODS: Patients with ABPA with nasal symptoms were evaluated radiologically. Consent was taken for antral wash and/or Caldwell-Luc operation in those with radiological evidence of sinusitis and the material was sent for histopathological and mycological studies. RESULTS: Of the 95 patients with ABPA, 22 had radiological evidence of sinusitis. Nine consented to surgery, seven of whom were diagnosed as concomitant AAS. Nasal symptoms preceded chest symptoms in two patients, vice versa in one and occurred simultaneously in four. Familial occurrence of ABPA, middle lobe syndrome and collapse with effusion along with an operated aspergilloma were seen in one patient each. Transient pulmonary infiltrates and central bronchiectasis were seen in all patients. Computed tomography of the paranasal sinuses, carried out in six patients, revealed mucosal thickening with hyperdense lesions, without any bony erosion or destruction. All patients had positive skin tests, positive precipitin study and raised total and specific IgE. Allergic mucin was seen in all patients, fungal hyphae in five, and culture grew Aspergillus spp. in four. All patients responded favourably to oral prednisolone. CONCLUSION: Concomitant occurrence of ABPA and AAS seems to be infrequently recognized. Since asthma and sinusitis are often seen by two different specialities, the occurrence of AAS in ABPA and ABPA in AAS may easily be overlooked.