非侵袭性真菌性鼻窦炎的实验室诊断及致病菌分析

目的 探讨非侵袭性真菌性鼻窦炎的实验室诊断方法，分析其致病菌，为鼻窦炎合并真菌感染的临床诊断、治疗提供依据。方法 对我院临床及鼻内镜下所诊断的10例真菌性鼻窦炎患者，鼻内镜手术时直接吸取病变的鼻窦黏膜及窦腔内容物，通过直接镜检、真菌培养、传统鉴定及分子生物学鉴定和组织病理学检查对其进行检查。结果 10例病例中，直接镜检阳性者8例；病理学检查可见真菌菌丝或者孢子者8例；接种培养及基因鉴定阳性者5例（感染菌株包括2例烟曲霉复合体、1例杂色曲霉、1例枝孢样枝孢霉、1例帚霉）。不同方法检测出的阳性病例并非完全重叠。结论 真菌镜检、真菌培养、真菌分子生物学鉴定、组织病理学检查在诊断真菌感染时可以互补，有助于明确诊断及发现新菌株。

Analysis of pathogens causing fungal sinusitis and its clinical significance

Abstract: Objective To discuss the laboratory diagnostic method of noninvasive fungal sinusitis and analyze the pathogens in order to provide basis for clinical diagnosis and treatment. Methods Ten cases of fungal sinusitis were enrolled in this study. The mucosal tissue specimens of sinus lesion and contents of sinus cavity were collected by using nasal endoscopy and examined by means of direct microscopy, fungal culture and identification, molecular biology and histopathology. Results Among the 10 cases, 8 cases were fungi-positive by direct microscopy examination, 8 cases by histopathology, while 5 cases by fungal culture and gene identification (including 2 cases of Aspergillus fumigatus infection, 1 case of Aspergillus versicolor infection, 1 case of Cladosporium cladosporium infection and 1 case of Scopulariopsis infection). The positive results obtained with different ways of detection were not entirely overlapped. Conclusion Direct microscopy examination, fungi culture, molecular biology and histopathology complement each other in diagnosing fungal sinusitis and discovering new strains.