Computer-Assisted Analysis of Oral Antifungal Therapy in Chronic Rhinosinusitis with Airway Mycosis: a Retrospective Cohort Analysis.
Computer-Assisted Analysis of Oral Antifungal Therapy in Chronic Rhinosinusitis with Airway Mycosis: a Retrospective Cohort Analysis.
复制标题
慢性鼻窦炎伴气道真菌病口服抗真菌治疗的计算机辅助分析：回顾性队列分析。
DOI：
10.1128/aac.01697-21
复制
发表时间：
2021
影响因子：
4.9
通讯作者：
Corry,DavidB
中科院分区：
文献类型：
--
作者：
Li,Evan;Scheurer,Michael;Kheradmand,Farrah;Luong,AmberU;Corry,DavidB
环境真菌在病因学上与慢性鼻-鼻窦炎(CRS)合并呼吸道真菌病有关，但它们的感染作用仍不确定，部分原因是潜在的疾病量化方法不足。我们的目的是通过计算机辅助分析来确定成人CRS和呼吸道真菌病患者口服抗真菌治疗的客观放射学和症状结果。我们在一项基于单中心转诊的学术实践中对65名CRS和培养证实的呼吸道真菌病患者进行了回顾性研究，利用计算机辅助鼻窦粘膜面积分析(CAASMA)比较了慢性口服抗真菌治疗前和治疗期间的配对鼻窦计算机断层扫描(CT)和症状评分。对照组接受不含抗真菌药物的标准治疗。抗真菌药物的应用与CAASMA评估的鼻窦粘膜增厚显著减少有关(−6.85%绝对减少；95%可信区间[CI]，−11.8283至−1.8717；P<；0.005)，但与Lund-Mackay评分无关。相比之下，CAASMA将标准护理单独与增强的粘膜增厚联系在一起(4.14%绝对增加；95%可信区间，−1.8066至10.0866；P<；0.005)。在41名接受抗真菌治疗的患者中，有30名(73%)的鼻窦粘膜负荷减轻，而接受标准治疗的患者中只有21名(43%)的影像表现有所改善(优势比[OR]为11.65；95%可信区间为3.2至42.2；P<；0.05)。19名患者(50%)在随访CT扫描时发现症状有所改善，而接受标准治疗的患者中只有8名(20%)有改善(OR，6.21；95%CI，1.7至22.7；P<；0.05)。这些回顾性研究结果表明，口服抗真菌药物可以减轻CRS合并呼吸道真菌病的黏膜增厚和改善症状。有必要进行随机临床试验来验证这些发现。
Environmental fungi are etiologically related to chronic rhinosinusitis (CRS) with airway mycosis, but their infectious role remains uncertain, in part because of potentially inadequate methods of disease quantitation. Our objective was to determine objective radiographic and symptomatic outcomes of oral antifungal therapy in adult patients with CRS and airway mycosis by using computer-assisted analysis. We conducted a retrospective study of 65 patients with CRS and culture-proven airway mycosis in a single-center referral-based academic practice, comparing paired sinus computed tomography (CT) scans and symptom scores prior to and during chronic oral antifungal therapy using computer-assisted analysis of sino-mucosal area (CAASMA). A comparator group received standard therapy without antifungals. Administration of antifungals was associated with significantly reduced sinus mucosal thickening as assessed by CAASMA (−6.85% absolute reduction; 95% confidence interval [CI], −11.8283 to −1.8717;P< 0.005), but not by Lund-Mackay score. In contrast, standard care alone was linked by CAASMA to enhanced mucosal thickening (4.14% absolute increase; 95% CI, −1.8066 to 10.0866;P< 0.005). Thirty of the 41 antifungal-treated patients (73%) showed decreased sinus mucosal burdens, while only 21 patients (43%) receiving standard therapy showed improved imaging (odds ratio [OR], 11.65; 95% CI, 3.2 to 42.2;P< 0.05). Nineteen patients (50%) noted improved symptoms at the time of a follow-up CT scan, while only 8 patients (20%) on standard therapy improved (OR, 6.21; 95% CI, 1.7 to 22.7;P< 0.05). These retrospective findings indicate that oral antifungals can reduce mucosal thickening and improve symptoms in CRS with airway mycosis. Randomized clinical trials are warranted to verify these findings.