Preoperative diagnosis of allergic fungal sinusitis
Preoperative diagnosis of allergic fungal sinusitis
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DOI：
10.1097/00005537-200304000-00020
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发表时间：
2003-04-01
期刊：
影响因子：
2.6
通讯作者：
Chhabra, SK
中科院分区：
文献类型：
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作者：
Dhiwakar, M;Thaker, A;Chhabra, SK
目的/假设：虽然变应性真菌性鼻窦炎的诊断主要是基于特征性的组织病理学发现，但已提出了某些术前诊断标准。然而，它们在鉴别变应性真菌性鼻窦炎与其他鼻窦疾病中的作用尚不清楚。本研究的目的是确定准确的术前诊断参数变应性真菌性鼻窦炎。研究设计：前瞻性比较研究。研究方法：前瞻性评价了20例连续的变应性真菌性鼻窦炎，并与16例筛窦息肉病和5例侵袭性鼻窦曲霉菌病的各种临床、放射学和免疫学参数进行了比较。根据组织病理学结果对所有患者进行分类。结果如下：20例变应性真菌性鼻窦炎、16例筛窦息肉病、5例侵袭性鼻窦曲菌病中2例均见鼻息肉。20例变应性真菌性鼻窦炎CT扫描均呈高密度，2例筛窦息肉病（13%）和2例侵袭性鼻窦曲菌病（40%）CT扫描均呈高密度。14例（70%）变应性真菌性鼻窦炎、2例（13%）筛窦息肉病和3例（60%）侵袭性鼻窦曲菌病患者血清特异性抗曲霉免疫球蛋白E水平升高。在任何筛窦息肉病或侵袭性鼻窦曲菌病病例中均未发现所有三种情况（即鼻息肉、CT扫描高衰减和抗曲霉菌免疫球蛋白滴度升高）的组合。此三联征对变应性真菌性鼻窦炎术前诊断的敏感性为70%，特异性为100%。结论：鼻息肉、CT扫描和特异性免疫球蛋白E滴度，当结合考虑时，对变应性真菌性鼻窦炎有很高的术前诊断价值。然而，不应该孤立地考虑这些疾病，因为它们与侵袭性鼻窦曲霉病和筛窦息肉病有相当多的重叠。
Objectives/Hypothesis: Although the diagnosis of allergic fungal sinusitis is mainly based on characteristic histopathological findings, certain preoperative diagnostic criteria have been proposed. However, their usefulness in differentiating allergic fungal sinusitis from other sinus diseases is unknown. The objective of the study was to identify accurate preoperative diagnostic parameters for allergic fungal sinusitis. Study Design: Prospective, comparative study. Methods: Twenty consecutive cases of allergic fungal sinusitis were evaluated prospectively and compared with 16 cases of ethmoidal polyposis and 5 cases of invasive sinus aspergillosis, with regard to various clinical, radiological, and immunological parameters. All patients were categorized based on histopathological findings. Results: Nasal polyps were seen in all 20 cases of allergic fungal sinusitis, all 16 cases of ethmoidal polyposis, and 2 of 5 cases of invasive sinus aspergillosis. Computed tomography (CT) scan hyper-attenuation was seen in all 20 cases of allergic fungal sinusitis but also in 2 (13%) cases of ethmoidal polyposis and 2 (40%) cases of invasive sinus aspergillosis. Serum levels of specific anti-Aspergillus immunoglobulin E were elevated in 14 (70%) cases of allergic fungal sinusitis, 2 (13%) cases of ethmoidal polyposis, and 3 (60%) cases of invasive sinus aspergillosis. The combination of all three (ie, nasal polyps, CT scan hyper-attenuation, and elevated titers of anti-Aspergillus immunoglobulin) was not found in any case of ethmoidal polyposis or invasive sinus aspergillosis. This triad demonstrated a sensitivity of 70% and a specificity of 100% for the preoperative diagnosis of allergic fungal sinusitis. Conclusions: Nasal polyps, CT scan, and specific immunoglobulin E titers, when considered in combination, have a high preoperative diagnostic value in allergic fungal sinusitis. However, they should not be considered in isolation because considerable overlap occurs with invasive sinus aspergillosis and ethmoidal polyposis.