本文選題：真菌性鼻竇炎 + 血漿1-3-β-D葡聚糖�。� 參考：《中國(guó)醫(yī)科大學(xué)》2008年碩士論文

【摘要】： 目的 近年來,真菌性鼻竇炎的發(fā)病率隨著廣譜抗生素,免疫抑制劑的應(yīng)用及糖尿病的多發(fā)呈逐年上升趨勢(shì),目前臨床診斷主要依靠影像學(xué)檢查。具有典型影像學(xué)改變的病人其診斷率較高,但對(duì)于缺乏典型影像學(xué)表現(xiàn)的患者臨床診斷困難。術(shù)后病理組織學(xué)及真菌學(xué)檢查雖然可以明確術(shù)后診斷,但對(duì)術(shù)前診斷無法提供幫助。臨床診斷上的困難給治療方案的選擇以及病人的預(yù)后等帶來一系列的問題,故早期、快速、準(zhǔn)確的診斷方法對(duì)真菌性鼻竇炎的診斷及治療方案的選擇意義重大。 方法 采用北京金山川科技公司生產(chǎn)的試劑盒及MB—80微生物快速檢測(cè)系統(tǒng)分別檢測(cè)中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院耳鼻喉科于2007年4月至2008年2月經(jīng)鼻竇內(nèi)窺鏡手術(shù)治療,并經(jīng)術(shù)后病理證實(shí)為真菌性鼻竇炎患者(19例為真菌球型,1例為慢性侵襲性真菌性鼻竇炎)的血液樣品20例,患者年齡19歲—80歲,平均年齡51歲,采取中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院耳鼻喉科于2008年1月住院?jiǎn)渭儽侵懈羝颊?無鼻竇炎)的血液樣品5例作為對(duì)照組,患者年齡16—56歲,平均年齡32歲(以上血樣標(biāo)本的采集患者均已簽署知情同意書)。 結(jié)果 經(jīng)過實(shí)驗(yàn)檢測(cè)20例真菌性鼻竇炎(19例為真菌球型,1例為慢性侵襲性真菌性鼻竇炎)及5例對(duì)照組患者血漿中1-3-β-D葡聚糖的含量,可以發(fā)現(xiàn)其中18例真菌性鼻竇炎患者血漿中1-3-β-D葡聚糖的含量大于試劑盒的診斷標(biāo)準(zhǔn)10pg/ml,其中一例慢性侵襲性真菌性鼻竇炎患者血漿中1-3-β-D葡聚糖的含量達(dá)到21.82pg/ml,2例真菌性鼻竇炎患者血漿中1-3-β-D葡聚糖的含量小于10pg/ml,而對(duì)照組患者血漿中1-3-β-D葡聚糖的含量均小于10pg/ml,病例組與對(duì)照組間采用卡方檢驗(yàn)測(cè)得卡方值為16.071,(P＜0.05)兩組間有差異,有統(tǒng)計(jì)學(xué)意義。 結(jié)論 本研究共計(jì)對(duì)20例真菌性鼻竇炎(19例為真菌球型,1例為慢性侵襲性真菌性鼻竇炎)患者及5例對(duì)照組患者血漿中1-3-β-D葡聚糖進(jìn)行檢測(cè),發(fā)現(xiàn)其中18例真菌性鼻竇炎患者血漿中1-3-β-D葡聚糖的含量大于試劑盒的診斷標(biāo)準(zhǔn)10pg/ml,實(shí)驗(yàn)的陽性率為90%,血漿1-3-β-D葡聚糖水平可以用于診斷真菌性鼻竇炎。血漿1-3-β-D葡聚糖的檢測(cè)是一種簡(jiǎn)便、快速、實(shí)用的診斷真菌性鼻竇炎的方法。
[Abstract]:Objective in recent years, the incidence of fungal sinusitis has been increasing with the use of broad-spectrum antibiotics, immunosuppressants and diabetes mellitus. The diagnostic rate of patients with typical imaging changes is higher, but it is difficult to diagnose the patients without typical imaging findings. Although postoperative histopathology and mycology can confirm the postoperative diagnosis, it is not helpful for preoperative diagnosis. The difficulty of clinical diagnosis brings a series of problems to the choice of treatment plan and the prognosis of patients, so the early, rapid and accurate diagnosis method is of great significance to the diagnosis and treatment of fungal sinusitis. Methods the kit produced by Beijing Jinshanchuan Science and Technology Company and the MB-80 microorganism rapid detection system were used to detect the otolaryngology of Shengjing Hospital affiliated to China Medical University from April 2007 to February 2008. Endoscopic sinus surgery, The blood samples of 20 patients with mycosinusitis (19 cases with fungal bulbar type and 1 case with chronic invasive fungal sinusitis) were confirmed by postoperative pathology. The age of the patients ranged from 19 to 80 years, with an average age of 51 years. The blood samples of patients with simple nasal septum deviation (without sinusitis) were collected from Department of Otolaryngology of Shengjing Hospital affiliated to China Medical University in January 2008 as control group. The patients were aged 16-56 years. The average age was 32 years (all patients with blood samples collected had signed informed consent). Results the plasma levels of 1-3- 尾 -D glucan were measured in 20 cases of fungal sinusitis (19 cases of fungal bulbous sinusitis) and 5 cases of control group. It was found that the concentration of 1-3- 尾 -D glucan in plasma of 18 patients with fungal sinusitis was greater than the diagnostic criteria of 10 PG / ml of the kit, and that of one patient with chronic invasive fungal sinusitis was 21.82 pgml / ml of 1-3- 尾 -D glucan. The plasma levels of 1-3- 尾 -D glucan in patients with sinusitis were less than 10pg / ml, while those in the control group were less than 10pg / ml. There was significant difference between the two groups by chi-square test (P < 0.05). There is statistical significance. Conclusion the plasma levels of 1-3- 尾 -D glucan were measured in 20 patients with fungal sinusitis (19 patients with fungal bulbous sinusitis) and 5 patients with chronic invasive fungal sinusitis. It was found that the concentration of 1-3- 尾 -D glucan in plasma of 18 patients with fungal sinusitis was higher than that of the diagnostic standard of 10 PG / ml. The positive rate of the experiment was 90. The plasma level of 1-3- 尾 -D glucan could be used to diagnose fungal sinusitis. The detection of plasma 1-3-尾-D glucan is a simple, rapid and practical method for the diagnosis of fungal sinusitis.
【學(xué)位授予單位】：中國(guó)醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R763

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