過敏性黴菌鼻竇炎與嗜伊紅性黏液鼻竇炎之異同

The Difference between Allergic Fungal Sinusitis and Eosinophilic Mucin Rhinosinusitis

黃苔晏(Tai-Yen Huang) ； 蔣敬文(Ching-Wen Chiang)

《台灣耳鼻喉頭頸外科雜誌》 50卷1期 (2015/03) Pp. 27-35

https://doi.org/10.6286/2015.50.1.27

摘要

背景：自鼻腔中過敏性黏液在1981年發現以來，過敏性黴菌鼻竇炎（allergic fungal rhinosinusitis, AFS）與嗜伊紅性黏液鼻竇炎（Eosinophilic mucin rhinosinusitis, EMRS）之間的診斷標準及病理機轉，在學界一直有爭論。方法：本研究回溯自2008年至2014年6年間，於本院接受同1名主治醫師手術治療鼻竇炎的病患中，經病理檢查確定過敏性黏液存在，再依是否於病理檢查或培養中發現黴菌，區分AFS及EMRS兩組病患，比較兩組在臨床、病理學實驗室、及影像學上的表現。結果：共912人次接受鼻竇炎手術治療，其中5名患者診斷為AFS，7名為EMRS，兩組病人於追蹤期間合計接受59人次手術治療，合佔6.4%。AFS患者平均年齡為51.6歲，EMRS則為58.2歲，兩者無統計意義。EMRS較多女性患者（男：女2:5），AFS則相當（男：女2:3）。EMRS患者43%有氣喘，AFS僅有20%。影像學上兩組均無眼眶及顱底侵犯，且多為兩側疾病。AFS組有3例（60%）於病理檢查發現Charcot-Leyden crystal，EMRS組則無。其餘在病史、理學檢查、及血清學上，並無法區分兩者。在正確診斷前，病患大多接受多次手術治療；一旦確定診斷後，局部治療加上短期口服類固醇可有效控制疾病。結論：AFS與EMRS有諸多相似性，仍需更多的研究來闡釋兩者病因與病理機轉不同處。臨床醫師對於過敏性黏液需有高度警覺心，以提早診斷及適當治療此類疾病。

關鍵字

過敏性黏液 ； 過敏性黴菌鼻竇炎 ； 嗜伊紅黏鼻竇炎

並列摘要

Background: Since allergic fungal sinusitis was recognized in 1981, there were controversies in differential diagnosis and pathogenesis of allergic fungal sinusitis (AFS) and eosinophilic mucin rhinosinusitis (EMRS). Methods: In this retrospective study, we reviewed the charts of patients who had received paranasal sinus surgery by the same doctor from 2008 to 2014. Patients with histologic evidence of allergic mucin were included. They were separated into AFS and EMRS groups according to the identification of fungus. The clinical, pathologic, laboratory, and imaging findings were compared. Results: Of the 912 operations reviewed, a total of 12 cases and 59 operations with allergic mucin were identified. The incidence was 6.4%. There were 5 patients with AFS and 7 with EMRS. The mean age was 51.6 years old in AFS group and 58.2 years old in EMRS group, without significant difference. There were more female in EMRS group (male: female, 2:5) and no gender difference in AFS group (male: female, 2:3). Forty-three percent of EMRS patients and 20% of AFS patients had asthma. In radiology, there was no orbital and skull base invasion and most of the patients had bilateral disease. Charcot-Leyden crystals were revealed histologically in three patients (60%) with AFS, but none in EMRS group. There were no differences between these two groups in history, physical examination, and serology. Most patients had received multiple surgical procedures before definite diagnosis made. Meticulous examination and local treatments and short-term peroral steroids can effectively control both diseases. Conclusions: There are many similarities between AFS and EMRS. Additional studies are required to investigate the diagnostic criteria and pathophysiology of these diseases. High vigilance to allergic mucin is important in clinical practice for the precise diagnosis and proper treatment of AFS and EMRS.

並列關鍵字

Allergic mucin ； allergic fungal sinusitis ； eosinophilic mucin rhinosinusitis