中国北方真菌性鼻窦炎患者的临床特征、病原谱及侵袭性危险因素：一项回顾性研究（2015-2024年）
Clinical characteristics and pathogen spectrum of patients with fungal rhinosinusitis and risk factors for invasiveness in Northern China: a retrospective study (2015-2024).
文献信息
| PMID | 42928136 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Na Li |
| 作者单位 | Department of Laboratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China. |
| 期刊 | BMC infectious diseases |
| SCI 分区 | Q2 |
| IF | 3.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 真菌性鼻窦炎（FRS）日益常见，但由于侵袭性病例症状不典型且区域流行病学数据有限，仍存在诊断不足或误诊。本研究旨在系统描述过去十年中国北方FRS患者的病原谱、临床特征及侵袭性疾病的危险因素。
方法： 本回顾性研究纳入2015年1月至2024年12月在中国北方一家三级医院诊断为FRS的511例患者。所有病例均经组织病理学和真菌培养确诊。根据组织病理学组织侵袭证据，患者被分类为侵袭性真菌性鼻窦炎（IFRS）或非侵袭性真菌性鼻窦炎（NIFRS）。收集并分析人口学特征、临床表现、基础疾病、实验室检查结果及病原体数据。采用多因素logistic回归识别IFRS的独立危险因素。
结果： 在511例患者中，52例（10.2%）被分类为IFRS，459例（89.8%）为NIFRS。慢性感染占主导（93.3%），上颌窦是最常受累部位（86.7%）。曲霉属是主要病原体（64.6%），主要为烟曲霉（25.8%）和黄曲霉（25.6%）。47.2%的患者存在细菌共感染。与NIFRS相比，IFRS患者眼部症状（50.0% vs. 16.1%，P < 0.001）和鼻面部肿胀（34.6% vs. 14.6%，P < 0.001）的发生频率显著更高，但鼻塞和流涕的发生频率更低（44.2% vs. 80.2%，P < 0.001）。IFRS中毛霉目的检出率显著更高（9.6% vs. 0.9%，P < 0.001）。多因素分析显示，糖尿病与IFRS独立相关（OR = 5.187，95% CI：2.576-10.446，P < 0.001）。亚组分析显示急性和慢性IFRS之间具有不同的临床和病理特征。
结论： 中国北方FRS以慢性、曲霉驱动为主。眼部症状和鼻面部肿胀是侵袭性疾病的关键警示信号，糖尿病与IFRS独立相关。临床医生应对出现不典型症状的糖尿病患者保持对IFRS的高度警惕，以实现早期诊断和及时干预。
英文摘要
BACKGROUND: Fungal rhinosinusitis (FRS) is becoming increasingly common but remains underdiagnosed or misdiagnosed due to atypical symptoms in invasive cases and limited regional epidemiological data. The aim of this study was to systematically describe the pathogenic spectrum, clinical characteristics, and risk factors for invasive disease in patients with FRS in Northern China over the past decade.
METHODS: This retrospective study included 511 patients diagnosed with FRS at a tertiary hospital in Northern China from January 2015 to December 2024. All cases were confirmed by histopathology and fungal culture. Patients were classified as invasive fungal rhinosinusitis (IFRS) or non-invasive fungal rhinosinusitis (NIFRS) based on histopathological evidence of tissue invasion. Demographic characteristics, clinical manifestations, underlying diseases, laboratory findings, and pathogen data were collected and analyzed. Multivariate logistic regression was used to identify independent risk factors for IFRS.
RESULTS: Among 511 patients, 52 (10.2%) were classified as IFRS and 459 (89.8%) as NIFRS. Chronic infection predominated (93.3%), with the maxillary sinus being the most frequently involved site (86.7%). Aspergillus species were the predominant pathogens (64.6%), primarily Aspergillus fumigatus (25.8%) and Aspergillus flavus (25.6%). Bacterial co-infection was present in 47.2% of patients. Compared to NIFRS, IFRS patients had significantly higher frequencies of ocular symptoms (50.0% vs. 16.1%, P < 0.001) and nasofacial swelling (34.6% vs. 14.6%, P < 0.001), but lower frequencies of nasal obstruction and rhinorrhoea (44.2% vs. 80.2%, P < 0.001). The detection rate of Mucorales was significantly higher in IFRS (9.6% vs. 0.9%, P < 0.001). Multivariate analysis showed that diabetes mellitus was independently associated with IFRS (OR = 5.187, 95% CI: 2.576-10.446, P < 0.001). Subgroup analysis revealed distinct clinical and pathological profiles between acute and chronic IFRS.
CONCLUSIONS: FRS in Northern China is predominantly chronic and Aspergillus-driven. Ocular symptoms and nasofacial swelling are critical warning signs of invasive disease, and diabetes mellitus was independently associated with IFRS. Clinicians should maintain a high index of suspicion for IFRS in diabetic patients presenting with atypical symptoms to enable early diagnosis and timely intervention.