真菌性中耳炎及相关变应原研究

发布时间：2018-04-26 02:10

本文选题：真菌变应原 + 真菌性中耳炎　；参考：《长江大学》2017年硕士论文

【摘要】：目的探讨真菌变应原与真菌性中耳炎的关系,并为此类疾病的预防和诊疗提供理论支持。方法1选真菌性中耳炎(Fungal otitis media,FOM)的病例共21例为实验组,44例无真菌感染的中耳炎性疾病病例为对照组,分析其临床特点;2通过对鼓膜处及中耳乳突腔分泌物进行压片/涂片镜检和培养确定致病真菌种类;3通过对患者术中标本行病理切片进行显微镜下观察,观察其是否有嗜酸性粒细胞浸润;4结合两组患者皮肤点刺试验、血清s Ig E检测结果进一步分析验证。结果实验组患者病灶处的分泌物及标本经真菌涂片镜检和真菌鉴定查出主要致病真菌为:曲霉菌属(7例,33.3%)、白色念珠菌属(2例,9.5%)、毛癣菌属(1例,4.8%)、酵母菌属(3例,14.3%)、青霉菌属(5例,23.8%)、链格孢(3例,14.3%)。(表2,图1-3)真菌镜检、培养及鉴定结果与文献报道的中耳常见致病真菌种类一致。两组中真菌变应原皮肤点刺试验阳性者共9例,其中实验组患者中有6例,对照组患者中有3例。实验组患者及对照组患者中真菌变应原皮肤点刺实验总阳性率为(13.8%,9/65),21例实验组患者中真菌变应原皮肤点刺试验阳性率为(28.6%,6/21),44例对照组患者中真菌变应原皮肤点刺试验阳性率为(6.8%,3/44)。(表4)实验组与对照组两者间差异有显著性意义,χ2=3.963(校正),p0.05,实验组变应原皮肤点刺试验中真菌变应原阳性率明显高于对照组。即提示在两组患者中都存在着真菌引起的变态反应,并且是有真菌感染的实验组中存在真菌感染引起的变态反应患者数量更多。这些患者真菌变应原皮肤点刺试验阳性可能与其中耳乳突腔致病真菌有关。21例实验组患者中真菌变应原血清特异性Ig E检测阳性者有7例,占实验组33.3%,占研究总病例10.8%;44例对照组患者中真菌变应原血清特异性Ig E检测阳性者4例,占对照组9.1%,占实验总病例6.2%。实验组患者与对照组患者真菌血清特异性Ig E检测阳性率差异存在统计学意义,χ2=4.343(校正),p0.05。(表5)实验组患者中真菌变应原血清特异性Ig E检测阳性率明显高于对照组患者中真菌变应原血清特异性Ig E检测阳性率,两组间真菌变应原血清特异性Ig E检测阳性率存在统计学差异。表明两组患者中存在着真菌变应原引起的变态反应,并且在实验组中真菌变应原引起的变态反应发生率明显高于对照组。此外真菌变应原血清特异性Ig E检测阳性率与之前真菌变应原皮肤点刺试验中真菌变应原阳性率基本一致,进一步验证了部分患者机体正处于真菌变应原导致的致敏状态。实验组有16例患者行手术治疗,术后中耳乳突腔病变组织标本行病理检查,通过对病理标本切片的镜检,其中有8例可见嗜酸性粒细胞浸润(图5),占实验组行中病理检查者的50%;对照组中31例患者行手术治疗,术后中耳乳突腔病变组织标本行病理检查,通过对病理标本切片的镜检,其中有5例可见嗜酸性粒细胞浸润,占对照组中行病理检查者的16.1%。实验组与对照组中行病理检查者嗜酸性粒细胞浸润情况比较结果存在统计学差异,χ2=4.476(校正),p0.05。(表6)提示可能存在真菌变应原引起的局部变态反应。结论1.在吸入性变应原中,真菌变应原是阳性率较高的变应原之一,可为临床变应性疾病的诊疗提供指导;2在真菌相关的中耳炎性疾病(如真菌性中耳炎及慢性化脓性中耳炎合并真菌感染)中存在着真菌变应原引起的变态反应,在临床中诊治此类疾病时需考虑此种情况。3可能存在着一种以真菌为变应原的变应性的真菌性中耳炎。
[Abstract]:Objective to explore the relationship between fungal allergens and fungal otitis media, and to provide theoretical support for the prevention and treatment of such diseases. Methods 1 cases of Fungal otitis media (FOM) were selected as experimental group, and 44 cases of otitis media with no fungal infection were used as the control group, and 2 were analyzed in the tympanic membrane. And the mastoid cavity secretions in the middle ear were used to determine the species of pathogenic fungi by compression / smear microscopy and culture. 3 by observing the pathological sections of the specimens in the patients, the eosinophil infiltration was observed, and 4 in two groups of patients with skin prick test, the results of serum s Ig E detection were further analyzed and verified. The secretions and specimens of the lesions were identified by fungal smear microscopy and fungal identification: Aspergillus (7, 33.3%), Candida albicans (2, 9.5%), Trichophyton (1, 4.8%), yeasts (3, 14.3%), Penicillium (5, 23.8%), 3, 14.3%). (Table 2, plots 1-3) fungal microscopy, culture and identification results Among the two groups, there were 9 cases of fungal allergen skin pricking test in the two groups, including 6 in the experimental group and 3 in the control group. The total positive rate of fungal allergen test in the experimental group and the control group was (13.8%, 9/65) and 21 in the experimental group. The positive rate of the original skin prick test was (28.6%, 6/21), and the positive rate of the skin prick test in 44 cases of the control group was (6.8%, 3/44). (Table 4) the difference between the experimental group and the control group was significant, X 2=3.963 (Xiao Zheng), P0.05, the positive rate of fungal allergen in the experimental group was significantly higher than that of the control group. It is suggested that there is a fungal allergy in all two groups of patients, and the number of allergic reactions caused by fungal infection in the experimental group with fungal infection is more. The positive skin prick test in these patients may be related to the fungal allergen in the.21 experimental group. There were 7 cases of serum specific Ig E positive, accounting for 33.3% of the experimental group, accounting for 10.8% of the total cases, 44 cases of the control group were 4 cases of positive Ig E detection in the serum of fungal allergen, accounting for 9.1% of the control group, accounting for the difference in the positive rate of the specific Ig E detection of the fungal blood clear in the 6.2%. experimental group and the control group, and there was a statistically significant difference in the positive rate of the positive rate of Ig E in the patients with the control group and the control group. 2=4.343 (Xiao Zheng), p0.05. (Table 5), p0.05. (Table 5) experimental group of fungal allergen serum specific Ig E detection positive rate is significantly higher than the control group of fungal allergen serum specific Ig E positive rate, the positive rate of serum specific Ig E detection of fungal allergens among the two groups is statistically significant, indicating the presence of fungi in the two groups of patients with fungi. The allergic reaction caused by allergens, and the incidence of allergic reaction caused by fungal allergen in the experimental group was significantly higher than that in the control group. In addition, the positive rate of the serum specific Ig E detection in the fungal allergen and the positive rate of the fungal allergen in the previous fungal allergen skin pricking test were the same, and further verified that some patients were in the right place. In the experimental group, 16 patients were treated with surgical treatment, and the pathological examination of the tissue specimens of the middle ear and mastoid cavity was performed after operation. Through the microscopic examination of the pathological specimens, 8 of them showed eosinophil infiltration (Figure 5), accounting for 50% of the patients in the experimental group, and 31 of the control groups were treated with surgical treatment. The pathological examination of the tissue specimens of the middle ear and mastoid cavity lesions after the operation, through the microscopic examination of the pathological specimens, 5 of them were eosinophil infiltration, which accounted for a statistically significant difference in the eosinophil infiltration between the 16.1%. experimental group and the control group in the control group. X 2=4.476 (correction) P0.05. (Table 6) suggests that there may be a local allergy caused by fungal allergen. Conclusion 1. in inhalation allergens, fungal allergen is one of the higher positive allergens, providing guidance for the diagnosis and treatment of clinical allergic diseases; 2 in fungal related otitis media, such as fungal otitis media and chronic suppurative otitis media. The allergic reaction caused by fungal allergen exists in the combined fungal infection. In the clinical diagnosis and treatment of such diseases, it is necessary to consider the presence of a fungal otitis media with fungal allergens in.3.

【学位授予单位】：长江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.21

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