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摘要: 目的 探讨单侧上颌窦真菌球(UMFB)的病变特点以提高临床诊断的准确性。方法 回顾性分析2017年1月-2019年6月于山东大学齐鲁医院青岛院区行鼻内镜手术治疗的单侧上颌窦病变且术后经病理证实为UMFB或单侧慢性上颌窦炎(UCMS)患者共86例, 分别从年龄、性别、是否合并糖尿病、病变上颌窦CT特征及上颌窦后外侧壁GOSS骨炎评分进行对比分析, 比较两组病变的差异。CT特征包括: ①上颌窦内见高密度影; ②上颌窦内充满软组织密度影(包括凸入或不凸入中鼻道内软组织密度影); ③上颌窦内未充满软组织密度影(包括表面不平凸起, 表明光滑凸起如类圆形光滑凸起、气泡症)。行卡方、独立样本t检验, Mann-Whitney U检验对差异有统计学意义的指标进行二元Logistic回归分析, 对有意义的数值型变量指标进行受试者工作特征(ROC)曲线分析, 分析分界值与敏感度和特异性的关系, 找到诊断UMFB的最佳截断值。结果 86例单侧上颌窦病变中UMFB 62例(72.1%), UCMS 24例(27.9%)。UMFB好发于中老年患者, 女性多于男性。是否合并糖尿病在两种病变间差异无统计学意义。在鼻窦CT特征上, 经组间比较及二元Logistic回归分析, 上颌窦内高密度影或钙化、上颌窦内未充满软组织密度影表面不平凸起、上颌窦内充满软组织密度影并凸入中鼻道是UMFB的显著预测因素(均P < 0.05)。UMFB骨炎评分明显高于UCMS(P < 0.001), 经ROC曲线分析, 当截断值>3.5时(曲线下面积为0.824), 相应的敏感度和特异性分别为0.516、0.958。结论 通过年龄、性别、CT特征表现以及上颌窦骨炎评分可以将UMFB与单侧上颌窦慢性炎症进行鉴别, 提高临床诊断的准确性。Abstract: Objective The aim of this study is to investigate the pathological characteristics of unilateralmaxillary sinus fungus ball(UMFB) in order to improve the accuracy of clinical diagnosis.Methods A total of 86 patients with unilateral maxillary sinus lesions who underwent nasal endoscopic surgery in Qilu Hospital of Shandong University(Qingdao) from January 2017 to June 2019 were included. Those patients were confirmed UMFB or unilateral chronic maxillary sinusitis(UCMS) by pathology. The characteristics including age, sex, diabetes mellitus or no, CT features of the diseased maxillary sinus and GOSS osteitis score of the posterolateral wall of the maxillary sinus were analyzed, and the differences between the two groups were compared. CT features include: ①intralesional hyperdensity(calcification); ②maxillary sinus full haziness with or without mass effect; ③the irregular lobulated protruding lesion(fuzzy appearance) or smooth. Chi-square, independent sample t test and Mann-Whitney U test were performed. Logistic regression analysis and receiver operating Characteristic(ROC) curve analysis were used to find the best cutoff value for UMFB diagnosis.Results Among the 86 cases of unilateral maxillary sinus lesions, 62 cases were UMFB, which accounted for 72.1%, and 24 cases were UCMS, which accounted for 27.9%. UMFB usually occurs in middle-aged and elderly patients, and there are more females than males. There was no statistical difference between the two groups with or without diabetes. In terms of CT characteristics of paranasal sinuses, intergroup comparison and binary Logistic regression analysis, intralesional hyperdensity, maxillary sinus full haziness with mass effect, the irregular lobulated protruding lesion(fuzzy appearance) were significant predictors of MFB(all P < 0.05). The score of osteitis in UMFB was significantly higher than that in UCMS(P < 0.001). ROC curve analysis showed that when the cutoff value was more than 3.5(the area under the curve was 0.824), the corresponding sensitivity and specificity were 0.516 and 0.958, respectively.Conclusion The age, gender, CT characteristics and maxillary sinus osteitis score can distinguish UMFB from unilateral maxillary sinus chronic inflammation, and improve the accuracy of clinical diagnosis.
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Key words:
- maxillary sinus /
- sinusitis /
- fungus ball
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表 1 UMFB组与UCMS组上颌窦CT特征比较
指标 UMFB (62例) UCMS (24例) P 高密度影或钙化 44 1 < 0.001 充满上颌窦但未凸入中鼻道 6 6 0.066 充满上颌窦且凸入中鼻道 28 4 0.024 表面不平凸起 22 2 0.012 表面光滑凸起 6 12 < 0.001 GOSS骨炎评分 4[3；4] 2[0.25；3.0] < 0.001 
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表 2 各项预诊断UMFB指标二元Logistic回归分析结果
预测诊断指标 P OR 95%CI 高密度影或钙化 0.008 71.119 3.038~1665.134 表面不平凸起 0.014 25.357 1.908~337.079 充满上颌窦且凸入中鼻道 0.028 10.154 1.277~80.716 骨炎评分 0.005 7.499 1.824~30.836
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