慢性鼻-鼻窦炎鼻息肉患者细菌生物膜的观察  

Observation of bacterial biofilms in patients with chronic rhinosinusitis

作　　者：尤慧华[1] 诸葛盼[1] 施海明[1] 李栋[1] 杜欢乐[1] 

机构地区：[1]浙江省金华市中心医院耳鼻咽喉头颈外科,321000

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第7期547-551,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：浙江省卫生厅项目（2007A190）;金华市科技局项目（2007-3-032）

摘　　要：目的 观察慢性鼻-鼻窦炎鼻息肉患者手术黏膜组织中细菌生物膜的形态特征,并分析其与临床因素、术后疗效的关系.方法 试验组获取72例慢性鼻-鼻窦炎鼻息肉患者手术中筛窦黏膜组织,对照组获取15例鼻中隔偏曲患者、10例鼻骨骨折患者钩突黏膜组织（患者均知情同意）,所有组织标本均行扫描电镜检查.对两组患者进行术后随访,分别应用Lund-Kennedy鼻内镜检查、慢性鼻窦炎疗效评定标准（1997年,海口）评估患者病情改善程度.采用t检验分析细菌生物膜对术后Lund-Kennedy评分的影响;采用卡方检验分析细菌生物膜与内镜手术疗效的相关性,以P＜0.05为差异有统计学意义.结果 试验组72例慢性鼻-鼻窦炎鼻息肉患者中有3例患者失访,失访率为4.2%.69例慢性鼻-鼻窦炎鼻息肉患者的细菌生物膜阳性率71.0%（49/69）,并且可以观察到黏膜组织纤毛不同程度的损伤.对照组未发现细菌生物膜,可以观察到黏膜纤毛较浓密,排列整齐.卡方检验结果显示,性别、慢性鼻-鼻窦炎鼻息肉类型、病程等因素在试验组细菌生物膜阴性组与阳性组间差异无统计学意义（P值均＞0.05）.细菌生物膜阳性组患者术后6个月和12个月的Lund-Kennedy 评分（4.78 ±1.67;4.55 ±1.61）分别高于细菌生物膜阴性组患者（3.65 ±1.39;3.65 ±1.18）,差异均有统计学意义（t=-2.654,P＜0.01;t=-2.264,P＜0.05）;细菌生物膜阴性组术后6个月和12个月的疗效明显优于细菌生物膜阳性组,差异有统计学意义（x2值分别为18.014、22.063,P值均＜0.001）.结论 慢性鼻.鼻窦炎鼻息肉患者手术黏膜组织中存在细菌生物膜的生命周期不同形态,细菌生物膜的存在与否,与慢性鼻-鼻窦炎鼻息肉的类型、性别、病程无明显相关.细菌生物膜可能对患者术后疗效产生不良的影响.Objective To explore the presence of bacterial biofilms（BF） in patients with CRS and the effect of BF on clinical symptoms and postoperative outcomes.Methods Seventy-two patients with chronic sinusitis were enrolled in this study.The control group included 15 patients with deviation of the nasal septum and 10 patients had a fracture of the nasal bone.Mucosa of the uncinate process or ethmoid near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery.The specimens were subjected to scanning electron microscopy.Patients were followed for 1 year and observed by the LundKennedy endoscopy,and the Haikou standard classification （ESS-1997）.Statistical analysis was performed by t-test or chi-square test Results Three patients were lost to follow-up.The scanning electron microscopy analysis showed bacterial biofilms in 49 of the 69 patients with chronic sinusitis.A marked destruction of the epithelium and cilia was observed in samples positive for bacterial biofilms.No bacterial biofilms were detected in the control group,and scanning electron microscopy showed normal epithelium and cilia in those specimens.There was no significant difference in gender,classification or duration of disease between the BF（-） and BF（ ＋ ） groups.At six months and one year postoperative,the Lund-Kennedy endoscopy scores for CRS patients with BF（4.78 ± 1.67 ;4.55 ± 1.61） were significantly higher than those without BF（3.65 ±1.39;3.65 ±1.18） （t =-2.654,P＜0.01;l =-2.264,P＜0.05）.Based on the Haikou standard classification,there was a significantly difference between patients with BF and those without BF（ x2 = 18.014,22.063 ,P ＜ 0.001,respectively）.Conclusions Different life stages of bacterial biofilms were demonstrated to be present in CRS.Gender,classification or duration of disease did not affect the presence of bacterial biofilms in patients with CRS.There is a correlation between bacterial biofilms and an unfavorable outcome in patients with CRS after ESS.

关 键 词：鼻窦炎 鼻息肉 生物膜 显微镜检查 电子 扫描 随访研究 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]