分泌性中耳炎患儿鼻咽部与中耳腔致病菌分布的相关性研究  

Study of the Correlation between the Distribution of Pathogens in Nasopharyngeal and Middle Ear Cavities in Children with Chronic Secretory Otitis Media

作　　者：宋桂林[1] 李湘胜[1] 彭亚[1] 李琴[1] 柳浩[1] 谢东海[1] 陶维平 姚汉斌 邓晓雯[1] 聂瑾[1] 樊涛[1] 

机构地区：[1]长沙市第四医院耳鼻喉科,湖南长沙410006

出　　处：《医学临床研究》2017年第11期2081-2083,2087,共4页Journal of Clinical Research

基　　金：湖南省医药卫生科研计划课题（B2013-125）

摘　　要：【目的】探讨分泌性中耳炎（secretory otitis media，SOM）患儿鼻咽部分泌物（nasopharyngeal secretion，NPS）及中耳积液（Middle ear fluid，MEF）耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌和草绿色链球菌的分布情况及相关性。【方法】采集SOM患儿MEF及NPS分泌物标本，应用PCR技术，观察上述6种细菌在NPS和MEF中的分布情况并分析其相关性。【结果】①SOM患儿NPS及MEF中，金黄色葡萄球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌的分布均各自呈正相关；其中，金黄色葡萄球菌、肺炎链球菌在NPS与MEF之间分别呈显著正相关，且阳性预测值高，敏感性、特异性强；流感嗜血杆菌、卡他莫拉菌在NPS与MEF之间虽分别呈正相关，但相关性低。②SOM患儿NPS及MEF之间，草绿色链球菌、耳炎差异球菌的分布均无相关性。③s0M患儿NPS中检出率最高的致病菌为流感嗜血杆菌（79．63％），其次为肺炎链球菌（77．78％）、金黄色葡萄球菌（70．37％）；MEF中检出率最高的致病菌为肺炎链球菌（77．93％）及金黄色葡萄球菌（77．93％）。【结论】SOM患儿NPS中，若检出肺炎链球菌或金黄色葡萄球菌，对预测MEF中是否也存在相同细菌感染有一定价值。SOM患儿NPS如未检出肺炎链球菌或卡他莫拉菌，那么中耳感染肺炎链球菌、卡他莫拉菌的概率较低。[Objective]To analyze the distribution of pathogens and its correlation with middle ear fluid （MEF） and nasopharyngeal secretion （NPS） in children with chronic secretory otitis media （SOM）. [Methods]MEF and NPS secretions were collected from SOM children. The pathogen distribution of NPS and MEF were observed by PCR technique for detection of A.otitidis, S.pneumonia, H.influenzae, M.catarrhails, S.aureus, and S.viridans. The correlation was evaluated.[Results] 1）The presence of S. pneumonia or S.aureus in middle earfiuid was significantly positively correlation with the presence of the same species in the nasopharynx （S.pneumoniae, P = 0.000, V= 0.638 ; S.aureus, P = 0.000, V= 0.761）. Higher prevalence（Sensitivity, specificity and positive predictive values）was found for S.pneumonia and S.aureus. H. influenzae or M. catarrhails in middle earfiuid correlated positively with the presence of the same species in the nasopharynx, however, the correlation was low （H.influenzae, P =0.021, V=0.258 M.catarrhails, P 20.000, V=0.459）. 2）. Alloiococcus otitidis and Streptococcus viridans were not significantly associated with MEF and NPS PCR results. 3） The highest prevalence in NPS was found for H. influenzae （ 79.63 % ）, followed by S. aureus （75.93%） and S. pneumonia（75.93%）. The highest prevalence in MEF was found for S. pneumonia（75.93%）and S. aureus （75.93%）. [Conclusion]The results indicate that PCR results from NPS are valuable for prediction of the pathogen presence in MEF in children with SOM.

关 键 词：中耳炎 伴渗出液/微生物学 鼻咽 儿童 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]