1050例鼻窦炎病原菌分析  

Analysis of pathogenic microorganism in 1 050 cases with sinusitis

作　　者：黄艳飞[1] 王丽赟[1] 王玫[1] 岳燕[1] 隋文君[1] 袁梁[1] 王向东[2] 鲁辛辛[1] HUANG Yanfei;WANG Liyun;WANG Mei;YUE Yan;SUI Wenjun;YUAN Liang;WANG Xiangdong;LU Xinxin(Department of Laboratory Medicine;Department of Clinical Head attd Neck Surgery, Bering Tongren Hospital, Capital Medical University, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院检验科,北京100730 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《临床检验杂志》2018年第7期545-548,共4页Chinese Journal of Clinical Laboratory Science

基　　金：国家科技重大专项(2017ZX10103004)

摘　　要：目的分析鼻窦炎的病原微生物分布及与鼻窦炎感染类型的关系。方法收集2013—2017年诊治的1 050例鼻窦炎患者经鼻内窥镜手术所取的窦腔内容物标本,行直接涂片镜检、普通细菌培养、真菌培养、厌氧菌培养和质谱仪菌种鉴定。统计分析急性和慢性鼻窦炎病原菌分布差异。结果 1 050例鼻窦炎患者分为急性鼻窦炎164例、慢性鼻窦炎384例和真菌性鼻窦炎502例。细菌直接涂片和培养结果一致。经培养鉴定共检出1 283株病原菌,细菌分布为金黄色葡萄球菌177株(13.8%)、铜绿假单胞菌101株(7.9%)、流感嗜血杆菌78株(6.1%)、链球菌属90株(7.0%)、克雷伯菌属54株(4.2%);厌氧菌主要为普雷沃菌14株(1.0%)和具核梭杆菌5株(0.1%);真菌以曲霉200株(15.6%)为主,多伴有细菌的混合感染。急性鼻窦炎多为一种病原菌,慢性鼻窦炎多混合2种以上病原菌。急性和慢性鼻窦炎病原菌中链球菌(χ2=13.819,P<0.01)、肠杆菌科细菌(χ2=9.849,P<0.01)和凝固酶阴性葡萄球菌(χ2=75.407,P<0.01)的分离率差异有统计学意义,其余细菌分离率差异无统计学意义。2013—2016年真菌涂片镜检和培养阳性率分别为66.5%和49.9%;2017年改进真菌培养前处理方法后培养阳性率为87.1%,涂片镜检阳性率为68.8%。结论急性和慢性鼻窦炎致病细菌以金黄色葡萄球菌、铜绿假单胞菌和流感嗜血杆菌为主,厌氧菌多为普雷沃菌和具核梭杆菌;真菌性鼻窦炎以曲霉属为主,同时伴有细菌的混合感染。临床应根据细菌和真菌培养结果合理用药。Objective To analyze the relationship between the spectrum of pathogenic microorganism in sinusitis and the infection types.Methods The specimens of cavity contents of 1 050 sinusitis patients were collected by endoscopic sinus surgery from 2013 to2017 for direct smear microscopy,culture for aerobes,anaerobes and fungi and identified by matrix-assisted laser desorption ionizationtime of flight mass spectrometry. The difference of pathogenic bacteria between acute and chronic sinusitis was analyzed by Chi square test.Results Among the 1 050 sinusitis cases,164 cases were acute bacterial rhinosinusitis,384 cases were chronic rhinosinusitis and502 cases were fungal rhinosinusitis. The results of direct smear were consistent with those of culture of bacteria. A total of 1 283 strains of pathogens were cultured and identified. The top three of bacteria were Staphylococcus aureus（ 177,13.8%）,Pseudomonas aeruginosa（ 101,7.9%） and Haemophilus influenza（ 78,6. 1%）,followed by Streptococcus（ 90,7. 0%） and Klebsiella（ 54,4. 2%）. The main anaerobic bacteria were Prevotella sp.（ 14,1.0%） and Fusobacterium nucleatum（ 5,0. 1%）. Aspergillus was the most common fungus（ 200,15.6%） accompanied by mixed infection with bacteria.In acute sinusitis only one pathogen was mostly found,but chronic sinusitis was usually caused by mixed infections of more than 2 kinds of pathogens. In both acute and chronic sinusitis,the isolated rates of Streptococcus（ χ2= 13.819,P〈0.01）,Enterobacteriaceae bacteria（ χ2= 9.849,P〈0.01） and coagulase negative Staphylococcus（ χ2= 75.407,P〈0.01） showed statistically significant differences,and no significant difference was found in the other bacteria. From2013 to 2016,the total positive rate of fungal smear microscopy was 66.5% and the positive rate of culture was 49.9%. In 2017,following the application of modified pretreatment before culture the positive rate of fungal elevated to 87.1%,and the positive rate of smear microscopy for fungal was 68.8%.Conclusi

关 键 词：鼻窦炎 细菌 金黄色葡萄球菌 铜绿假单胞菌 曲霉属 

分 类 号：R446.5[医药卫生—诊断学]