慢性鼻窦炎伴鼻息肉手术前后鼻腔微生物组学的变化  

The impact of endoscopic sinus surgery on sinonasal microbiome of chronic rhinosinusitis with nasal polyps

作　　者：吴玉彬[1,2] 孙炎 黄振校[1] 黄谦[1] 崔顺九[1] 李云川[1] 马晶影[1] 成雷[2] 曲静[1] 陈函 周兵 WU Yubin;SUN Yan;HUANG Zhenxiao;HUANG Qian;CUI Shunjiu;LI Yunchuan;MA Jingying;Cheng Lei;QU Jing;CHEN Han;ZHOU Bing(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery,Ministry of Education,Beijing,100730,China;Department of Otolaryngology,Beijing Daxing Hospital)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,教育部耳鼻咽喉头颈外科学重点实验室(首都医科大学),北京100730 [2]北京市大兴区人民医院耳鼻咽喉科,北京102600

出　　处：《临床耳鼻咽喉头颈外科杂志》2020年第12期1097-1102,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:81541108);北京市医院管理局“登峰”人才培养计划(No:DFL20150202)。

摘　　要：目的:比较慢性鼻窦炎伴鼻息肉(CRSwNP)患者与健康人群的鼻腔微生物组学差异,前瞻性观察以手术为中心的综合治疗对鼻腔微生物组学的影响。方法:采用病例对照及前瞻性自身对照研究,收集拟行手术治疗的CRSwNP患者的中鼻道分泌物,并进行为期3个月的随访,间隔为1个月,同时募集健康志愿者收集其中鼻道分泌物。以第二代高通量测序法进行鼻腔微生物组学分析,对所有研究对象进行主客观评分,并行相关性分析。结果:(1)实验组术前与对照组的微生物α多样性分析差异无统计学意义,其Shannon指数分别为4.41和3.89;但实验组术后α多样性存在动态变化过程,术后1、2、3个月的Shannon指数分别为2.33、2.89、4.24,呈先下降后上升的变化。β多样性分析实验组术前较对照组蓝细菌门平均相对丰度(MRA)高(P<0.05),术后蓝细菌门MRA下降,至术后3个月时与术前比较差异有统计学意义(P<0.05),并且与对照组接近。(2)鼻腔微生物组与临床伴随因素及预后比较发现,假单胞菌属与Lund-Kennedy评分及是否伴随哮喘呈正相关性(r=0.397,P=0.012;r=0.420,P=0.008);弯曲菌属与SNOT-22评分改善幅度呈负相关性(r=-0.63,P=0.038),肠球菌属与Lund-Kennedy评分改善幅度呈负相关性(r=-0.77,P=0.005)。结论:以手术为中心的综合治疗对鼻腔微生物组重构起重要作用。假单胞菌属可能会加重鼻窦炎以及增加合并哮喘的风险,手术预后可能受弯曲菌属和肠球菌属的影响。Objective:To compare the sinonasal microbiome of patients with chronic rhinosinusitis with nasal polyps(CRSwNP)and healthy subjects,and to prospectively observe the effect of surgery-centered comprehensive treatment on microbiome.Method:A case-control and prospective self-controlled study was conducted,recruiting the CRSwNP patients who were surgically treated,and collecting swab samples from the middle meatus.They were followed up for three months at an interval of one month.And we recruited healthy volunteers’samples as well.All specimens were analyzed by the second-generation high-throughput sequencing,collecting subjective and objective data,and analyzed the relationship between them.Result:(1)There was no significant difference ofαdiversity between the two groups(Shannon index were 4.41 vs.3.89).However,there was a dynamic change of theαdiversity in the CRSwNP group,and the Shannon index for 1,2,3 months follow-up were 2.33,2.89,4.24 respectively,which showed an increase followed a descend.Theβdiversity showed that the MRA of cyanobacteria was higher in the CRSwNP group than the control group before the operation(P<0.05),but significantly decreased(P<0.05)to be close to the control group at 3 months postoperatively.(2)Comparing the microbiome with clinical factors and prognosis,we found that both the Lund-Kennedy scores and the history of asthma were positively correlated with the MRA of pseudomonas(r=0.397,P=0.012;r=0.420,P=0.008).Campylobacter was negatively correlated with improvement of SNOT-22 scores(r=-0.63,P=0.038),and enterococcus was negatively correlated with improvement of Lund-Kennedy scores(r=-0.77,P=0.005).Conclusion:The surgery-centered comprehensive treatment played an important role in the reconstruction of sinonasal microbiome.Pseudomonas may aggravate sinusitis and increase the risk of combined asthma.Campylobacter and enterococcus may affect the prognosis of surgery.

关 键 词：鼻窦炎 鼻息肉 微生物组学 蓝细菌门 假单胞菌属 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]