防控COVID-19期间上呼吸道炎症患者嗅区病原微生物分布与嗅觉障碍的关系  

Analysis of relationship between distribution of pathogenic microorganisms in olfactory cleft and olfactory disorders among patients with upper respiratory inflammation during the prevention and control of COVID-19

作　　者：张丽川[1] 孙海丽 沈悦然 常菲凡 孙敬武 魏永祥 Zhang Lichuan;Sun Haili;Shen Yueran;Chang Feifan;Sun Jingwu;Wei Yongxiang(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Key Laboratory of Upper Airway Dysfunction,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of USTC(Anhui Provincial Hospital),Hefei 230026,China;Department of Otorhinolaryngology Head and Neck Surgery,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京安贞医院耳鼻咽喉头颈外科,北京100029 [2]首都医科大学附属北京安贞医院上气道功能障碍重点研究室,北京100029 [3]中国科学技术大学附属第一医院(安徽省立医院)耳鼻咽喉头颈外科,合肥230026 [4]首都儿科研究所附属儿童医院耳鼻咽喉头颈外科,北京100020

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第6期683-691,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81670903)。

摘　　要：目的探索防控新型冠状病毒病(2019 novel coronavirus disease,COVID-19)期间上呼吸道炎症(upper respiratory inflammation,URI)患者的嗅区病原微生物分布与嗅觉障碍的关系。方法连续性收集2020年9月至2021年3月就诊于北京安贞医院包括急性上呼吸道感染、慢性鼻窦炎(CRS)、变应性鼻炎(AR)在内的URI患者234例,健康成人98名纳入对照组。所有受试者均在鼻内镜下用鼻拭子采集嗅区分泌物,采用多重实时荧光定量聚合酶链反应法对33种/型呼吸道病原微生物进行核酸检测。URI患者均行Sniffin′Sticks嗅觉测试。对URI伴嗅觉障碍患者进行电话随访,随访时间9(8,10)个月[M(Q1,Q3)]。采用SPSS 20.0软件进行统计学分析。结果98名对照组中病原微生物阳性者9名(9.18%),其中鼻病毒1名(1.02%)、副流感病毒3型1名(1.02%)、肠道病毒3名(3.06%)、金黄色葡萄球菌1名(1.02%)、卡他莫拉菌3名(3.06%)。234例URI患者中嗅觉障碍者111例(47.44%)、嗅觉正常者123例(52.56%)。嗅觉障碍组(111例)病原微生物阳性者38例(34.23%),混合感染者4例(3.60%),其中鼻病毒11例(9.91%)、冠状病毒229E 5例(4.50%)、冠状病毒OC43/NL632例(1.80%)、副流感病毒1型3例(2.70%)、肠道病毒2例(1.80%)、乙型流感病毒BV系1例(0.90%)、金黄色葡萄球菌11例(9.91%)、卡他莫拉菌7例(6.31%)、肺炎克雷伯菌1例(0.90%)。嗅觉正常组(123例)病原微生物阳性者18例(14.63%),混合感染者1例(0.81%),其中鼻病毒3例(2.44%)、冠状病毒229E 4例(3.25%)、副流感病毒3型1例(0.81%)、肠道病毒3例(2.44%)、金黄色葡萄球菌3例(2.44%)、卡他莫拉菌4例(3.25%)、肺炎克雷伯菌1例(0.81%)。两组间单因素分析发现,病原微生物检出率、鼻病毒和金黄色葡萄球菌检出率的组间差异均存在统计学意义(P值均<0.05)。副流感病毒1型、金黄色葡萄球菌、鼻病毒检出率分别在急性上呼吸道感染、CRS和AR 3个亚组的嗅觉障碍和嗅觉正常者中存Objective To explore the relationship between pathogens in the olfactory cleft area and olfactory disorders in patients with upper respiratory inflammation(URI)during the prevention and control of 2019 novel coronavirus disease(COVID-19).Methods A total of 234 URI patients including acute upper respiratory infection,chronic rhinosinusitis(CRS),allergic rhinitis(AR)were continuously selected from September 2020 to March 2021 in Beijing Anzhen Hospital and 98 healthy adults were enrolled as controls.The secretions from the olfactory cleft of all subjects were collected with nasal swabs under nasal endoscopy.Multiple real-time fluorescent quantitative polymerase chain reaction detection method was used to detect nucleic acids of 33 types of respiratory pathogenic microorganism.Sniffin′Sticks olfactory test was performed on all patients with URI.URI patients with olfactory dysfunction were followed up for 9(8,10)months(M(Q1,Q3)).SPSS 20.0 software was used for statistical analysis.Results Among the 98 controls,9(9.18%)were positive for pathogenic microorganisms,including 1(1.02%)rhinovirus,1(1.02%)parainfluenza virus type 3,3(3.06%)enterovirus,1(1.02%)staphylococcus aureus and 3(3.06%)Moraxella catarrhalis.Among the 234 URI patients,111(47.44%)had olfactory disorders and 123(52.56%)had normal sense of smell.In the olfactory disorder group(111 cases),38 cases(34.23%)were positive for pathogenic microorganisms,and 4 cases(3.60%)were mixed infection,including 11 cases of rhinovirus(9.91%),5 cases of coronavirus 229E(4.50%),2 cases of coronavirus OC43/NL63(1.80%),3 cases of parainfluenza virus type 1(2.70%),2 cases of enterovirus(1.80%),1 case of influenza B virus type BV(0.90%),11 cases of Staphylococcus aureus(9.91%),7 cases of Moraxella catarrhalis(6.31%),and 1 case of Klebsiella pneumoniae(0.90%).In the normal smell group(123 cases),18 cases(14.63%)were positive for pathogenic microorganisms,and 1 case(0.81%)was mixed infection,including 3 cases of rhinovirus(2.44%),4 cases of coronavirus 229E(3.25%),1 case of Infl

关 键 词：病原微生物 嗅觉 急性上呼吸道感染 慢性鼻窦炎 变应性鼻炎 

分 类 号：R56[医药卫生—呼吸系统]