窦口鼻道复合体微生态系需氧菌的初步研究

Aerobes in the microecosystem of ostiomeatal complex

目的 初步研究窦口鼻道复合体微生态系需氧菌分布及临床意义。方法 选择Ⅰ型 (S)与Ⅱ型 (P)慢性鼻窦炎成年患者 40例 ,另设对照组 (N) 2 0例 ,对窦口、鼻道、复合体 3个不同的部位 (共 180个部位 ) ,无菌操作采集标本 ,进行需氧菌培养。采用阳性率、3个部位需氧菌培养相同率 (RSAC)、优势菌等多个指标分析。结果 对照组 60个部位中 ,共有4例 4个部位检出菌 ,病变组 40例 12 0个部位中共检出细菌 5 0株 ,阳性率N为 2 0 %、S为 75 %、P为 70 %;N、S与P组的RSAC分别为 80 %、2 5 %和 3 0 %;优势菌为表皮葡萄球菌、类白喉棒状杆菌、流感嗜血杆菌、产气肠杆菌、金黄色葡萄球菌等。S与P各指标比较差异无显著性意义 (P >0 .0 5 ) ,病变组 (S、P)与对照组相比 ,差异具有非常显著意义 (P <0 .0 1)。结论 提出窦口鼻道复合体微生态一体化的观点 :正常为较洁净的一体化微生态系 ;慢性炎症病变时 ,一体化被破坏 ,呈现多种需氧菌存在。

Objective To investigate the distribution and clinical significance of aerobes in the microecosystem of ostiomeatal complex. Methods Forty adult patients with chronic nasosinusitis were divided into group S (type Ⅰ chronic nasosinusitis) and group P (type Ⅱ chronic nasosinusitis with nasal polyp), and 20 control subjects (group N). Swab specimens were taken aseptically from 3 various sites on each individual and sent for aerobic culture. Positive culture rate, rate of the same aerobic culture from three sites (RSAC), and predominant species were analyzed. Results Aerobes were found in 4 sites of 4 patients in group N, and 50 strains were found in 120 sites of 40 patients in groups S and P. The positive culture rates were 20% (N), 75% (S), and 70% (P) while the RSAC were 80% (N), 25% (S), and 30% (P). The predominant species were Staphylococcus epidermidis , Corynebacterium Diphtheroid , Haemophilus influenzae, Enterobacter aerogenes, Staphylococcus aureus et al. Significant difference between indexes of S and P was not found ( P >0.05), but the difference between indexes of control subjects (N) and patients (S and P) was significant ( P <0.01). Conclusion Ostiomeatal complex is a clean and united microecosystem under normal conditions, but chronic inflammation can break the balance of the microecosystem, resulting in existence of various aerobes and separated different parts.