慢性鼻-鼻窦炎的细菌生物膜表达

Bacterial biofilm in patients with chronic rhinosinusitis

目的探讨细菌生物膜在慢性鼻-鼻窦炎患者手术黏膜样本的表达。方法获取69例慢性鼻-鼻窦炎患者手术中筛窦黏膜样本为试验组,获取15例鼻中隔偏曲患者、10例鼻骨骨折患者钩突黏膜样本为对照组,所有样本均行扫描电子显微镜检查及细菌培养;Fisher′s精确概率检验分析细菌生物膜与细菌培养的相关性、细菌生物膜与慢性鼻-鼻窦炎的相关性、细菌培养与慢性鼻-鼻窦炎的相关性,Pearson卡方检验分析细菌生物膜与慢性鼻-鼻窦炎临床分型分期的相关性。结果试验组发现细菌生物膜的病例49例,阳性率为71.0%;培养检出细菌的病例共45例,均分离自细菌生物膜阳性病例样本,阳性率为65.2%,均观察到黏膜纤毛不同程度的损伤;对照组未发现细菌生物膜,未培养出细菌,可以观察到黏膜纤毛较浓密,排列整齐;细菌培养与细菌生物膜表达存在相关性(P=0.001),细菌生物膜表达与慢性鼻-鼻窦炎存在相关性(P=0.000),细菌培养阳性与慢性鼻-鼻窦炎存在相关性(P=0.000),细菌生物膜表达与慢性鼻-鼻窦炎临床分型分期不存在相关性(P=0.942)。结论慢性鼻-鼻窦炎患者黏膜可以观察到细菌生物膜存在,细菌生物膜可能参与慢性鼻-鼻窦炎的发病过程;细菌生物膜表达与细菌培养阳性结果相关。

OBJECTIVE To explore the presence of bacterial biofilm in patients with CRS. METHODS Sixty-nine patients with chronic sinusitis were enrolled in the study goup.The control group was 15 patients with deviation of nasal septum and 10 patients with fracture of nasal bone.Mucosa of uncinate process or ethmoid near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery.The specimens were divided into 2 fragments： the first was processed for bacterial cultures,and the second was subjected to scanning electron microscopy.Statistical analysis was performed. RESULTS The scanning electron microscopy analysis showed bacterial biofilms in 49 of the 69 patients with chronic sinusitis.Forty-five isolates of bacteria were found from specimens with bacterial biofilms.The positive rate of bacterial culture in the study group was 65.2%.A marked destruction of the epithelium and cilia was observed in all samples of study group.No bacterial biofilm or bacterium was detected in the control group,and scanning electron microscopy showed normal epithelium and cilia in those specimens.Results of Fisher exact test showed a statistical association between bacterial biofilm and bacterial culture in CRS（P=0.001）,between bacterial biofilm and CRS（P=0.000）,between bacterial culture and CRS（P=0.000）.Result of Pearson Chi-Square showed no statistical association between bacterial biofilm and severity of CRS（P=0.942）. CONCLUSION Bacterial biofilms are demonstrated to be present in CRS and may play a role in the pathogenesis of CRS.Positive result of bacterial culture is correlated with the presence of bacterial biofilm in CRS.