新疆不同民族中耳炎病原菌特点分析

Characteristics of pathogens causing otitis media in patients of different nationalities in Xinjiang

目的探讨新疆地区慢性化脓性中耳炎与中耳胆脂瘤分泌物病原菌分布及其与民族、中耳炎分型等的关系。方法选择2006年2月—2008年4月新疆地区151例不同民族的住院及门诊中耳炎患者进行中耳分泌物微生物培养及药物敏感试验,获取细菌分离率的排序、病原菌种类等。结果本组164耳中,中耳胆脂瘤58耳(35.37%),慢性化脓性中耳炎106耳(64.63%);病原菌分布以金黄色葡萄球菌(37.04%)、变形杆菌属(21.30%)、铜绿假单胞菌(17.59%)、凝固酶阴性葡萄球菌(14.81%)为主。不同民族患者病原菌的检出率有所不同,维吾尔族以金黄色葡萄球菌最多见(40.79%),其次是变形杆菌属(25.00%);汉族各类病原菌均有检出;哈萨克族以金黄色葡萄球菌感染最多(35.30%),变形杆菌属很少(5.88%),未发现真菌感染(0.00%)。金黄色葡萄球菌、变形杆菌属、铜绿假单胞菌、凝固酶阴性葡萄球菌株数在中耳炎分型分布间差异无统计学意义(P>0.05);真菌在中耳胆脂瘤患者中的检出率18.96%明显高于慢性化脓性中耳炎者的0.00%(χ2=20.812,P<0.01);其他病原菌在中耳胆脂瘤中的检出率15.52%明显低于慢性化脓性中耳炎的43.40%(χ2=13.072,P<0.01)。结论新疆不同民族中耳炎病原菌的主次顺序与国内外不同;中耳炎分型不同,病原菌的种类与分布也不同。真菌感染常见于胆脂瘤型中耳炎。

Objective To evaluate the relationship between the pathogen distribution and nationalities as well as classification of chronic suppurative otitis media （CSOM） and cholesteatoma in Xinjiang region. Methods Middle ear secretion were collected from 151 inpatients and outpatients with otitis media, and all samples were performed microbial culture as well as antimicrobial susceptibility testing, the isolation rates and types of microbials were gained and analyzed. Results Among 164 ears, 58（35.37%） and 106（64. 63%）were cholesteatoma and CSOM respectively; the major pathogens were Staphylococcus aureus （37. 04%）, Proteus spp. （21. 30%）, Pseudornonas aeruginosa （17. 59%） and coagulase-negative staphylococci （14. 81%）. The isolation rate of pathogens in different nationalities was varied, the top isolated pathogen from Weiwuer nationality was Staphylococcus aureus （40.79 %）, the next was Proteus spp. （25.00%） ; all kinds of pathogens were isolated from Han nationality; the major patho- gen isolated from Hasake nationality was Staphylococcus aureus （35.30%） ,but only 5.88% Proteus spp. was iso- lated, no fungus was isolated （0. 00%）. The distribution of Staphylococcus aureus, Proteus spp. , Pseudomonas aeruginosa and coagulasemegative staphylococci was not significantly different among different nationalities （P〉 0. 05） ;isolation rate of fungi from patients with cholesteatoma was significantly higher than that from patients with CSOM （18. 96% vs 0. 00%, x2 = 20. 812, P〈0. 01）; isolation rate of other pathogens from patients with chol- esteatoma was significantly lower than that from patients with CSOM （15.52 % vs 43. 40 %, Za = 13. 072, P〈0. 01 ）. Conclusion Isolation rates and species of pathogens, as well as types of otitis media in patients of different nationalities in Xinjiang is different from the other area of China and other countries, fungal infection is commonly found in eholesteatoma.