下呼吸道大肠埃希菌感染诊断与痰液半定量培养细菌数量的相关研究

Related Research on E. coli Infection Diagnosis of Lower Respiratory and Bacteria Number in Sputum Semi-quantitative Cultured Sputum

目的探索自然咳出痰标本半定量培养12级法筛检大肠埃希菌的菌量指标。方法每份痰标本均同时涂片和接种。涂片观察标本质量，以白细胞吞噬菌或白细胞浓集区域优势菌为拟分离菌；培养采用半定量12级法，选相对数量大于该菌口咽部平均携带数量的涂片对应菌做鉴定及药敏试验（当地健康人群口咽部G-杆菌的携带概率为33％，平均携带菌量小于0．1，故临床标本G-杆菌量以≥O．1为筛检指标）。查阅2005年6月1日～2011年5月31日住院病人痰内筛检出大肠埃希菌者病历，统计分析首次培养的细菌数量、标本质量与出院时临床诊断的关系。结果大肠埃希菌163株，其首次培养的相对数量0．1的临床诊断率为43．33％，≥O．2的临床诊断率为50．38％；首次培养的标本质量为A＋B级的临床诊断率为55．56％，C级的临床诊断率为38．18％；前者高于后者17．38％，但r=4．89，P〈0．05。结论按规定要求采集自然咳出痰标本，若其半定量12级法培养出涂片拟分离菌对应性大肠埃希菌的相对数量≥O．1时，应做药敏试验并报告医师。

Objective To explore how to screen Escherlchia coti in the natural wough sputum. Methods Smeared and inocula- ted each sputum sample at the same time and observe two things. One was the quality of samples, the other was these bacte- ria phagocytized by white blood cells or the dominant bacteria in the white blood ceils centralized region,which would be iso- lated. The inoculated sputum samples were cultured by ＂semi-quantitative 12 order method＂. Selected the bacteria whose rel- ative amount was more than the oropharyngeal average carrying amount, then did identification and drug sensitivity test. （Local healthy people＇ carrying probability of pharyngeal gram negative bacteria was 33%,and the average carrying bacteria amount was less than 0.1, so the number of clinical specimens of gram negative bacilli, which ≥0.1, was regarded as the screening index）. Searched the patients＇ medical records from June 1st, 2005 to May 31st, 2010, who were screened out Esche- richia coti from their putum. Then analysed the relation between the quantity of bacteria and diagnosis and the relation be- tween quality of sample and diagnosis. Results The amount of Escherichia coli was 163. The clinical diagnosis rate of rela- tive amount （=0.1） was 43.33M ,while that of amount （≥0.2） was 50. 38%. The clinical diagnosis rate of first cultured sample quality （grade A-t-B） was 55.56M ,while that of grade C was 38.18%. The former was higher than 17.38% （k3 = 4.89, P〈0.05）. Conclusion From the approved natural cough sputum,if the relative amount of Escherichia coil,which is cultured by ＂semi-quantitative 12 order method＂,is or more than 0.1 ,do an antibiotic susceptibility test and report the result to the doctor.