不同外周血嗜酸粒细胞表型的慢性鼻-鼻窦炎伴鼻息肉的微生物学研究

The microbiology of chronic rhinosinusitis with nasal polyps in different phenotype of peripheral blood eosinophils

目的:观察不同外周血嗜酸粒细胞(PBEOS)表型的慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的微生物学构成特点,探讨机体免疫状态与微生物群落的关系。方法:回顾性分析125例CRSwNP患者和49例健康对照组的临床资料,根据PBEOS比例将CRSwNP患者分为PBEOS正常组和PBEOS升高组。采集中鼻道区域鼻分泌物标本,采用微生物培养的方法进行微生物分离和鉴定,分析组间微生物定植的差异。用SPSS 19.0软件对数据进行统计学分析。结果:PBEOS正常组(0<PBEOS≤5%)61例,PBEOS升高组(PBEOS>5%)64例。其中CRSwNP患者总体微生物培养阳性率为84.4%,以革兰阳性需氧或兼性厌氧菌为主,前3位的分别为凝固酶阴性葡萄球菌、表皮葡萄球菌、棒状杆菌;平均金黄色葡萄球菌培养阳性率为10.4%,表皮葡萄球菌培养阳性率为20.0%。PBEOS升高组较正常组金黄色葡萄球菌的检出率有升高趋势(3.3%、17.2%),表皮葡萄球菌检出率有下降趋势(29.5%、10.9%),同时PBEOS升高组较对照组表皮葡萄球菌的检出率亦有下降趋势(10.9%、30.6%)。结论:不同PBEOS表型CRSwNP,金黄色葡萄球菌和表皮葡萄球菌的分布呈相反趋势,PBEOS升高组金黄色葡萄球菌定植率升高,表皮葡萄球菌定植率降低,PBEOS正常组则相反,同时PBEOS升高组较对照组表皮葡萄球菌的定植率下调。提示金黄色葡萄球菌可能促进嗜酸粒细胞型炎症反应,而表皮葡萄球菌可能促进非嗜酸粒细胞型炎症反应,发挥一定的保护作用。

Objective：To investigate the association between immune status and microbial community in patients with chronic rhinosinusitis with nasal polyps（CRSwNP）in different phenotype of peripheral blood eosinophils（PBEOS）.Method：Retrospective analysis of clinical data of 125 patients with CRSwNP and and 49 control subjects was performed.According to the proportion of peripheral blood eosinophils,the patients with CRSwNP were divided into PBEOS normal group and PBEOS elevated group.The samples of nasal secretions in middle meatus were collected,and then isolated and identified by microbial culture.Differences of microbial colonization rate between the groups were analyzed.SPSS 19.0software was used to analyze the data.Result：There were 61 cases in PBEOS normal group（0PBEOS≤5%）,64 cases in PBEOS elevated group（PBEOS5%）and 49 control subjects.In patient with CRSwNP,the positive rate of microbial culture was 84.4%,and the main microorganisms were Gram-positive Aerobic and facultative anaerobic bacteria.The most common bacteria were coagulase-negative staphylococci,Staphylococcus epidermidis（S.epidermidis）and Corynebacterium.The average positive rate of Staphylococcus aureus（S.aureus）was 10.4%,and S.epidermidis was 20.0%.The positive rate of S.aureus in the elevated group was higher than that in the normal group（17.2%,3.3%）,and the rate of S.epidermidis was lower（10.9%,29.5%）.The positive rate of S.epidermidis in the elevated group was also lower than that in control subjects（10.9%,30.6%）.Conclusion：In different PBEOS phenotypes,the colonization rate of S.aureus and S.epidermidis showed the opposite trend.In contrast to the normal goup,the colonization rate of S.aureus in the elevated group increased,and the rate of S.epidermidis decreased.At the same time,the colonization rate of S.epidermidis decreased in elevate group in contrast to the control subjests.This suggests that S.aureus may promote eosinophilic inflammatory response and S.epidermidis may promote noneosinophilic inflammatory response,which plays protective role.