慢性鼻窦炎患者病原菌分布情况及免疫状态变化研究

Distribution of pathogens and changes of immune status in patients with chronic sinusitis

目的探讨和分析慢性鼻窦炎患者的病原菌分布情况及其免疫状态变化情况。方法选取2015年1月至2016年12月期间医院所收治的100例慢性鼻窦炎患者作为研究组,另选取同期在医院进行体检的100例健康人群作为对照组,分别对慢性鼻窦炎患者的病原菌分布情况及其免疫状态变化情况进行统计、比较和分析。结果 100例慢性鼻窦炎患者共检出病原菌71株,其中革兰阴性菌27株(38.03%),并以产气肠杆菌、肺炎克雷伯杆菌为主;革兰阳性菌42株(59.15%),并以表皮葡萄球菌、金黄色葡萄球菌为主;真菌2株(2.82%)。慢性鼻窦炎患者病原菌中主要革兰阴性菌对头孢唑林、氨苄西林均呈现出较高的耐药性,耐药率均为50%以上,而对亚胺培南则均未呈现出耐药性;主要革兰阳性菌对青霉素、苯唑西林均呈现出较高的耐药性,耐药率均为70%以上,而对万古霉素则均未呈现出耐药性。与对照组相比,研究组患者T淋巴细胞亚群CD3+(55.28±3.35)%,CD4^+(34.01±6.32)%,CD8^+(21.46±3.21)%,CD4^+/CD8^+(1.52±0.21)水平均明显降低,经过统计学处理,差异均具有显著性意义(P<0.05)。结论慢性鼻窦炎患者病原菌分布以革兰阳性菌为主,其次为革兰阴性菌,在选择抗菌药物时应结合病原菌分布及其耐药情况合理使用,且慢性鼻窦炎患者的免疫功能呈现失衡状态,细胞免疫功能出现损伤。

Objective To investigate the distribution of pathogens and changes of immune status in patients with chronic sinusitis. Methods 100 patients with chronic sinusitis from January 2015 to December 2016 in the hospital were included in the study(chronic sinusitis group). 100 healthy subjects were enrolled as the control group during the same period. The distribution of pathogens and the changes of immune status in patients with chronic sinusitis were analyzed. Results 71 strains of pathogens were detected in 100 patients with chronic sinusitis,including 27 strains of gram-negative bacteria(38.03%) mainly consisted of Enterobacter aerogenes and Klebsiella pneumoniae,42 strains of gram-positive bacteria(59.15%) mainly consisted of Staphylococcus epidermidis and Staphylococcus aureus,and 2 strains of fungi(2.82%). In the pathogens from patients with chronic sinusitis,the main gram-negative bacteria showed high resistance against cefazolin,ampicillin. The resistance rates were more than 50%. Nevertheless,those did not display resistance against the imipenem. The main gram-positive bacteria showed high resistance against penicillin,oxacillin,and the resistance rates were more than 70%,Howeverthose did not display resistance against the vancomycin.The levels of T lymphocyte subsets of patients in study group were CD3^+(55.28±3.35)%,CD4^+(34.01±6.32)%,CD8^+(21.46±3.21)%and CD4^+/CD8^+(1.52 ±0.21). There were significantly decreased compared with the control group(P <0.05). Conclusions The pathogen distribution of patients with chronic sinusitis is mainly in gram-positive bacteria,followed by gram-negative bacteria. In the choice of antimicrobial drugs,should be combined with the distribution of pathogens and their rational use of drug resistance.The patients with chronic sinusitis immune function showed imbalance and cell immune function is damaged. The treatment should be accorded to the distribution pathogens and the context of drug resistance of those.