应用糖皮质激素进行鼻腔冲洗对慢性鼻窦炎患者鼻腔菌群多样性和生物膜的影响

Effects of nasal irrigation with glucocorticoid on nasal flora diversity and biofilm in patients with chronic rhinosinusitis

目的分析应用糖皮质激素进行鼻腔冲洗对慢性鼻窦炎(CRS)患者鼻腔菌群多样性及生物膜的影响。方法将2018年1月至2018年6月于我院治疗的40例慢性鼻窦炎患者随机分成两组,每组各20例,一组给予0.9%氯化钠注射液进行鼻腔冲洗(NS组),另一组给予0.9%氯化钠注射液及布地奈德进行鼻腔冲洗(NS+BUD组),对两组患者治疗前后的菌群结构差异、多样性及细菌生物膜生成情况进行比较。结果治疗前两组患者菌群多样性指标(Chao1指数、Ace指数、Simpson指数及Shannon指数)比较,差异均无统计学意义(均P>0.05),治疗后两组患者的Chao1指数、Ace指数及Shannon指数均明显下降(均P<0.05),且NS+BUD组患者明显低于NS组(t=3.130,3.867,2.587;均P<0.05),而Simpson指数较前明显升高,且NS+BUD组明显高于NS组(t=2.095,P=0.043)。治疗后两组患者组内鼻腔粘膜菌群群落结构发生明显变化,组间部分菌群群落重叠,但仍有明显差异。且治疗后两组患者细菌生物膜的定性及定量分析均较前下降,但NS组患者细菌生物膜的定性及定量分析均明显高于NS+BUD组(均P<0.05)。结论应用糖皮质激素对慢性鼻窦炎患者进行鼻腔冲洗可降低患者鼻腔微生物多样性,减少菌群的异常增殖,降低主要致病菌的生物膜表达,提高临床疗效。

Objective To analyze the effects of glucocorticoids on nasal flora and biofilm in patients with chronic rhinosinusitis(CRS). Methods Forty patients with CRS who were treated in our hospital from January 2018 to June 2018 were randomly divided into two groups, each group containing 20 patients. One group received nasal irrigation with 0.9% sodium chloride injection while the other group received nasal irrigation with 0.9% sodium chloride injection combined with budesonide(NS+BUD). The differences in bacterial structure, diversity and biofilm formation between the two groups before and after treatment were compared. Results There were no significant differences in the biodiversity-related indicators(Chao1 index, Ace index, Simpson index, and Shannon index) between the two groups before treatment(all P>0.05). After treatment, the Chao1 index, ACE index and Shannon index in both groups significantly decreased(all P<0.05), and those in the NS+BUD group were significantly lower than in the NS group(t=3.130, 3.867, 2.587;all P<0.05), while the Simpson indexes were significantly higher, with that in the NS+BUD group significantly higher than in the NS group(t=2.095, P=0.043). After treatment, the structure of bacterial community in the nasal mucosa in both groups changed significantly, and some of the bacterial communities overlapped, but there were still significant differences between the two groups. The abundance of bacteria in both groups decreased, but the qualitative and quantitative analyses of bacterial biofilm in NS group were significantly higher than those in NS+BUD group(all P<0.05). Conclusion The application of glucocorticoid in nasal irrigation in patients with CRS can reduce the diversity of the microorganisms in nasal cavity, inhibit the abnormal proliferation of the flora, reduce the expression of the biofilm of the main pathogens, and improve the clinical efficacy.