难治性鼻窦炎的病原菌分布特征、炎症介质及IgE水平分析

Analysis of the pathogen distribution,inflammatory mediators,and IgE levels in refractory sinusitis

目的分析难治性鼻窦炎的病原菌分布特征、相关炎症介质及血清免疫球蛋白E(IgE)水平。方法选择2018年1月-2019年10月本院收治的慢性鼻窦炎伴鼻息肉患者66例,术后随访时间超过半年,依据其临床症状及控制情况分为控制组(n=40)和未控制组(n=26)。选择同期接受鼻中隔偏曲矫正术的30例患者为对照组。采集3组患者术中鼻分泌物作细菌培养,比较分析未控制组患者术中及随访期间感染病原菌的种类及构成。采集未控制组、控制组患者静脉血,分离血清,ELISA法测定炎症介质水平,体外变异原检测系统检测IgE水平,并进行比较分析。结果未控制组、控制组、对照组患者鼻分泌物细菌培养阳性率分别为61.54%(16/26)、65.22%(30/46)和56.67%(17/30),差异无统计学意义(P>0.05)。未控制组感染率较高的前3种细菌依次为金黄色葡萄球菌(占18.75%),铜绿假单胞菌(占18.75%)和产气肠杆菌(12.50%);控制组为凝固酶阴性葡萄球菌(占30.00%),产气肠杆菌(占16.67%)及表皮葡萄球菌和金黄色葡萄糖菌(均占13.33%);对照组为凝固酶阴性葡萄球菌(占41.18%),表皮葡萄球菌(占23.53%)和拥挤棒状杆菌(占11.76%)。随访半年,未控制组患者鼻分泌物细菌培养阳性率为84.62%(22/26),其中金黄色葡萄球菌占31.82%(7/22),肺炎克雷伯杆菌占22.73%(5/22)。对照组革兰阳性菌检出率及病程均高于控制组、未控制组(均P<0.05);未控制组年龄、革兰阴性菌和革兰阴性杆菌检出率、hs-CRP、IL-1β、TNF-α水平均高于控制组和对照组(均P<0.05);未控制组术中与随访过程中感染病原菌分布差异无统计学意义(均P>0.05),血清IgE水平0级、I级率均低于控制组(均P<0.05);其它指标阳性率3组间差异均无统计学意义(均P>0.05)。结论难治性鼻窦炎在疾病发展过程中存在病原菌菌种的改变,以革兰阴性杆菌多见。未控制患者血清hs-CRP、IL-1β、TNF-α、IgE水平增高。可为临床诊疗提供参考。

Objective To analyze the pathogen distribution,inflammatory mediators,and immunoglobulin E(IgE)levels in refractory sinusitis.Methods Subjects were patients with chronic sinusitis and nasal polyps who underwent surgery at this Hospital and who were followed for more than six months from January 2018 to October 2019.Depending on their clinical symptoms and the status of control of sinusitis and nasal polyps,patients were divided into those with controlled sinusitis and nasal polyps(n=40)and those with uncontrolled sinusitis and nasal polyps(n=26).Thirty 30 patients who had deviation of the nasal septum corrected at this Hospital served as the control group.Nasal secretions were collected intraoperatively from the three groups for bacterial culture and the results were compared.The types and composition of pathogenic bacteria isolated during surgery and follow-up in patients with uncontrolled sinusitis and nasal polyps were compared.Venous blood was collected from the two groups and centrifuged to separate serum.The levels of inflammatory mediators were measured using ELISA,and the levels of IgE were detected using a multiple-antigen simultaneous test(MAST).Results Bacteria were detected in 61.54%(16/26)of cultures from patients with uncontrolled sinusitis and nasal polyps,65.22%(30/46)of cultures from patients with controlled sinusitis and nasal polyps,and 56.67%(17/30)of cultures from the control group.The rate of detection did not differ significantly among the three groups(P>0.05).The top three bacteria in patients with uncontrolled sinusitis and nasal polyps were Staphylococcus aureus(18.75%),Pseudomonas aeruginosa(18.75%),and Enterobacter aerogenes(12.50%).The top three bacteria in patients with controlled sinusitis and nasal polyps were coagulase-negative Staphylococci(30.00%),E.aerogenes(16.67%),and S.epidermidis/S.aureus(13.33%).The top three bacteria in the control group were coagulase-negative Staphylococci(41.18%),S.epidermidis(23.53%),and Corynebacterium accolens(11.76%).During the six-month follow-up,84.62%(22/26)of cultures from patients with uncontrolled sinusitis and nasal polyps tested positive for bacteria,which were mainly S.aureus(31.82%,7/22)and K.pneumoniae(22.73%,5/22).Gram-positive bacteria were detected at a higher rate and disease course was more severe in the control group than in patients with controlled sinusitis and nasal polyps and in patients with uncontrolled sinusitis and nasal polyps(P<0.05 for all).Age,the rate of detection of Gram-negative bacteria,and levels of hS-CRP,IL-1β,and TNF-α in patients with uncontrolled sinusitis and nasal polyps were higher those in patients with controlled sinusitis and nasal polyps and the control group(P<0.05 for all).There were no significant differences in the distribution of pathogenic bacteria isolated from patients with uncontrolled sinusitis and nasal polyps during surgery and follow-up(P>0.05).The proportion of patients with uncontrolled sinusitis and nasal polyps with grade 0 or I serum IgE was lower than that in patients with controlled sinusitis and nasal polyps(P<0.05),and levels of other indicators did not differ significantly among the three groups(P>0.05).Conclusion Bacterial species vary in patients with refractory sinusitis over the course of disease development,and infection is mainly caused by Gram-negative bacteria.Moreover,levels of hs-CRP,IL-1β,TNF-α,and IgE are elevated in patients with uncontrolled sinusitis.These findings can provide a reference for clinical treatment.