中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2010年
1期
19-23
,共5页
熊高云%陈海红%汪审清%谢晓兴%林炜%沈强
熊高雲%陳海紅%汪審清%謝曉興%林煒%瀋彊
웅고운%진해홍%왕심청%사효흥%림위%침강
鼻窦炎%生物膜%显微镜检查%电子%扫描
鼻竇炎%生物膜%顯微鏡檢查%電子%掃描
비두염%생물막%현미경검사%전자%소묘
Sinusitis%Biofilms%Microscopy,electron,scanning
目的 观察慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者鼻内镜下所取钩突、筛窦黏膜标本是否存在细菌生物膜(bacterial biofilms,BF)及其形态学特征,探讨细菌生物膜在CRS发病机制中的作用.方法 对15例CRS伴有鼻息肉患者(试验组)和11例无CRS的鼻骨骨折患者(对照组),在鼻内镜下取钩突、筛窦黏膜(患者均知情同意),扫描电镜电镜下观察,判断标本中是否存在细菌生物膜,并描述其形态学特征.分析试验组与对照组之间的差异,对细菌生物膜的存在与部分临床指标进行相关分析.所有患者均行鼻窦CT检查并行CT评分.计量资料实验数据采用t检验,计数资料采用卡方检验,小样本计数资料用Fisher精确检验.结果 试验组15例患者中发现9例有细菌生物膜;对照组11例患者中发现1例有细菌生物膜,两者比较差异有统计学意义(χ~2=6.949,P<0.01).扫描电镜下,试验组9例患者标本中发现具有水通道、三维结构、基质包被的球形和椭圆形小体等典型特征的细菌生物膜.5例(包括1例对照组)标本发现除具有典型细菌生物膜特征外,还可见到与普通炎症导致的纤毛排列紊乱、缺失不同的纤毛黏聚.试验组细菌生物膜阳性患者的鼻窦CT评分(15.89±6.30)高于细菌生物膜阴性的患者(9.50±5.79),两者比较差异有统计学意义(t=2.14,P<0.05).结论 扫描电镜下可观察到CRS患者鼻黏膜中存在水通道、三维结构、基质包被的球形和椭圓形小体的典型形态特征的细菌生物膜.纤毛黏聚可能是细菌生物膜形成过程中的一种特有表现,是否也可以作为判断细菌生物膜存在的标志,有待于今后进一步研究.细菌生物膜的存在与CRS的发病密切相关,与疾病的严重程度相关,也可能是CRS难治的原因之一.
目的 觀察慢性鼻-鼻竇炎(chronic rhinosinusitis,CRS)患者鼻內鏡下所取鉤突、篩竇黏膜標本是否存在細菌生物膜(bacterial biofilms,BF)及其形態學特徵,探討細菌生物膜在CRS髮病機製中的作用.方法 對15例CRS伴有鼻息肉患者(試驗組)和11例無CRS的鼻骨骨摺患者(對照組),在鼻內鏡下取鉤突、篩竇黏膜(患者均知情同意),掃描電鏡電鏡下觀察,判斷標本中是否存在細菌生物膜,併描述其形態學特徵.分析試驗組與對照組之間的差異,對細菌生物膜的存在與部分臨床指標進行相關分析.所有患者均行鼻竇CT檢查併行CT評分.計量資料實驗數據採用t檢驗,計數資料採用卡方檢驗,小樣本計數資料用Fisher精確檢驗.結果 試驗組15例患者中髮現9例有細菌生物膜;對照組11例患者中髮現1例有細菌生物膜,兩者比較差異有統計學意義(χ~2=6.949,P<0.01).掃描電鏡下,試驗組9例患者標本中髮現具有水通道、三維結構、基質包被的毬形和橢圓形小體等典型特徵的細菌生物膜.5例(包括1例對照組)標本髮現除具有典型細菌生物膜特徵外,還可見到與普通炎癥導緻的纖毛排列紊亂、缺失不同的纖毛黏聚.試驗組細菌生物膜暘性患者的鼻竇CT評分(15.89±6.30)高于細菌生物膜陰性的患者(9.50±5.79),兩者比較差異有統計學意義(t=2.14,P<0.05).結論 掃描電鏡下可觀察到CRS患者鼻黏膜中存在水通道、三維結構、基質包被的毬形和橢圓形小體的典型形態特徵的細菌生物膜.纖毛黏聚可能是細菌生物膜形成過程中的一種特有錶現,是否也可以作為判斷細菌生物膜存在的標誌,有待于今後進一步研究.細菌生物膜的存在與CRS的髮病密切相關,與疾病的嚴重程度相關,也可能是CRS難治的原因之一.
목적 관찰만성비-비두염(chronic rhinosinusitis,CRS)환자비내경하소취구돌、사두점막표본시부존재세균생물막(bacterial biofilms,BF)급기형태학특정,탐토세균생물막재CRS발병궤제중적작용.방법 대15례CRS반유비식육환자(시험조)화11례무CRS적비골골절환자(대조조),재비내경하취구돌、사두점막(환자균지정동의),소묘전경전경하관찰,판단표본중시부존재세균생물막,병묘술기형태학특정.분석시험조여대조조지간적차이,대세균생물막적존재여부분림상지표진행상관분석.소유환자균행비두CT검사병행CT평분.계량자료실험수거채용t검험,계수자료채용잡방검험,소양본계수자료용Fisher정학검험.결과 시험조15례환자중발현9례유세균생물막;대조조11례환자중발현1례유세균생물막,량자비교차이유통계학의의(χ~2=6.949,P<0.01).소묘전경하,시험조9례환자표본중발현구유수통도、삼유결구、기질포피적구형화타원형소체등전형특정적세균생물막.5례(포괄1례대조조)표본발현제구유전형세균생물막특정외,환가견도여보통염증도치적섬모배렬문란、결실불동적섬모점취.시험조세균생물막양성환자적비두CT평분(15.89±6.30)고우세균생물막음성적환자(9.50±5.79),량자비교차이유통계학의의(t=2.14,P<0.05).결론 소묘전경하가관찰도CRS환자비점막중존재수통도、삼유결구、기질포피적구형화타원형소체적전형형태특정적세균생물막.섬모점취가능시세균생물막형성과정중적일충특유표현,시부야가이작위판단세균생물막존재적표지,유대우금후진일보연구.세균생물막적존재여CRS적발병밀절상관,여질병적엄중정도상관,야가능시CRS난치적원인지일.
Objective To determine the presence and the morphological features of bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis (CRS) compared with control patients without CRS by scanning electron microscopy (SEM), and to evaluate the role of biofilm on the pathogenisis of CRS. Methods Fifteen patients with CRS undergoing endoscopic sinus surgery and 11 control patients with fracture of nasal bone were enrolled in this study. Clinical information was recorded from each patient. All patients underwent a thorough otolaryngological examination, preoperative paranasal sinus computerized tomography (CT) scanning which were evaluated according to the Lund-Mckay CT scoring system. All the samples including ancinate process, ethmoid mucosa from CRS group and uncinate process, ethmoid bulls from control group were prepared using standard methods for SEM. The presence of bacterial biofilms on the samples of two groups was observed by SEM. Statistical analysis was performed using SPSS 13.0. Continuous data was analyzed by Student t test and dichotomous data was analyzed by χ~2 or Fisher exact test. P was considered to be significant at a level of 0.05. Results Nine (60.0% )of the 15 patients were found to have evidence of biofilms. In control group, only 1 (9.1%) of 11 patients had biofilm. The difference was statistical significant(χ~2=6.949 ,P<0. 01 ). All controls except one had healthy appearing cilia and goblet cells without biofilms. All the 16 CRS patients showed aberrant findings of the mueosal surface with variation in degrees of severity from disarrayed cilia to complete absence of cilia and goblet cells. Among them the typical morphologic feature such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in 9 cases. Five samples including one case from control showed cilia aggregation. The preoperative CT scores of the CRS patients with biofilms (n=9) were significantly higher than those without biofilms (n=6,t=2.14,P<0.05 ). Conclusions The typical morphologic feature of BF such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in sinus mucosa of patients with CRS by the SEM. The positive rate of bacterial biofilms in CRS group was significantly higher compared to control group, which indicated bacterial biofilms might play an important role in the pathogenesis of CRS. Besides the typical bacterial biofilm features, cilia aggregation was found in five cases of CRS patients. We consider cilia aggregation can be regarded as one morphologic feature of bacterial biofilm in nasal mueosa, which needs further study. The presence of bacterial biofilms in CRS patients is associated with paranasal CT scores, which indicates that bacterial biofilm is correlated with the severity of CRS.
