儿童慢性鼻窦炎合并腺样体肥大菌谱及预后相关因素分析

Analysis of bacterial spectrum and related factors in children with chronic rhinosinusitis and adenoid hypertrophy

摘要:

目的 分析慢性鼻窦炎（CRS）合并腺样体肥大患儿腺样体表面及鼻腔内细菌谱，比较腺样体手术对CRS的临床疗效及相关因素分析。方法 收集2017年10月—2019年10月就诊于北京儿童医院耳鼻咽喉科的30例CRS合并腺样体肥大患儿的相关临床资料，其中男22例，女8例。所有患儿均行腺样体和/或扁桃体切除术，术中采集腺样体表面及鼻腔分泌物，采用16S rRNA方法对细菌谱进行分析。并分别于术后3、6、12个月对患儿进行随访，通过术前和术后上呼吸道感染频次、各项鼻部主观评分变化，分析腺样体手术对患儿CRS症状改善的有效性，探讨腺样体切除术对CRS患儿预后的影响因素。结果 30例患儿腺样体和鼻腔内细菌检出率为100%。患儿鼻腔表面的主要细菌为卡拉莫氏菌、流感嗜血杆菌、肺炎链球菌、金黄色葡萄球菌。腺样体表面主要细菌为肺炎链球菌、流感嗜血杆菌、具核酸杆菌、卡拉莫氏菌。腺样体切除术3个月后所有患儿鼻部主观症状除喷嚏外，评分均明显降低（P<0.01），随访至12个月，上呼吸道感染次数明显减少（P<0.01）。术后12个月CRS完全控制率63.3%（19/30），部分控制36.7%（11/30）。结论 腺样体切除术可以明显改善CRS患儿的临床症状，是治疗儿童CRS的有效治疗手段。由于样本量有限，相关数据显示环境因素、细菌谱等CRS致病因素对腺样体术后的患儿预后均没有明确影响。

Abstract:

Objective To analyze the bacterial spectrum of adenoid surface and nasal cavity in children with chronic rhinosinusitis (CRS) and adenoid hypertrophy, and to observe the clinical effect and the related factors of adenoidectomy on CRS. Methods Clinical data of 30 children suffering from CRS complicated with adenoid hypertrophy hospitalized in our department between Oct 2017 and Oct 2019 were collected. Of them, 22 were male and 8 were female. All children underwent adenoidectomy and/or tonsillectomy. The secretion samples from the surface of adenoid and nasal cavity were collected during operation, and the bacterial spectrum was analyzed by 16S rRNA method. The patients were followed up at 3, 6 and 12 months after operation. The effect of adenoidectomy on the improvement of CRS symptoms was analyzed through the changes of upper respiratory tract infection frequency and nasal subjective scores before and after operation, and the influencing factors of adenoidectomy on the prognosis of CRS were discussed. Results The detection rates of bacteria in adenoid and nasal cavity were both 100% by 16S-RNA method. The main bacteria in the nasal cavity were Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae and Staphylococcus aureus. The main bacteria on the surface of adenoid were Streptococcus pneumoniae, Haemophilus influenzae, Fusobacterium nucleatum and Moraxella catarrhalis. Three months after adenoidectomy, the scores of subjective nasal symptoms except sneezing in all the children were significantly decreased (P<0.01). Follow-up of 12 months revealed that the upper respiratory tract infection frequency was significantly reduced (P<0.01) with a complete CRS control rate of 63.3% (19/30) and a partial control rate of 36.7% (11/30). Conclusions Adenoidectomy is an effective treatment for pediatric CRS as it can significantly improve the clinical symptoms of CRS in children. Due to the limited sample size, the relevant data show that environmental factors, bacterial spectrum and other pathogenic factors have no clear impact on the prognosis of pediatric CRS after adenoidectomy.