Correlation between nasal mucosal microbiota diversity and the pathogenesis and prognosis of chronic sinusitis
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摘要: 目的 分析鼻腔黏膜菌群多样性与慢性鼻窦炎发病及预后的相关性。方法 选取在本院收治的80例慢性鼻窦炎(CRS)患者作为研究组，同期本院收治的未合并鼻窦炎症的慢性泪囊炎、鼻中隔偏曲80例患者作为对照组，用鼻拭子在鼻内镜引导下采集受试者鼻分泌标本，行基质辅助激光解吸电离分型时间质谱分析、厌氧细菌培养及普通细菌培养，比较组间鼻腔黏膜菌群差异。对慢性鼻窦炎患者进行为期6个月的随访，再次采集患者鼻腔分泌物检测菌群，根据患者有无复发分为复发组(21例)和未复发组(59例)。比较组间鼻腔菌属多样性。结果 2组术前疣微菌门、蓝藻菌门、绿湾菌门平均相对丰度(MRA)、卟啉单胞菌属、肠球菌属、梭杆菌属、未分类肠杆菌属、红球菌属、罗尔斯通菌属、埃希-志贺菌属、拟杆菌属及链球菌属MRA比较差异无统计学意义(P>0.05)。研究组酸杆菌门、变形菌门、放线菌门MRA、莫拉克斯菌属、狡诈菌属、棒状杆菌属及葡萄球菌属MRA均明显低于对照组(P < 0.05)，梭杆菌门、拟杆菌门、厚壁菌门MRA、奈瑟菌属、假单胞菌属、嗜血杆菌属、乳酸菌属MRA明显高于对照组(P < 0.05)；复发组手术前后鼻腔菌群门、属水平MRA比较差异无统计学意义(P>0.05)；非复发组术后拟杆菌属MRA高于术前(P < 0.05)，棒状杆菌属、放线菌门MRA明显低于术前(P < 0.05)，其他菌属、菌门MRA比较差异无统计学意义(P>0.05)。结论 CRS的发病与鼻腔黏膜菌群失调有关，且术后菌群失调是否改善与患者预后相关性。Abstract: Objective To analyze the correlation between nasal mucosal microbiota diversity and the pathogenesis and prognosis of chronic sinusitis.Methods A total of 80 patients with chronic sinusitis(CRS) admitted to Second Affiliated Hospital of Suzhou University were selected as the research group, and 80 patients with chronic dacryocystitis and nasal septum deviation without sinus inflammation admitted to our hospital during the same period were selected as the control group, nasal secretory specimens were collected under nasal endoscopic guidance by nasal swab, and matrix-assisted laser desorption ionization classification time mass spectrometry, anaerobic bacterial culture and common bacterial culture were performed to compare the differences in nasal mucosal flora between groups. Patients with chronic sinusitis were followed up for 6 months, and nasal secretions were collected again to detect microflora, and the patients were divided into relapse group(21 cases) and non-recurrence group(59 cases) according to whether the patients had relapse. Compare the diversity of nasal microbiota between groups.Results There were no significant differences in mean relative abundance(MRA) between the two groups of preoperative phylum Microbacterium verrucobacterium, Cyanobacterium phylum, Phylum Laubia mlaus, Porphyromonas species, Enterococcus species, Fusobacterium species, Enterobacter species, Enterobacter species, Erythrobacterium species, Ralstonia species, Bacteroides and Streptococcus species(P>0.05). The MRA of Acidobacterium, Proteobacteria, Actinomycetes MRA, Moraxia, Cyanobacterium, Corynebacterium and Staphylococcus were significantly lower than those of the control group(P < 0.05), and the MRA of Escher-Shigella species, Fusobacterium, Bacteroides, Firmicutes, Neisseria, Pseudomonas, Haemophilus and Lactobacillus was significantly higher than that of the control group(P < 0.05), and there was no significant difference in MRA at the level of nasal flora and genus before and after surgery in the relapsed group(P>0.05). The MRA of Bacteroides after surgery was significantly lower in the non-recurrent group than that before surgery(P < 0.05), the MRA of Corynebacterium and Actinomycetes was higher significantly than that of preoperative(P < 0.05), and there was no significant difference in MRA of other species and phylum(P>0.05).Conclusion The onset of CRS is related to nasal mucosal dysbacteria, and whether the dysbacteriosis improves after surgery is correlated with the prognosis of patients.
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Key words:
- chronic sinusitis /
- microbiota diversity /
- nasal mucosa /
- prognosis /
- relapse
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表 1 术前鼻腔菌群门水平鼻腔黏膜定植MRA比较
X±S，% 项目 研究组(n=80) 对照组(n=80) t P 疣微菌门 0.41±0.12 0.45±0.15 1.862 0.064 蓝藻菌门 0.49±0.10 0.46±0.11 1.805 0.073 绿湾菌门 0.51±0.11 0.49±0.10 1.203 0.231 酸杆菌门 0.24±0.06 1.05±0.11 57.820 < 0.001 梭杆菌门 2.61±0.13 0.14±0.08 144.732 < 0.001 拟杆菌门 10.11±1.05 3.13±0.46 54.461 < 0.001 变形菌门 17.85±1.82 19.46±1.95 5.399 < 0.001 放线菌门 10.57±1.08 29.43±2.95 53.697 < 0.001 厚壁菌门 53.47±5.35 42.11±4.23 14.898 < 0.001 
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表 2 术前鼻腔菌群属水平MRA比较
X±S，% 项目 研究组(n=80) 对照组(n=80) t P 卟啉单胞菌属 0.72±0.08 0.71±0.07 0.841 0.401 肠球菌属 0.33±0.08 0.35±0.10 1.397 0.164 梭杆菌属 1.72±0.18 1.68±0.16 1.486 0.139 奈瑟菌属 2.12±0.23 0.35±0.05 67.261 < 0.001 未分类肠杆菌属 1.23±0.13 1.25±0.14 0.936 0.351 红球菌属 1.62±0.17 1.59±0.15 1.184 0.238 罗尔斯通菌属 1.66±0.18 1.61±0.16 1.857 0.065 假单胞菌属 2.19±0.23 1.36±0.14 27.571 < 0.001 嗜血杆菌属 3.65±0.37 0.15±0.07 83.133 < 0.001 埃希-志贺菌属 1.23±0.14 2.78±0.27 45.583 < 0.001 拟杆菌属 3.05±0.31 2.96±0.29 1.896 0.060 莫拉克斯菌属 1.61±0.16 5.45±0.56 58.972 < 0.001 狡诈菌属 0.59±0.06 7.42±0.75 81.193 < 0.001 链球菌属 6.12±0.63 5.94±0.59 1.865 0.064 乳酸菌属 20.13±2.11 4.90±0.51 62.753 < 0.001 棒状杆菌属 5.41±0.56 21.15±2.13 63.923 < 0.001 葡萄球菌属 10.57±1.06 16.35±1.63 26.589 < 0.001
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表 3 复发组CRS患者手术前后鼻腔菌群门水平鼻腔MRA比较
X±S，% 项目 术前 术后 t P 疣微菌门 0.39±0.06 0.41±0.07 0.994 0.326 蓝藻菌门 0.41±0.05 0.44±0.07 1.598 0.118 绿湾菌门 0.48±0.05 0.52±0.08 1.943 0.059 酸杆菌门 0.21±0.05 0.23±0.07 1.065 0.293 梭杆菌门 2.45±0.26 2.56±0.27 1.345 0.186 拟杆菌门 9.78±1.05 9.84±1.09 0.182 0.857 变形菌门 17.21±1.73 17.34±1.75 0.242 0.810 放线菌门 10.42±1.05 10.51±1.12 0.269 0.790 厚壁菌门 52.23±5.24 52.46±5.27 0.142 0.888 卟啉单胞菌属 0.67±0.08 0.71±0.09 1.522 0.136 肠球菌属 0.31±0.06 0.35±0.11 1.463 0.151 梭杆菌属 1.67±0.17 1.72±0.19 0.899 0.374 奈瑟菌属 2.04±0.25 1.98±0.20 0.859 0.396 未分类肠杆菌属 1.17±0.13 1.21±0.15 0.923 0.361 红球菌属 1.59±0.16 1.64±0.18 0.951 0.347 罗尔斯通菌属 1.61±0.16 1.66±0.21 0.868 0.391 假单胞菌属 2.13±0.23 2.17±0.25 0.540 0.592 嗜血杆菌属 3.61±0.37 3.67±0.41 0.498 0.621 埃希-志贺菌属 1.15±0.15 1.22±0.18 1.369 0.179 拟杆菌属 2.89±0.29 2.94±0.31 0.540 0.592 莫拉克斯菌属 1.57±0.16 1.63±0.18 1.142 0.260 狡诈菌属 0.53±0.06 0.57±0.09 1.695 0.098 链球菌属 6.02±0.61 6.11±0.64 0.466 0.643 乳酸菌属 20.16±2.11 20.02±2.05 0.218 0.828 棒状杆菌属 5.11±1.06 5.14±1.09 0.090 0.928 葡萄球菌属 10.38±1.06 10.15±1.02 0.716 0.478
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表 4 非复发组CRS患者手术前后鼻腔菌群门水平鼻腔MRA比较
X±S，% 项目 术前 术后 t P 卟啉单胞菌属 0.74±0.09 0.72±0.07 1.347 0.180 肠球菌属 0.34±0.08 0.37±0.10 1.799 0.075 梭杆菌属 1.74±0.18 1.68±0.17 1.861 0.065 奈瑟菌属 2.15±0.23 2.11±0.21 0.987 0.326 未分类肠杆菌 1.25±0.15 1.20±0.13 1.935 0.055 红球菌属 1.64±0.17 1.61±0.16 0.987 0.326 罗尔斯通菌属 1.67±0.17 1.62±0.16 1.645 0.103 假单胞菌属 2.21±0.25 2.26±0.27 1.044 0.299 嗜血杆菌属 3.68±0.38 3.75±0.41 0.962 0.338 埃希-志贺菌属 1.26±0.17 1.31±0.19 1.506 0.135 拟杆菌属 3.15±0.32 3.02±0.31 2.241 0.027 莫拉克斯菌属 1.63±0.17 1.67±0.18 1.241 0.217 狡诈菌属 0.62±0.08 0.62±0.09 < 0.001 1.000 链球菌属 6.16±0.65 6.21±0.64 0.428 0.670 乳酸菌属 19.98±2.02 20.06±2.11 0.210 0.834 棒状杆菌属 5.51±0.55 5.96±0.61 4.208 < 0.001 葡萄球菌属 10.62±1.08 10.78±1.13 0.786 0.433 疣微菌门 0.42±0.08 0.45±0.09 1.914 0.058 蓝藻菌门 0.51±0.06 0.52±0.07 0.833 0.406 绿湾菌门 0.54±0.06 0.56±0.09 1.276 0.205 酸杆菌门 0.25±0.06 0.26±0.07 0.833 0.406 梭杆菌门 2.65±0.27 2.71±0.31 1.121 0.265 拟杆菌门 10.22±1.08 10.31±1.12 0.444 0.658 变形菌门 18.09±1.84 18.42±1.89 0.961 0.339 放线菌门 10.61±1.08 11.23±1.15 3.019 0.003 厚壁菌门 53.91±5.43 54.12±5.45 0.210 0.834
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