慢性鼻竇炎患者上頜竇黏膜及中鼻道之細菌學

Bacteriology of Middle Meatus and Maxillary Sinus Mucosa in Patients with Chronic Rhinosinusitis

許天彥(Tien-Yen Hsu) ； 朱繡棟(Sau-Tung Chu) ； 劉博仁(Po-Jen Liu)

《台灣耳鼻喉頭頸外科雜誌》 48卷4期 (2013/12) Pp. 265-271

https://doi.org/10.6286/2013.48.4.265

摘要

背景：細菌感染所引發的慢性鼻竇炎在治療過程中常常因為經驗性抗生素的治療效果不佳，需要更換不同的抗生素接續治療。近年來許多臨床研究證實，一些難以根除的慢性鼻竇炎與鼻竇黏膜持續性的發炎感染以及細菌生物膜形成有顯著相關，而在這治療過程中也可能因此產生抗藥性，因此如果能利用簡單的中鼻道細菌培養來及早得知慢性鼻竇炎患者其鼻竇黏膜上的感染菌種，將有助於更精確的投予適當的抗生素，以縮短慢性鼻竇炎的治療病程。本研究旨在比較慢性鼻竇炎患者中鼻道及上頜竇黏膜之細菌學的相關性。材料及方法：本研究以前瞻性方式，收集2010年4月至2011年6月，因慢性鼻竇炎至本院住院，並接受內視鏡鼻竇手術的患者。共計48名（男27名，女21名），平均年齡為42.1歲（範圍：20歲至74歲），術中採集中鼻道及上頜竇內帶有黏液性膿（mucopus）的黏膜，進行嗜氧及厭氧菌的培養，並分析此兩個部位細菌培養結果的關聯性。結果：48名受試者之中，29名病人（60.4%）中鼻道及上頜竇黏膜的細菌培養結果完全吻合；10名病人（20.8%）此兩個部位培養結果部分吻合；而有9名病人（18.8%）兩個部位培養結果不吻合。若將所有受試者之中鼻道及上頜竇黏膜的優勢菌種的菌株數做分析，則兩處所培養出的各優勢菌種之菌株數分布無顯著差異。結論：慢性鼻竇炎患者上頜竇黏膜上的致病菌與中鼻道黏液所含的菌種吻合程度相當高。藉由收集中鼻道分泌物進行細菌培養，可以大致推測鼻竇炎患者鼻竇黏膜上可能的感染菌種，以協助更精確地使用抗生素，避免抗藥性細菌產生。

關鍵字

慢性鼻竇炎(chronic rhinosinusitis) ； 中鼻道(middle meatus) ； 上頜竇(maxillary sinus) ； 細菌培養(bacterial culture)

並列摘要

OBJECTIVES: Empiric antibiotic therapy for patients with chronic rhinosinusitis often fails. In recent years, recalcitrant chronic rhinosinusitis is most often found associated with persist bacterial infection and formation of biofilm. Empiric antibiotic selection would be more optimal if the bacteria type of sinus mucosa could be predicted using bacterial culture results obtained from the patients' middle meatus. As a result, the antibiotic treatment duration might also be shortened. Our specific aim is to clarify the relationship between the bacterial compositions of middle meatal discharge and maxillary sinus mucopus in patients with chornic rhinosinusitis.METHODS: This prospective study collected data from 48 adult patients with an average age of 42.1 years. These patients were diagnosed as having chronic rhinosinusitis and received endoscopic sinus surgery (ESS) in our hospital from April 2010 to June 2011. Aerobic and anaerobic bacteria cultures were collected during the surgery from the discharges of the middle meatus and ipsilateral maxillary sinus mucosa. The association of bacterial culture results from these two sites were then analyzed.RESULTS: There were 48 patients enrolled in this study. The bacterial type of middle meatus and ipsilateral maxillary sinus mucosal infection was identical in 29 patients (60.4%). Bacterial typing of these two sites revealed similar results for 10 patients (20.8%) and dissimilar results for 9 patients (18.8%). There was no difference in distribution of dominant bacterial numbers between these two sites.CONCLUSIONS: The bacterial types associated with middle meatus discharge have very high similarity with ipsilateral maxillary sinus mucosa in patients with chronic rhinosinusitis. The choice of antibiotic may be more accurate if the probable bacteria type of infected maxillary sinus could be predicted from bacterial culture results simply obtained from the patients' middle meatus discharge.