社区获得性肺炎患者的痰对病原检出影响的研究

发布时间：2019-03-30 07:25

【摘要】：目的：社区获得性肺炎（Community-acquired Pneumonia，CAP）是呼吸系统的常见疾病，其发病率和死亡率一直居高不下，严重危害着人们的身体健康。其最主要的病原体是肺炎链球菌。目前我国常用的检测呼吸道感染致病菌的方法主要为痰细菌培养，但是这种方法的阳性率一直不高，使得基于痰细菌培养的诊断标准饱受争议。肺炎链球菌尿抗原检测法又称为免疫层析法（Immunochromatographic test，ICT）,是采用免疫层析法测定肺炎链球菌抗原脂多糖（LPS）。有研究显示，应用肺炎链球菌尿抗原检测法可以明显提高肺炎链球菌的阳性率。本研究通过对54例CAP患者痰细菌培养、肺炎链球菌混入15例患者痰标本后培养以及用ICT来测定54例患者尿标本的结果的比较，来探索CAP患者痰细菌培养时肺炎链球菌阳性率低的原因以及ICT用于快速诊断社区获得性肺炎链球菌感染的临床意义。方法： 1.收集2011年7月～2012年3月大连医科大学附属医院呼吸内科住院的社区获得性肺炎的患者63例，其中54例患者留取了痰标本和尿标本。 2.对临床收集的54例CAP患者行痰细菌培养。 3.用ICT检测临床收集的54例CAP患者的尿标本。 4.将肺炎链球菌与痰标本混匀后行半定量培养。实验组将4个浓度梯度的肺炎链球菌与15例CAP患者痰标本混合后接种于血平板上行半定量培养观察肺炎链球菌生长情况，对照组用同等浓度的肺炎链球菌菌悬液与生理盐水混合后接种于血平板上行半定量培养，比较两种培养结果肺炎链球菌生长是否有差异；将大肠杆菌（Escherichia coli，E.coli）和铜绿假单胞菌（Pseudomonas aeruginosa，P.aeruginosa）按照同样的方法与痰标本混合后行半定量培养，观察两种细菌的生长情况。结果： 1.54例患者痰培养共分离出5种细菌，其中包括白色念珠菌（9.26%）、肺炎克雷伯杆菌（3.71%）、鲍曼不动杆菌（1.85%）、大肠杆菌（1.85%），未培养出肺炎链球菌，其中有1例为鲍曼不动杆菌和白色念珠菌的混合感染，占1.85%。 2.用ICT检测54例标本结果显示，阳性率为5.56%（3/54），48/54同时行ICT和痰培养，其中ICT阳性率为6.25%（3/48），而痰培养未培养出肺炎链球菌，，阳性率为0%，两者比较无明显差异（P＞0.05）。 3.肺炎链球菌与15份痰标本混合培养后，与混生理盐水对照组相比，当肺炎链球菌浓度为10~3～10~5cfu/ml，肺炎链球菌生长数量明显减少（P0.01）；当肺炎链球菌浓度为102cfu/ml时，混痰后肺炎练球菌生长无明显减少。大肠杆菌混入痰液培养后，与混生理盐水组比较，10~2～10~4cfu/ml3个浓度梯度菌落的生长数量无显著改变（P＞0.05）。结论： 1.本研究显示用ICT可能提高肺炎链球菌的检出率，但本组研究ICT阳性率并不高，其临床应用价值有待于进一步研究。 2.54例患者痰标本细菌培养无肺炎链球菌生长。通过将肺炎链球菌混入痰液培养，推断患者的痰液对肺炎链球菌的生长有抑制作用。
[Abstract]:Objective: community acquired pneumonia (Community-acquired Pneumonia,CAP) is a common respiratory disease. The main pathogen is Streptococcus pneumoniae. At present, sputum culture is the main method to detect the pathogenic bacteria of respiratory tract infection in our country, but the positive rate of this method is not high all the time, so the diagnostic standard based on sputum bacterial culture has been controversial. The urine antigen detection of Streptococcus pneumoniae, also known as immune chromatography (Immunochromatographic test,ICT), is the detection of lipopolysaccharide (LPS). Against Streptococcus pneumoniae by immunochromatography. Some studies have shown that the positive rate of Streptococcus pneumoniae can be significantly increased by the detection of streptococcus pneumoniae urine antigen. The results of sputum bacterial culture in 54 patients with CAP, Streptococcus pneumoniae mixed in sputum specimens of 15 patients, and urine samples of 54 patients were compared by ICT. To explore the causes of low positive rate of Streptococcus pneumoniae in sputum culture of CAP patients and the clinical significance of ICT in rapid diagnosis of community acquired Streptococcus pneumoniae infection. Methods: 1. From July 2011 to March 2012, 63 patients with community-acquired pneumonia were collected in the Department of Respiratory Medicine, affiliated Hospital of Dalian Medical University. Sputum samples and urine samples were collected from 54 patients. 2. Sputum bacterial culture was performed in 54 patients with CAP. 3. The urine samples of 54 patients with CAP were detected by ICT. 4. Streptococcus pneumoniae and sputum samples were mixed and cultured semi-quantitatively. In the experimental group, four concentrations of Streptococcus pneumoniae were mixed with 15 sputum samples from CAP patients and then inoculated on the blood plate to observe the growth of Streptococcus pneumoniae in semi-quantitative culture. The control group was mixed with the same concentration of Streptococcus pneumoniae suspension and then inoculated on the blood plate for semi-quantitative culture to compare the difference of the growth of Streptococcus pneumoniae between the two cultures. Escherichia coli (Escherichia coli,E.coli) and Pseudomonas aeruginosa (Pseudomonas aeruginosa,P.aeruginosa) were mixed with sputum in the same way and then cultured semi-quantitatively to observe the growth of the two bacteria. Results: five kinds of bacteria were isolated from sputum culture of 1.54 patients, including Candida albicans (9.26%), Klebsiella pneumoniae (3.71%), Acinetobacter baumannii (1.85%) and Escherichia coli (1.85%). Streptococcus pneumoniae was not cultured, of which 1 case was mixed infection of Acinetobacter baumannii and Candida albicans, accounting for 1.85%. 2. The positive rate of ICT and sputum culture was 5.56% (3 / 54) and 48 / 54 respectively by ICT in 54 samples. The positive rate of ICT was 6.25% (3 / 48), while the positive rate of Streptococcus pneumoniae was 0% in sputum culture. There was no significant difference between the two groups (P > 0.05). 3. After mixed culture of Streptococcus pneumoniae and 15 sputum specimens, the growth of Streptococcus pneumoniae decreased significantly (P0.01) when the concentration of Streptococcus pneumoniae was 10 ~ 3 ~ 10 ~ 5 cm 路ml ~ (- 1) compared with that of the control group (P < 0.01). When the concentration of Streptococcus pneumoniae was 102cfu/ml, there was no significant decrease in the growth of S. pneumoniae after sputum. Compared with the mixed saline group, the number of 10~2~10~4cfu/ml3 colonies with gradient concentration did not change significantly (P > 0.05) after Escherichia coli was mixed into sputum culture. Conclusions: 1. This study shows that ICT may improve the detection rate of Streptococcus pneumoniae, but the positive rate of ICT in this study is not high, and its clinical application value needs to be further studied. There was no growth of Streptococcus pneumoniae in sputum samples of 2.54 patients. By mixing Streptococcus pneumoniae into sputum culture, it can be concluded that the sputum of the patients has an inhibitory effect on the growth of Streptococcus pneumoniae.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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