成人与儿童分泌性中耳炎中耳积液中耳炎差异球菌对比分析

A Comparative Study of Alloiococeus Otitidis in Adults and Children with Chronic Otitis Media with Effusion

邓欣欣;梁耕田;卢岭;刘莉;杨丽萍;金辉;邓欢欢;

1:武汉大学附属同仁医院(武汉市第三医院)耳鼻咽喉科

2:武汉大学人民医院重症监护室

摘要
目的通过比较儿童与成人慢性分泌性中耳炎(SOM)中耳积液中耳炎差异球菌(alloiococeus otitidis)的检出率,探讨耳炎差异球菌对SOM发生、发展的意义。方法在181耳慢性分泌性中耳炎(儿童组111耳,成人组70耳)中耳积液标本中,采用常规细菌培养方法和PCR方法,检测耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌,分别比较成人组和儿童组中耳积液中耳炎差异球菌的检出率。结果采用常规细菌培养,儿童与成人SOM中耳积液中均未培养出耳炎差异球菌、肺炎链球菌、卡他莫拉菌,仅5耳检测出流感嗜血杆菌,其中儿童组4耳,成人组1耳。通过PCR法检测,在儿童组中耳积液中,耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌的检出率分别为42.3%(47/111)、5.4%(6/111)、5.4%(6/111)、3.6%(4/111);成人组分别为25.7%(18/70)、5.7%(4/70)、5.7%(4/70)、0(0/70),耳炎差异球菌在儿童SOM中耳积液中检出率高于成人(P<0.05)。在儿童组,耳炎差异球菌在粘稠积液中的检出率为48.3%(29/60),在稀薄积液中为35.3%(18/51),两者之间差异无统计学意义(P>0.05);在成人组,耳炎差异球菌在粘稠积液中的检出率为58.4%(14/24),在稀薄的积液中为8.7%(4/46),前者高于后者(P<0.05);且儿童组中耳稀薄积液中耳炎差异球菌的检出率高于成人(P<0.05)。结论无论成人或儿童,耳炎差异球菌均可能是SOM的主要致病菌;耳炎差异球菌可能与儿童及成人慢性SOM的发病机制有关,且与儿童慢性SOM相关性更明显。
关键词
分泌性中耳炎;中耳积液;耳炎差异球菌;儿童;成人
基金项目(Foundation):
作者
邓欣欣;梁耕田;卢岭;刘莉;杨丽萍;金辉;邓欢欢;
参考文献

1孔维佳.耳鼻咽喉头颈外科学[M].北京:人民卫生出版社,2010.8~116.

2 Jung H,Lee SK,Cha SH,et al.Current bacteriology of chronic otitis media with effusion:high rate of nosocomial infection and decreased antibiotic sensitivity[J].J Infect,2009,59:308.

3 Khoramrooz SS,Mirsalehian A,Emaneini M,et al.Frequency of alloicoccus otitidis,streptococcus pneumoniae,moraxella catarrhalis and haemophilus influenzae in children with otitis media with effusion(OME)in Iranian patients[J].Auris Nasus Larynx,2012,39:369.

4 Harimaya A,Takada R,Hendolin PH,et al.High incidence of alloiococcus otitidis in children with otitis media,despite treatment with antibiotics[J].Clin Microbiol,2006,44:946.

5 Leskinen K,Hendolin P,Virolainen-Julkunen A,et al.The clinical role of Alloicoccus otitidis in otitis media with effusion[J].Int J Pediatr Otorhinolaryngol,2002,66:41.

6 Leskinen K,Hendolin P,Virolainen-Julkunen A,et al.Alloiococcus otitidis in acute otitis media[J].Int J Pediatr Otorhinolaryngol,2004,68:51.

7 De MMI,Macias AR.Serous otitis media in children:implicationof alloiococcus otitidis[J].Otology&Neurotology,2008,29:526.

8 Kalcioglu MT,Oncel S,Durmaz R,et al.Bacterial etiology of otitis media with effusion:focusing on the high positivity of alloiococcus otitidis[J].New Microbiol,2002,25:31.

9 Harimaya A,Takada R,Himi T,et al.Evidence of local antibody response against Alloiococcus otitidis in the middle ear cavity of children with otitis media[J].FEMS Immunol Med Microbiol,2007,49:41.

10 Emine A,Eren T,Mihriban Y,et al.Concurrent assay for four bacterial species including alloiococcus otitidis in middle ear,nasopharynx and tonsils of children with otitis media with effusion:apreliminary report[J].Clinical and Experimental Otorhinolaryngology,2012,5:81.

11 Guvenc MG,Midilli K,Inci E,et al.Lack of chlamydophila pneumoniae and predominance of alloi ococcus otitidis in middle ear fluids of children with otitis media with effusion[J].Auris Nasus Larynx,2010,37:269.

12 邓欣欣,惠莲,姜学钧.儿童慢性分泌性中耳炎的细菌研究[J].临床耳鼻咽喉头颈外科杂志,2014,28:1457.

13 Kaur R,Adlowitz DG,Casey JR,et al.Simulta neous assay for four bacterial species including alloiococcus otitidis using multiplex-PCR in children with culture negative acute otitis media[J].Pediatr Infect Dis J,2010,29:741.

14 Ashhurst-Smith C,Sharron T,Sharron T,et al.Hall hall,alloiococcus otitidis:an emerging pathogen in otitis media[J].Journal of Infection,2012,64:233.

15 Himi T,Kita H,Mitsuzawa H,et al.Effect of alloiococcus otitidis and three pathogens of otitis media in production of interleukin-12by human monocyte cell line[J].FEMS Immunol Med Microbiol,2000,29:101.

16 Kita H,Himi T,Fujii N,et a1.Interleukin一8secretion of human epithelial and monocytic cell lines induced by middl ear pathogen[J].Microbiol Immunol,2000,44:511.