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目的 通过电子显微镜观察慢性鼻-鼻窦炎患者手术黏膜样本是否存在细菌生物膜及其形态学特征,分析细菌生物膜形成与临床因素的相关性.方法 实验组获取69例慢性鼻-鼻窦炎患者手术中筛窦黏膜样本,对照组获取15例鼻中隔偏曲患者、10例鼻骨骨折患者钩突黏膜样本,所有样本均行扫描电子显微镜检查.以CRS患者常见的临床表现为调查条目,借鉴鼻窦炎专用量表—鼻腔鼻窦结局测试20的等级描述形式,对患者进行术前临床因素评估.应用SPSS 10.0软件进行统计学分析,细菌生物膜形成与临床因素的相关性分析采用卡方检验.结果 实验组样本发现细菌生物膜的病例49例,阳性率为71.0％(49/69).所有实验组样本均观察到黏膜纤毛不同程度的损伤.对照组样本未发现细菌生物膜,可以观察到黏膜纤毛较浓密,排列整齐.卡方检验结果表明细菌生物膜阴性组与阳性组在性别、疾病分期、病程,以及鼻塞、流涕、鼻涕臭味、头痛、涕血、嗅觉减退等临床症状方面差异无统计学意义.结论 慢性鼻-鼻窦炎患者黏膜可以观察到不同生命周期的细菌生物膜及黏膜纤毛损伤,细菌生物膜参与慢性鼻-鼻窦炎的发病过程.细菌生物膜形成与各临床症状无相关性.

Objective To observe the bacterial biofilm in patients with chronic rhinosinusitis (CRS), and to investigate the possible relationship between biofilm and clinical factors. Methods Sixtynine patients with CRS ( study group), 15 patients with nasal septum deviation and 10 patients with nasal bone fracture (control group) were enrolled in the study. Mucosa specimens of uncinate process or ethmoid near the ostium of the maxillary sinus were obtained during endoscopic sinus surgery. The specimens were subjected to scanning electron microscopy. All patients were evaluated by questionnaire of chnical factors based on sino-nasal outcome test-20. SPSS 10. 0 was used for statistical analysis, and the relationship between bacterial biofilm and clinical factors was evaluated by Chi-square test. Results Bacterial biofilms were found in 49 patients ( 71.0％ ) with CRS. A marked destruction of the epithelium and cilia was observed in all samples of study group. No bacterial biofilm was found in the control group, and scanning electron microscopy showed normal epithelium and cilia in those specimens. Chi-square test showed that bacterial biofilm was not associated with clinical factors (gender, staging, course, nasal obstruction, phlegm, nasal discharge with stinking smell, headache, bloody nasal discharge and olfactory degeneration) in CRS. Conclusions Bacterial biofilms and destruction of the epithelium and cilia can be obscrved in CRS patients, which may be involved in the pathogenesis of CRS, but the formation of bacterial biofilm is not correlated with the clinical factors in CRS.