【摘要】：目的：社區(qū)獲得性肺炎（community-acquired pneumonia,CAP）在世界范圍內(nèi)是一種常見的感染性疾病，具有較高的發(fā)病率和病死率。目前國內(nèi)外研究顯示，肺炎鏈球菌（Streptococcus pneumoniae,SP）仍是CAP最主要的病原體。痰標(biāo)本采集方便，是最常用的下呼吸道病原學(xué)檢測標(biāo)本，但痰培養(yǎng)肺炎鏈球菌陽性率并不高。本研究通過對住院的成人社區(qū)獲得性肺炎患者行痰細(xì)菌培養(yǎng)，肺炎鏈球菌混入痰中培養(yǎng)，肺炎鏈球菌與痰中分離的草綠色鏈球菌(Streptococcus viridans,SV)混合后培養(yǎng)，探討痰培養(yǎng)肺炎鏈球菌陽性率低的原因。 方法：1．收集我院2011年7月-2012年3月住院的成人CAP患者，采集痰標(biāo)本行細(xì)菌培養(yǎng)及鑒定，發(fā)熱≥38.5℃行靜脈血培養(yǎng)。 2．將肺炎鏈球菌與患者合格痰標(biāo)本混勻后行半定量培養(yǎng)。實(shí)驗(yàn)組將5個(gè)濃度梯度的肺炎鏈球菌與15例CAP患者痰標(biāo)本混勻，接種于血平板上行半定量培養(yǎng)，對照組用同等濃度的純肺炎鏈球菌菌懸液接種于血平板上行半定量培養(yǎng)，比較兩種培養(yǎng)結(jié)果肺炎鏈球菌生長是否有差異。 3．將肺炎鏈球菌與痰中分離的草綠色鏈球菌混合后行半定量培養(yǎng)：實(shí)驗(yàn)組將肺炎鏈球菌與痰中分離出的15株草綠色鏈球菌混勻后接種于血平板上行半定量培養(yǎng)，對照組用同等濃度的肺炎鏈球菌菌懸液與生理鹽水混合后接種于血平板行半定量培養(yǎng)，比較兩種培養(yǎng)結(jié)果肺炎鏈球菌生長是否有差異。 結(jié)果:1．54/63例行痰細(xì)菌培養(yǎng)，陽性率20.37%（11/53），共分離出5種病原體，大腸埃希菌3.7%（1/54）、白色念珠菌9.26%（5/54）、肺炎克雷伯桿菌3.7%（2/54）、鮑曼不動(dòng)桿菌桿菌3.7%（2/54），光滑假絲酵母菌1.85%（1/54），肺炎鏈球菌陽性率為0%（0/54）。 2．肺炎鏈球菌濃度10~3、10~4、10~5cfu/ml混痰培養(yǎng)，與混生理鹽水對照組相比，肺炎鏈球菌生長數(shù)量明顯減少（P＜0.05）；當(dāng)肺炎鏈球菌濃度為10~2cfu/ml時(shí)，混痰后肺炎鏈球菌生長無明顯減少（P=0.535）。 3．肺炎鏈球菌與A組草綠鏈球菌（SV濃度10~8cfu/ml）混合后倍比稀釋培養(yǎng)結(jié)果：與純肺炎鏈球菌菌懸液的對照組相比，草綠色鏈球菌濃度為10~7cfu/ml與肺炎鏈球菌濃度10~6cfu/ml、草綠色鏈球菌10~5cfu/ml與肺炎鏈球菌10~4cfu/ml混合培養(yǎng)后，肺炎鏈球菌生長數(shù)量明顯減少（P＜0.05），，草綠色鏈球菌濃度10~6與肺炎鏈球菌濃度10~5混合培養(yǎng)后，肺炎鏈球菌生長明顯減少，但差異無統(tǒng)計(jì)學(xué)意義（P=0.241）；肺炎鏈球菌與B組草綠鏈球菌（SV濃度10~7cfu/ml）混合后倍比稀釋培養(yǎng)結(jié)果：草綠色鏈球（濃度為10~6、10~5、10~4、10~3、10~2）與同等濃度的肺炎鏈球菌混合培養(yǎng)后（10~6、10~5、10~4、10~3、10~2），與對照組相比肺炎鏈球菌生長數(shù)量無明顯改變（P＞0.05）；肺炎鏈球菌與C組草綠鏈球菌（SV濃度10~6cfu/ml）混合倍比稀釋培養(yǎng)結(jié)果：草綠色鏈球菌（濃度為10~5、10~4、10~3、10~2、10~1），分別與肺炎鏈球菌（濃度為10~6、10~5、10~4、10~3、10~2）混合培養(yǎng)后肺炎鏈球菌生長數(shù)量無明顯改變（P＞0.05）。 結(jié)論： 本研究顯示草綠色鏈球菌可能對肺炎鏈球菌的生長有抑制作用，這可能是導(dǎo)致社區(qū)獲得性肺炎患者痰培養(yǎng)肺炎鏈球菌陽性率低的原因之一。
[Abstract]:Objective: Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality in the world. At present, studies at home and abroad show that Streptococcus pneumoniae (SP) is still the main pathogen of CAP. In this study, the sputum culture of adult community-acquired pneumonia patients was studied by sputum bacterial culture, pneumococcus mixed with sputum culture, Pneumonia Streptococcus viridans (SV) isolated from sputum mixed with Streptococcus pneumoniae. The positive rate of Streptococcus is low.
Methods: 1. Collect the adult patients with CAP hospitalized in our hospital from July 2011 to March 2012, collect sputum samples for bacterial culture and identification, fever (> 38.5 C) venous blood culture.
2. Streptococcus pneumoniae were mixed with qualified sputum specimens and then semi-quantitatively cultured. Five concentration gradients of Streptococcus pneumoniae were mixed with 15 CAP sputum specimens in the experimental group and inoculated on the blood plate for semi-quantitatively cultured. The control group was inoculated with the same concentration of pure Streptococcus pneumoniae suspension on the blood plate for semi-quantitatively cultured. The results showed that there were differences in the growth of Streptococcus pneumoniae.
3. Mixing Streptococcus pneumoniae with Streptococcus viridis isolated from sputum for semi-quantitative culture: 15 strains of Streptococcus viridis isolated from sputum and Streptococcus pneumoniae were inoculated on the blood plate for semi-quantitative culture, while the control group was inoculated on the blood level with the same concentration of Streptococcus pneumoniae suspension mixed with physiological saline. Semi quantitative culture was used to compare the growth of Streptococcus pneumoniae in two cultures.
Results: 1.54/63 cases of sputum bacterial culture, the positive rate was 20.37% (11/53), a total of 5 pathogens were isolated, Escherichia coli 3.7% (1/54), Candida albicans 9.26% (5/54), Klebsiella pneumoniae 3.7% (2/54), Acinetobacter baumannii 3.7% (2/54), Candida smooth 1.85% (1/54), Streptococcus pneumoniae 0% (0/54).
2. The growth of Streptococcus pneumoniae in the mixed sputum culture with the concentration of 10~3,10~4,10~5 cfu/ml was significantly lower than that in the mixed saline control group (P < 0.05). When the concentration of Streptococcus pneumoniae was 10~2 cfu/ml, the growth of Streptococcus pneumoniae did not decrease significantly (P = 0.535).
3. Pneumococcus mixed with group A Streptococcus grass green (SV concentration 10-8 cfu/ml) dilution culture results: compared with the control group of pure Streptococcus pneumoniae suspension, the concentration of Streptococcus grass green is 10-7 cfu/ml and Streptococcus pneumoniae 10-6 cfu/ml, Streptococcus grass 10-5 cfu/ml and Streptococcus pneumoniae 10-4 cfu/ml mixed culture, Streptococcus pneumoniae pneumoniae pneumoniae pneumoniae Pneumoni The growth of Streptococcus pneumoniae decreased significantly (P After mixed culture of 10~6,10~5,10~4,10~3,10~2 with the same concentration of Streptococcus pneumoniae (10~6,10~5,10~4,10~3,10~2), the growth quantity of Streptococcus pneumoniae had no significant change compared with the control group (P > 0.05); the mixed dilution culture of Streptococcus pneumoniae and Streptococcus grass green (SV concentration 10~6 cfu/ml) showed that Streptococcus grass (concentration 10~6 cfu/ml) had no significant change. There was no significant change in the growth of S. pneumoniae after mixed culture with S. pneumoniae at concentrations of 10~6, 10~5, 10~4, 10~3, 10~2 (P > 0.05).
Conclusion:
This study suggests that Streptococcus viride may inhibit the growth of Streptococcus pneumoniae, which may be one of the reasons for the low positive rate of Streptococcus pneumoniae cultured in sputum from patients with community acquired pneumonia.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R563.1

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