【摘要】：目的： 社區(qū)獲得性肺炎（Community-acquired Pneumonia，CAP）是呼吸系統(tǒng)的常見疾病，其發(fā)病率和死亡率一直居高不下，嚴重危害著人們的身體健康。其最主要的病原體是肺炎鏈球菌。目前我國常用的檢測呼吸道感染致病菌的方法主要為痰細菌培養(yǎng)，但是這種方法的陽性率一直不高，使得基于痰細菌培養(yǎng)的診斷標準飽受爭議。肺炎鏈球菌尿抗原檢測法又稱為免疫層析法（Immunochromatographic test，ICT）,是采用免疫層析法測定肺炎鏈球菌抗原脂多糖（LPS）。有研究顯示，應用肺炎鏈球菌尿抗原檢測法可以明顯提高肺炎鏈球菌的陽性率。本研究通過對54例CAP患者痰細菌培養(yǎng)、肺炎鏈球菌混入15例患者痰標本后培養(yǎng)以及用ICT來測定54例患者尿標本的結(jié)果的比較，來探索CAP患者痰細菌培養(yǎng)時肺炎鏈球菌陽性率低的原因以及ICT用于快速診斷社區(qū)獲得性肺炎鏈球菌感染的臨床意義。 方法： 1.收集2011年7月～2012年3月大連醫(yī)科大學附屬醫(yī)院呼吸內(nèi)科住院的社區(qū)獲得性肺炎的患者63例，其中54例患者留取了痰標本和尿標本。 2.對臨床收集的54例CAP患者行痰細菌培養(yǎng)。 3.用ICT檢測臨床收集的54例CAP患者的尿標本。 4.將肺炎鏈球菌與痰標本混勻后行半定量培養(yǎng)。實驗組將4個濃度梯度的肺炎鏈球菌與15例CAP患者痰標本混合后接種于血平板上行半定量培養(yǎng)觀察肺炎鏈球菌生長情況，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；將大腸桿菌（Escherichia coli，E.coli）和銅綠假單胞菌（Pseudomonas aeruginosa，P.aeruginosa）按照同樣的方法與痰標本混合后行半定量培養(yǎng)，觀察兩種細菌的生長情況。 結(jié)果： 1.54例患者痰培養(yǎng)共分離出5種細菌，其中包括白色念珠菌（9.26%）、肺炎克雷伯桿菌（3.71%）、鮑曼不動桿菌（1.85%）、大腸桿菌（1.85%），未培養(yǎng)出肺炎鏈球菌，其中有1例為鮑曼不動桿菌和白色念珠菌的混合感染，占1.85%。 2.用ICT檢測54例標本結(jié)果顯示，陽性率為5.56%（3/54），48/54同時行ICT和痰培養(yǎng)，其中ICT陽性率為6.25%（3/48），而痰培養(yǎng)未培養(yǎng)出肺炎鏈球菌，，陽性率為0%，兩者比較無明顯差異（P＞0.05）。 3.肺炎鏈球菌與15份痰標本混合培養(yǎng)后，與混生理鹽水對照組相比，當肺炎鏈球菌濃度為10~3～10~5cfu/ml，肺炎鏈球菌生長數(shù)量明顯減少（P0.01）；當肺炎鏈球菌濃度為102cfu/ml時，混痰后肺炎練球菌生長無明顯減少。大腸桿菌混入痰液培養(yǎng)后，與混生理鹽水組比較，10~2～10~4cfu/ml3個濃度梯度菌落的生長數(shù)量無顯著改變（P＞0.05）。 結(jié)論： 1.本研究顯示用ICT可能提高肺炎鏈球菌的檢出率，但本組研究ICT陽性率并不高，其臨床應用價值有待于進一步研究。 2.54例患者痰標本細菌培養(yǎng)無肺炎鏈球菌生長。通過將肺炎鏈球菌混入痰液培養(yǎng)，推斷患者的痰液對肺炎鏈球菌的生長有抑制作用。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.1

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