临床诊疗

儿童肺炎支原体肺炎合并EB病毒感染的临床表现及危险因素分析

:73-77
 
目的 分析儿童肺炎支原体肺炎(MPP)合并EB病毒(EBV)感染的临床表现及危险因素,以期进一步提升疾病预防及治疗有效率。方法 分析2020年4月—2022年4月间于我院进行入院治疗的MPP合并EBV感染患儿基本资料,选择84例进行研究,另选择单一EBV感染患儿作为对照组,对比两组患儿临床表现差异及各项指标,分析合并感染的危险因素。结果 一般资料上,研究组患儿低体质量、免疫力低下、流行病接触史占比均高于对照组,数据差异存在统计学意义(P<0.05);临床表现上,研究组患儿高热、发热时间≥10 d、呼吸困难、胸腔积液、侵犯多肺叶占比及白细胞、淋巴细胞指标均高于对照组,血小板、Hb低于对照组,数据差异存在统计学意义(P<0.05);经多因素分析发现,低体质量、免疫力低下、流行病接触史、高热、发热时间≥10 d、呼吸困难、胸腔积液、侵犯多肺叶、白细胞、血小板、Hb、淋巴细胞是MPP合并EBV感染的重要危险因素(P<0.05)。结论 儿童MPP合并EBV感染临床病症表现明显,且相较于单一EBV感染症状更为严重,医务人员需要根据患儿表现及相关危险因素及时予以准确诊断,对患儿实施针对性有效治疗,提升疾病治疗有效率。
临床诊疗

2018年—2021年广州市花都地区肺炎支原体流行特征分析

:68-72
 
目的 观察广州花都地区新冠疫情发生前后呼吸道肺炎支原体(MP)感染的流行病学特征,分析2018年—2019年(疫情前)和2020年—2021年(疫情后)期间的流行病学特点,为降低本地区的MP感染提供预防医学依据。方法 收集2018年1月—2021年12月于广州市中西医结合医院就诊的呼吸道感染患者51 005例,采用胶体金法检测血Mp- IgM抗体,对疫情前后年度、季节、性别和年龄段MP感染情况进行回顾性分析。结果 51 005例呼吸道感染患者中,MP感染总阳性率12.03%(6 134/5 1005),新冠疫情发生前(2018—2019)阳性率为19.11%(5 161/27 010),高于新冠疫情后(2020—2021)MP阳性率为4.06%(973/23 995)(χ2=2 721.32,P<0.001)。2018年和2019年(疫情前)不同季节MP检出率分别为:春季11.87%和17.76%,夏季13.26%和22.21%,秋季17.93%和24.59%,冬季14.20%和14.47%,以夏秋季阳性率高于春季和冬季;疫情后两年四季MP感染率均低于疫情前(P<0.001),春季和冬季阳性率略高于夏秋季节。4年来呼吸道感染患者中MP感染率男性(13.87%)与女性(14.09%)比较差异无统计学意义。且疫情前(18.91%,19.28%)显著高于疫情后(2.49%,2.69%),同时期不同性别阳性率比较差异无统计学意义。婴幼儿组(0~6岁),学龄儿童组(>6~14岁),青少年组(>14~30岁),中青年组(>30~60岁)及老年组(>60岁)MP阳性检出率分别为20.89%、29.98%、9.29%、5.55%和4.57%,不同年龄组间MP感染率差异有统计学意义(P<0.05),以学龄期儿童多见,其次为婴幼儿。结论 新冠疫情前后4年MP感染流行特点为:新冠疫情前后MP感染无性别差异;学龄期儿童和婴幼儿是高发人群;一年四季均可发病,疫情前两年夏秋季高发,疫情后两年四季发病率均较低且差异变小;新冠疫情下广州花都地区MP感染率显著低于疫情前,2019-nCov防控措施(佩戴口罩等)也减少了MP感染。
论著

苏黄止咳胶囊联合多索茶碱对慢性持续期支气管哮喘的疗效及对肺功能、FeNO的影响

Effect of Suhuang Zhike capsule combined with doxofylline on chronic persistent bronchial asthma,pulmonary function and FeNO

:40-44
 
目的 探讨苏黄止咳胶囊联合多索茶碱对慢性持续期支气管哮喘的疗效及对肺功能、呼出气一氧化氮(FeNO)的影响。方法 选择2020年3月—2022年3月70例慢性持续期支气管哮喘患者,随机分为2组各35例,对照组仅予以多索茶碱治疗,研究组在对照组基础上加服苏黄止咳胶囊治疗。治疗3个月,采用哮喘控制测试(ACT)对患者进行评估,记录哮喘急性加重、急救药物使用情况及急诊入院情况,测定肺功能和呼出FeNO。结果 2组治疗1月的ACT评分比较无统计学意义(P>0.05),治疗2、3个月时研究组的ACT评分高于对照组(P<0.05)。研究组哮喘急性加重次数、急救药物使用次数均少于对照组(P<0.05),而2组急诊入院次数比较差异无统计学意义(P>0.05)。与基线值相比,2组治疗3个月时的肺功能指标无改变(P>0.05)且组间比较差异亦无统计学意义(P>0.05);2组治疗3个月时的FeNO无改变(P>0.05),而研究组的FeNO低于对照组(P<0.05)。结论 苏黄止咳胶囊联合多索茶碱治疗慢性持续期支气管哮喘可降低FeNO,提高哮喘控制水平。
Objective To investigate the effect of Suhuang Zhike capsule combined with doxofylline on chronic persistent bronchial asthma, pulmonary function and exhaled nitric oxide(FeNO).Methods Seventy patients with chronic persistent bronchial asthma from March 2020 to March 2022 were randomly divided into two groups, 35 cases in each group.The control group was only treated with doxofylline, and the study group was treated with Suhuang Zhike capsule additionally.After 3 months of treatment, the patients were evaluated by asthma control test(ACT), the acute exacerbation of asthma was recorded, and the pulmonary function and exhaled FeNO were measured.Results There was no statistical significance in the ACT score of the two groups after one month of treatment(P>0.05).The ACT scores of the study group after two months and three months of treatment were significantly higher than those of the control group(P<0.05).The times of acute exacerbation of asthma and the use of emergency drugs in the study group were less than those in the control group(P<0.05), but there was no significant difference in the number of emergency hospitalizations between the two groups(P>0.05).Compared with the baseline value, there was no significant change in lung function indexes in the two groups after 3 months of treatment(P>0.05).Compared with the baseline value, there was no significant change in FeNO in the two groups after 3 months of treatment(P<0.05), while FeNO in the study group was lower than that in the control group(P<0.05).Conclusions Suhuang Zhike capsule combined with doxofylline in the treatment of chronic persistent bronchial asthma can reduce FeNO and improve the level of asthma control.
论著

中药熏蒸配合穴位按摩的健康管理对稳定期肺肾气虚型慢阻肺的疗效

Efficacy of traditional Chinese medicine fumigation combined with acupoint massage on stable COPD with lung-kidney deficiency

:70-75
 
目的 探讨基于中药熏蒸配合穴位按摩的健康管理对稳定期肺肾气虚型慢阻肺的疗效。方法 选取2020年1月—2021年1月在我院接受治疗的稳定期肺肾气虚型慢阻肺患者120例为研究对象,随机分为对照组和干预组。对照组采用西医常规干预,干预组在此基础上实施为期1年的中药熏蒸配合穴位按摩的健康管理,比较干预前后2组患者肺功能、血氧指标以及生活质量的差异。结果 干预前,2组患者第1秒用力肺活量(FEV1)、第1秒用力肺活量占预计值百分比(FEV1%)、用力肺活量(FVC)、第1秒用力肺活量占用力肺活量的比值(FEV1/FVC%)等指标比较差异无统计学意义(P>0.05),干预后,2组患者的FEV1、FEV1%、FVC、FEV1/FVC%明显上升,且干预组患者优于对照组(P<0.05);实施相关干预前,干预组和对照组患者的血氧指标比较差异无统计学意义(P>0.05),干预后,2组患者的PaO2、和SpO2上升,PaCO2下降,且干预组的变化幅度大于对照组(P<0.05);干预前2组患者在圣乔治问卷(SGRQ)生活质量评分比较差异无统计学意义(P>0.05),干预后2组患者的SGRQ生活质量评分降低,且干预组患者的SGRQ生活质量指标评分更低(P<0.05)。结论 中药熏蒸配合穴位按摩应用于稳定期肺肾气虚型慢阻肺患者中,能够提高患者的肺功能,改善血氧指标,提高患者的生活质量。
Objective To explore the effect of health management based on traditional Chinese medicine fumigation combined with acupoint massage on stable chronic obstructive pulmonary disease(COPD)with lung-kidney deficiency.Methods A total of 120 patients with stable COPD and lung-kidney deficiency who received treatment in our hospital from January 2020 to January 2021 were selected as the study objects and randomly divided into control group and intervention group.The control group received conventional Western medicine intervention,and the intervention group received 1-year traditional Chinese medicine fumigation combined with acupoint massage on the basis of Western management.The differences of lung function,blood oxygen index and quality of life between the two groups were compared before and after intervention.Results Before intervention,there were no significant differences in forced expiratory volume in one second(FEV1),the first second forced vital capacity percentage of expected value(FEV1%),forced vital capacity(FVC),the ratio of the first second forced vital capacity of forced vital capacity(FEV1/FVC%)between the two groups(P>0.05),but after intervention,the FEV1,FEV1%,FVC,FEV1/FVC% of the two groups increased significantly,and those in the intervention group were better(P<0.05).Before the implementation of relevant intervention,there was no difference in blood oxygen index between the two groups(P>0.05).After the intervention,PaO2 and SpO2 of the two groups were significantly increased,while PaCO2 was significantly decreased,and the change in the intervention group was significantly greater(P<0.05).Before intervention,there were no significant differences in the quality of life scores of St George’s Respiratory Questionnaire(SGRQ)between the two groups(P>0.05).After intervention,the scores of SGRQ of the two groups were significantly decreased,and the scores of the intervention group were significantly lower(P<0.05).Conclusions Traditional Chinese medicine fumigation combined with acupoint massage can significantly improve lung function,blood oxygen index and life quality of stable COPD patients with lung-kidney deficiency.
论著

CT征象在预测亚实性肺腺癌结节侵袭风险中的价值

Value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules

:46-51
 
目的 探讨亚实性肺腺癌结节CT征象在预测侵袭风险中的价值。方法 选取经胸部CT检查发现并经病理证实为肺腺癌的亚实性结节共76个病灶,病灶分为侵袭前组与侵袭组2组,分析结节CT征象,行统计学分析,明确亚实性肺腺癌结节侵袭性的预测因素。结果 侵袭前组(包括原位腺癌、微浸润性腺癌)共31例;侵袭组[浸润性腺癌(IAC)]共45例。2组在最大平均直径、结节平均CT值、结节形状、分叶、毛刺、胸膜牵拉征、有无实性成分、肿瘤微血管CT成像征间比较差异有统计学意义(P<0.05),而在空泡征、空气支气管征方面比较差异无统计学意义(P>0.05)。结节最大直径预测浸润性腺癌侵袭性界值为13.63 mm,敏感度、特异度分别为68.9%、96.8%,AUC为0.885;平均CT值预测IAC侵袭性界值为-528 HU,敏感度、特异度分别为84.4%、83.9%,AUC为0.867。回归分析显示病灶最大平均直径(OR=2.015、P=0.01)可以作为浸润性肺腺癌结节的独立预测因子。结论 亚实性肺腺癌结节侵袭前组和侵袭组在最大直径、平均CT值、形状、分叶、毛刺、微血管征存在差异;结节的最大平均直径是IAC的独立预测因子。
Objective To investigate the value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules.Methods A total of 76 subsolid pulmonary adenocarcinoma nodules detected by chest CT and pathologically confirmed were selected,and the lesions were divided into pre-invasion group and invasion group.CT signs of nodules were analyzed and statistical analysis was performed to determine the predictive factors of invasion of subsolid pulmonary adenocarcinoma nodules.Results There were 31 cases in the pre-invasion group(including adenocarcinoma in situ and minimally invasive adenocarcinoma)and 45 cases ininvasion group[invasive adenocarcinoma(IAC)].There were significant differences in maximum mean diameter,mean CT value of nodule,nodule shape,lobule,burr,pleural stretch sign,solid component and microvascular CT imaging signs between the two groups(P<0.05),but there were no significant differences in vacuole sign and air bronchial sign between the two groups(P>0.05).The maximum diameter of nodules predicted the invasion boundary of invasive adenocarcinoma was 13.63 mm,the sensitivity and specificity were 68.9% and 96.8%,respectively,and the AUC was 0.885.The mean CT value predicted the invasive boundary of IAC was -528 HU,the sensitivity and specificity were 84.4% and 83.9%,respectively,and the AUC was 0.867.Regression analysis showed that the maximum mean lesion diameter(OR=2.015,P=0.01)was an independent predictor of infiltrating lung adenocarcinoma nodules.Conclusions There were differences in the maximum diameter,mean CT value,shape,lobed,burr and microvascular signs between the pre-invasion group and the invasion group.The maximum mean diameter of nodules was an independent predictor of IAC.
论著

新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响

Effect of neostigmine antagonizing timing of cisatracurium on residual muscle relaxation and early lung function after laparoscopic radical resection of colorectal cancer

:70-74
 
目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激(TOF)比值将试验组患者分为试验组A(TOF≤0.1)、试验组B(0.10.8)。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组(P<0.01),空白对照组患者TOF比值高于其他组(P<0.01);空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义(P>0.01);试验组A患者肌松恢复指数低于其他组(P<0.01),空白对照组患者肌松恢复指数高于其他组(P<0.01)。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1/FVC比较差异无统计学意义(P>0.05)。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。
Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer.Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects.The patients were randomly divided into a blank control group and an experimental group using a random number table method.Then,combined with the train-of-four(TOF)ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A(TOF≤0.1),experimental group B(0.10.8).The residual muscle relaxation and lung function between groups were compared.Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups(P<0.01),while the TOF ratio of patients in the blank control group was higher than that of other groups(P<0.01).There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit(P>0.01).The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups(P<0.01),while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups(P<0.01).There were no significant differences in force expiratory volume in one second(FEV1),forced Vital capacity(FVC)and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation(P>0.05).Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels.
论著

呼出气一氧化氮测定在指导慢性阻塞性肺疾病急性加重患者使用全身激素的价值

Value of exhaled nitric oxide measurement in guiding the use of systemic glucocorticoid in patients with acute exacerbation of chronic obstructive pulmonary disease

:58-62
 
目的 探析慢性阻塞性肺疾病急性加重(AECOPD)患者在全身糖皮质激素(激素)使用过程中检测呼出气一氧化氮(FeNO)的价值。方法 于2019年1月—2021年12月梅州市人民医院采集病例展开随机对照研究,实施对象为58例AECOPD患者,均检测FeNO水平,根据FeNO水平是否>25 ppb,分组为FeNO高水平组和FeNO低水平组,根据是否接受全身激素治疗分为治疗组和对照组,对照组予以常规治疗,治疗组实行常规+全身激素治疗;检测治疗前后FeNO、肺功能指标水平变化,判定COPD评估测试(CAT)评分,对比组间差异。结果 FeNO高水平组全身激素治疗后(治疗组)FeNO降低(P<0.05),高水平组常规治疗后(对照组)FeNO前后比较差异无统计学意义(P>0.05),低水平组中治疗组和对照组治疗前后FeNO比较差异无统计学意义(P>0.05);FeNO高水平组治疗后第一秒用力呼气容积(FEV1)、第一秒用力呼气量占用力肺活量比值(FEV1/FVC)均升高,且治疗组升高程度较对照组更大(均P<0.05),FeNO低水平组治疗后FEV1、FEV1/FVC均升高(均P<0.05),但治疗组与对照组相比无差异(P>0.05);FeNO高水平组、低水平组治疗后CAT评分较治疗前均下降(均P<0.05),FeNO高水平组下降更明显。结论 AECOPD患者实施FeNO测定,其水平变化在一定程度上可反映气道炎症,并预测激素治疗反应,指导合理有效地应用全身激素,避免出现激素过度使用情况。
Objective To explore the value of detecting exhaled nitric oxide(FeNO)during systemic glucocorticoid use in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A randomized controlled study was conducted from January 2019 to December 2021 at the People's Hospital of Meizhou City. The subjects were 58 AECOPD patients,all of whom were tested for FeNO levels. Based on whether the FeNO levels were>25 ppb,they were divided into a high level FeNO group and a low level FeNO group. They were divided into a treatment group and a control group based on whether they received systemic glucocorticoid therapy. The control group received routine treatment,while the treatment group received routine and systemic glucocorticoid therapy. Changes in FeNO and lung function indicators before and after treatment were detected,COPD assessment test(CAT)scores were determined,and differences between groups were compared. Results After systemic glucocorticoid therapy,the high level group of FeNO showed a decrease in FeNO(P<0. 05),while the high level group showed no statistically significant difference in FeNO before and after routine treatment(P>0. 05). The low level group showed no statistically significant difference in FeNO between the treatment group and the control group before and after treatment(P>0. 05). The first second forced expiratory volume(FEV1)and the ratio of first second forced expiratory volume to forced vital capacity(FEV1/FVC)in the high level group of FeNO significantly increased after treatment,and the degree of increase in the treatment group was greater than that in the control group(all P<0. 05). The FEV1 and FEV1/FVC in low level group of FeNO significantly increased after treatment(all P<0. 05),but the difference between the treatment group and the control group was not significant(P>0. 05). The CAT scores of the high and low levels of FeNO groups decreased after treatment compared to before treatment(all P<0. 05),and the decrease was more significant in the high level FeNO group. Conclusions The implementation of FeNO measurement in AECOPD patients can reflect airway inflammation to a certain extent,predict glucocorticoid treatment response,guide the rational and effective application of systemic glucocorticoid and avoid excessive glucocorticoid use.
论著

非重症监护室护士对住院卧床老年患者肺康复知信行的调查研究

A study of non-ICU nurses'knowledge,attitude and practice about pulmonary rehabilitation in hospitalized bedridden elderly patients

:79-84
 
目的 调查非重症监护室护士对住院卧床老年患者肺康复的知信行现状,探讨其影响因素。方法 采用自行设计的卧床老年患者肺康复知信行现状调查问卷,对广州市第一人民医院的555 名非重症监护室护理人员进行调查。结果 共回收有效问卷513份。调查对象肺康复知信行总分为(76.01±12.27)分,知识维度、态度维度、行为维度得分分别为(14.09±3.25)、(21.89±3.38)、(40.03±9.87)分。多元回归分析显示,主要影响护士对住院老年卧床患者实施肺康复知信行的因素为护龄、是否参加过肺康复相关培训及科室是否已开展肺康复(P<0.05)。结论 非重症监护室护士对卧床老年患者肺康复的态度积极,行为良好,但知识有待提升。建议开展卧床老年人相关肺康复培训,激励护士主动学习肺康复新理念的积极性和主动性,强化理论联系临床实践,从而提高临床护理质量。
Objective To investigate the knowledge,attitude and practice of non-intensive care unit(ICU)nurses about pulmonary rehabilitation of hospitalized bedridden elderly patients,and to explore the influencing factors.Methods A self-designed questionnaire on the status of knowledge,attitude and practice about pulmonary rehabilitation of bedridden elderly patients was used to investigate 555 non-ICU nurses in our hospital.Results A total of 513 valid questionnaires were collected.The total score of pulmonary rehabilitation was(76.01±12.27),and the scores of knowledge,attitude and practice were(14.09±3.25),(21.89±3.38)and(40.03±9.87),respectively.Multiple regression analysis showed that the main factors affecting nurses' knowledge,attitude and practice in implementing pulmonary rehabilitation for hospitalized elderly bedridden patients were nursing age,whether they had participated in training related to pulmonary rehabilitation and whether pulmonary rehabilitation had been carried out in the unit(P<0.05).Conclusions Non-ICU nurses have positive attitudes and good practice toward pulmonary rehabilitation for bedridden elderly patients,but their knowledge needs to be improved.It is recommended that training on pulmonary rehabilitation for the bedridden elderly be carried out to motivate nurses to learn new concepts of pulmonary rehabilitation,strengthen the link between theory and clinical practice,and improve the quality of clinical care.
临床诊疗

老年重症肺炎多药耐药菌感染临床特点及头孢哌酮/舒巴坦联合胸腺肽α1的治疗效果

:105-108
 
目的 对本院老年重症肺炎患者的临床资料进行回顾性分析,为老年重症肺炎多药耐药菌感染的临床诊疗提供参考。方法 回顾性分析本院医院76例老年重症肺炎患者的病例信息,将患者随机分为研究组和对照组,每组38例,研究组患者在对照组基础上(头孢哌酮/舒巴坦)联合胸腺肽α1治疗。研究2组患者的痰液致病菌分布及其临床特点,通过对比2组患者治疗前后免疫功能指标T淋巴细胞CD4+及炎症因子超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)水平变化,对头孢哌酮/舒巴坦联合胸腺肽α1治疗老年重症肺炎的临床效果进行分析。结果 76例老年重症肺炎患者中,共检出143株病原菌,以不动杆菌属为主的革兰氏阴性菌(89株)为主要致病菌株,占比64.3%,革兰氏阳性菌(54株)以葡萄球菌属为主,占比35.7%;排名前3位的主要致病菌为:铜绿假单胞菌(33.6%)、金黄色葡萄球菌(22.4%)和大肠埃希菌(14.7%)。痰液分离出的致病菌出现了普遍的严重耐药性,主要以多药耐药铜绿假单胞菌为主。2组治疗前 T 淋巴细胞CD4+、hs-CRP、IL-6、TNF-α水平对比无差异(P>0.05),治疗后观察组CD4+水平更高,而 CRP、TNF-α、IL-6水平更低,与对照组有差异(P<0.05)。结论 老年重症肺炎多药耐药菌重症肺炎检出病原菌主要以铜绿假单胞菌为主,治疗上联合使用胸腺肽α1,能够有效改善患者的免疫抑制状态、减轻老年患者机体炎症反应,对于提高老年患者临床治疗效果及改善患者预后有着重要的临床意义,值得广泛推广。
论著

强化期抗结核治疗对肺结核患者肠道菌群的影响

Influence of intensive anti-tuberculosis treatment on intestinal flora

:70-75
 
目的 探讨肠道菌群多样性及丰度在抗结核治疗强化期的变化。方法 收集广州市胸科医院20例初治菌阳肺结核患者使用强化方案治疗1周及强化期结束的粪便标本,所有标本进行16S rDNA测序,进行生物信息学分析。结果 强化期结束治疗组的Alpha多样性指标Chao1和observed_otus指数分别为(97.8±28.3)和(97.6±28.2),高于治疗1周组的(81±34.7)和(81±34.7),差异有统计学意义(P=0.04;P=0.038)。基于加权和未加权Unifrac距离的PCoA分析显示两组整体菌群结构无明显差异。在相对丰度较高的菌科中,强化期结束治疗组的拟杆菌科、肠球菌科、肠杆菌科、丹毒菌科、卟啉单胞菌科、双歧杆菌科等相对丰度下降,毛螺菌科、梭杆菌科、普氏菌科、瘤胃球菌科、韦氏菌科等相对丰度增加。通过线性判别分析效应量LEfse分析两组数据,发现在属水平上,厚壁菌门的瘤胃球菌、乳杆菌及放线菌门的柯林氏菌为组间显著差异菌种。结论 强化期治疗结束与治疗1周相比,肠道菌群多样性增加,但肠道菌群结构无明显差异。肠道拟杆菌科丰度减少,毛螺菌科丰度增加。
Objective To investigate the changes in the diversity and abundance of intestinal flora during the intensive period of anti-tuberculosis treatment. Methods Stool specimens from 20 patients with newly treated bacteria-positive pulmonary tuberculosis in Guangzhou Chest Hospital, which were treated with the intensive treatment for 1 week and whole intensive treatment, were collected. All the specimens were subjected to 16S rDNA sequencing and bioinformatics analysis. Results The Alpha diversity index Chao1 and observed_otus index of the treatment group with whole process were (97.8±28.3) and (97.6±28.2) respectively, which were higher than (81±34.7) and (81±34.7) of the 1-week treatment group, which had statistical differences (P=0.04;P=0.038). PCoA analysis based on weighted and unweighted Unifrac distance showed that there was no significant difference in the overall flora community structure between the two groups. Among the bacteria families with higher relative abundance, the relative abundance of Bacteroidaceae,Enterococcaceae,Enterobacteriaceae,Erysipelotrichaceae,Porphyromonadaceae and Bifidobacteriaceae in the treatment group with whole process decreased, the relative abundance content of Lachnodoiraceae,Fusobacteriaceae,Prevotellaceae, Rumincoccaceae, and Veillonellaceae increased. By using linear discriminant analysis effect size (LEfse) to analyze the two sets of data, it was found that at the genus level,Rumincoccaceae of Firmicutes and Lactobacillus;Collinsella of Actinobacteria were significantly different species between the groups. Conclusion Compared with 1 week of treatment, the diversity of intestinal flora increased at the end of intensive treatment, but there was no significant difference in the community structure of intestinal flora. The abundance of intestinal Bacteroidaceae decreased, and the abundance of Lachnodoiraceae increased.
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