经鼻内镜下泪囊鼻腔吻合手术前后结膜囊菌群变化

Changes in conjunctival sac microbiota before and after endoscopic dacryocystorhinostomy

摘要

目的 探讨经鼻内镜下泪囊鼻腔吻合术前后术眼与健侧眼结膜囊菌群的变化规律，为术后内眼手术时机的选择提供理论依据。方法 选取行经鼻内镜下泪囊鼻腔吻合术患者16例(32眼)，并采集受试者双眼结膜囊拭子，所有患者均进行一般细菌培养，随机选取3例患者的双眼结膜囊样本进行16SrRNA测序。结果 细菌培养结果显示，术眼细菌培养阳性率由术前的10/16眼(62.50%)在术后第2天下降至2/16眼(12.50%)(P=0.001)；菌群数从术前的34个在术后第1天下降至20个，第2天下降至2个，并在后续随访期间保持阴性状态。16SrRNA测序结果显示，结膜囊菌群α多样性分析中，Pielou指数的时间主效应具有统计学意义(P=0.031)，β多样性差异无统计学意义。结论 经鼻内镜下泪囊鼻腔吻合术可有效降低术眼结膜囊的菌群丰度，对健侧眼菌群影响较小。术后术眼菌群负荷的下降有助于降低感染风险，为后续内眼手术时机的选择提供了微生物学依据。

Abstract

Objective This study aimed to characterise the temporal changes in the conjunctival sac microbiota of both the operated and contralateral eyes following endoscopic dacryocystorhinostomy (EN-DCR), and to provide microbiological evidence to optimise the timing of subsequent intraocular procedures. Methods This study included 16 patients (32 eyes) who underwent EN-DCR at our institution. Bilateral conjunctival sac swabs were collected from each patient and processed for conventional bacterial culture. In addition, 16SrRNA gene sequencing was conducted on samples obtained from three randomly selected patients. Results In the operated eyes, the rate of positive bacterial cultures declined significantly from 10/16(62.5%) preoperatively to 2/16(12.5%) on postoperative day 2(P=0.001). The number of bacterial species decreased from 34 preoperatively to 20 on postoperative day 1 and to 2 on day 2, and remained sterile throughout the subsequent follow-up period. 16SrRNA gene sequencing revealed significant temporal changes in alpha diversity, as measured by the Pielou index (P=0.031), while β diversity remained statistically unchanged over time. Conclusions EN-DCR leads to a marked reduction in the bacterial evenness within the conjunctival sac of the operated eye, with negligible effect on the contralateral eye. The postoperative decrease in microbial load may mitigate the risk of infection and provides microbiological evidence to guide the timing of subsequent intraocular procedures.

关键词

泪囊鼻腔吻合术 / 结膜囊菌群 / 16SrRNA测序

Key words

Endoscopic dacryocystorhinostomy / Conjunctival sac microbiota / 16SrRNA sequencing

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基金资助

遵义市红花岗区科技计划项目(遵红科合社字〔2021〕14号)