菌群失调患儿腹泻标本细菌学及pH值和球杆比变化的临床意义

目的:探讨小儿肠道菌群失调患者新鲜腹泻标本细菌学、pH值和细菌球杆比的变化,寻求肠道菌群失调的快速诊断方法。方法:2004年1月~2005年12月我院门诊及住院患儿因菌群失调(细菌学培养证实)致腹泻共118例为研究对象,对照组为同期保健科健康体检的小儿共80例。均采集新鲜粪便(10min内)进行细菌学普通培养、pH值检测及涂片做革兰染色镜检计数标本中球菌、杆菌比例。结果:①118例菌群失调患儿腹泻标本细菌学普通培养大肠埃希菌消失或减少42例(35.6%),肠道条件致病菌优势生长49例(41.5%),真菌27例(22.9%)。②肠道菌群失调患儿粪便pH值分布在6~8之间,pH值≥7者92例(78.0%);对照组粪便pH值分布在5~6.5之间,pH值≤5.5者68例(85.0%),≥7者无1例,两组标本pH值统计学比较,差异有显著性(χ2=116.52,P(0.005)。③标本涂片镜检细菌球杆比,菌群失调组为3/7~8/2,球菌≥40%者106例(89.8%);对照组标本细菌球杆比1/9~3/7,球菌≥40%者无1例,两组标本细菌球杆比统计学比较,差异有显著性(χ2=154.68,P(0.005)。结论:腹泻患儿新鲜粪便细菌学、pH值和细菌球杆比的变化有助于肠道菌群失调的诊断,以pH值≥7、细菌球杆比大于4/6为标准诊断肠道菌群失调简单、快速、准确、价廉,适合基层医院实验室推广使用。

The change and clinical significance of the bacteriology, pH value and the proportion of cocci and bacilli from infant with intestinal flora maladjustment

Objective:To investigate bacteriology, pH value and the change of cocci and bacilli of infant with intestinal flora maladjustment's fresh lax sample for searching fast diagnostic method.Methods:The investigative object were 118 lax infants for flora maladjustment (approving by bacteriology cultivating) from this hospital's outpatients and inpatients since January 2004 to December 2005.Control group were 80 health infants from health care section office.The pathogenic bacteria were cultivated to examine pH value and account the proportion of cocci and bacilli with patients' fresh dejecta in 10 minutes.Results:①In 118 flora maladjustment infant samples, 42 cases (35.6%) Escherichia coli vanishing or reducing, 49 cases(35.6%)enteric conditional pathogenic germs preponderant developed and 27 strains (22.9%) epiphytes. ②The dejecta pH value of enteric flora maladjustment infants were 6~8, 92 cases were larger than or equal to 7 (78.0%); Control group dejecta pH value were 5～6.5, 68 cases were smaller or equal to 5.5(85.0%). There was a significant diference between them(χ2=116.52,P<0.005).③The proportion of cocci and bacilli was determined by smearing and microscope examining, flora maladjustment teams were 3/7~8/2, 106 cases cocci were larger than or equal to 40% (89.8%); The proportion of cocci and bacilli of control group samples was 1/9~3/7, none sample cocci was larger than or equal to 40%. There was a significant dieference between them(χ2=154.68,P<0.005).Conclusion:It is beneficial to the diagnosis of intestinal flora maladjustment by measuring the bacteriology, pH value and the change of cocci and bacilli of lax infant's fresh dejecta by pH value larger than or equal to 7 and the proportion of cocci and bacilli larger than 4/6. It is simple, quickly, exact and cheap, fits to grass roots laboratory.