二丁二仙汤预防去势雌性大鼠泌尿道感染的作用与机制研究

目的：通过与雌激素比较,观察中药二丁二仙汤是否具有调节血清雌激素水平、膀胱雌激素受体表达,下调TNF-α蛋白、IKBα磷酸化表达,从而探讨二丁二仙汤预防泌尿道感染的作用机制。方法：取40只雌性SD大鼠随机分组：假手术组（Sham）8只,去势组（OVX）8只,模型组（Model）8只,雌激素组（Estrogen）8只,二丁二仙汤组（EDEX）8只,共5组,行双侧卵巢次切术,术后予药物灌胃8周,8周后予隔天膀胱内灌注大肠埃希氏菌2次。检测各组血清雌二醇水平,光镜下观察膀胱组织HE染色,运用Real Time-PCR方法检测膀胱雌激素受体α和雌激素受体β mRNA表达变化,运用Western Blot方法检测膀胱TNF-α、IΚBα、P- IΚBα蛋白表达变化。结果：光镜下观察膀胱HE染色情况,假手术组及去势组无炎症表现,模型组重度急性炎症表现,可见大量中性粒细胞浸润,两组药物组均为轻度炎症表现。二丁二仙汤组、雌激素组血清雌二醇水平较去势组明显上升（P＜0.05）。雌激素组膀胱雌激素受体βmRNA较模型组上升（P＜0.05）,二丁二仙汤组雌激素受体β mRNA较模型组有上升趋势。二丁二仙汤组、雌激素组膀胱TNF-α蛋白和磷酸化IΚBα蛋白表达,较模型组明显下降（P＜0.05）。结论：与雌激素比较,中药二丁二仙汤也能预防泌尿道感染发生,其机制可能为上调血清雌激素,局部激活膀胱雌激素受体β,调节NF-κB通路,抑制IΚBα磷酸化,下调TNF-α产生。     

二仙汤对去卵巢大鼠骨质疏松的影响

目的探讨二仙汤防治去卵巢大鼠骨质疏松的作用及其初步机制。方法实验SD大鼠分为假手术组、模型对照组、尼尔雌醇组和二仙汤高、中、低剂量组等6组,除假手术组施行假手术外,其余均行手术彻底摘除卵巢,术后连续10d以阴道涂片检测动情周期筛选动物,然后依照假手术组、模型对照组灌胃生理盐水,尼尔雌醇组灌胃尼尔雌醇(1.2 mg/(kg.w)),二仙汤高、中、低剂量组分别灌胃淫羊藿提取液(剂量依次为含生药12、8、4 g/kg),连续给药90 d,考察骨密度、骨生物力学,以及血清碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶(ACP)、超氧化物歧化酶(SOD)、丙二醛(MDA)的变化。结果与模型对照组相比,二仙汤能明显提高去卵巢大鼠骨密度(P0.01)、股骨三点弯曲最大弯应力(P0.01)和L5腰椎压缩载荷力(P0.01),提高血清ALP和SOD活性(P0.01),降低血清ACP和MDA的含量(P0.01)。结论二仙汤能明显改善去卵巢大鼠骨质疏松症,促进成骨细胞增殖分化、抑制破骨细胞功能,抗氧化应激可能是其机制之一。     

肾小管上皮细胞损伤在慢性肾脏疾病进展中的作用

肾小管间质病变程度是决定各种肾脏疾病预后的重要因素，而肾小管上皮细胞的损伤和损伤反应可进一步加重肾间质病变。疾病状态时在缺氧、蛋白尿及多种炎症／细胞因子作用下，肾小管上皮细胞可活化、增殖，并分泌多种炎症因子、趋化因子和血管活性因子进入肾间质，加重肾间质的炎症和纤维化进程。受损的肾小管上皮细胞除了发生坏死或凋亡外，还可能发生表型转化为肌纤维母细胞进入间质，直接参与肾间质纤维化。提示肾小管上皮细胞损伤和损伤后的反应是加重肾间质炎症、纤维化和慢性肾脏持续进展的重要因素。     

二丁二仙汤与三金片治疗再发性泌尿道感染的对照研究

目的：从生理、心理、社会等功能状态,全面、客观评价二丁二仙汤治疗中老年女性慢性泌尿道感染的临床疗效。方法：纳入80例慢性泌尿道感染中老年女性患者,符合中医证属肾阳不足、余邪未清。首先予基础治疗,根据中段尿培养予敏感抗生素治疗14d并缓解后,停用抗菌素,纳入试验,按随机原则分为两组,每组各40例,进行分组治疗,其中治疗组服用二丁二仙汤,对照组服用三金片。两组均以4周为1个疗程,共治疗2个疗程。观察患者治疗前后近期疗效及中医证候疗效,生活质量;随访6个月,观察远期复发率。结果：经过8周的治疗后,治疗组和对照组在近期有效率（92.5%vs72.5%）、中医证候有效率（95%vs45%）、临床症状积分（5.25±2.42vs14.90±4.69）、SF-36量表积分（112.06±8.85vs97.36±10.67）均差异有统计学意义,治疗组的疗效优于对照组;在随访6个月期间,治疗组复发率（12.5%）低于对照组（30%）。结论：与三金片比较,二丁二仙汤能明显改善中医证属肾阳不足、余邪未清型的中老年女性再发性泌尿道感染患者的临床症状和生命质量,降低复发率,安全无副作用。     

慢性肾小球疾病肾小管间质损伤分析

本文观察不同临床类型慢性肾小球疾病患者尿中肾小管损伤标志蛋白的变化,旨在了解慢性肾小球疾病与肾小管间质损伤的关系。     

康胰汤对大鼠慢性胰腺炎的防治作用

目的:探讨康胰汤对大鼠慢性胰腺炎模型的防治作用。方法:体重180～200g雄性Wistar大鼠30只,随机分为3组,模型组大鼠尾静脉注射DBTC溶液(7mg/Kg),对照组尾静脉注射相同体积的DBTC的溶解液,中药治疗组尾静脉注射DBTC溶液(7mg/Kg),自第2d起给予康胰汤灌胃(生药量14g/Kg),对照组、模型组给予同等体积生理盐水。3组连续灌胃28d,常规饲养,28d后取材。行尿BT-PABA试验,经下腔静脉取血,用于血清淀粉酶、脂肪酶检测;完整切取大鼠胰腺组织,用于组织学观察。结果:与模型组比,中药治疗组纤维组织的含量明显减少(P0.05);胰腺外分泌功能明显改善(P0.05)。结论:康胰汤对大鼠慢性胰腺炎纤维组织生成及改善胰腺外分泌有明显防治作用。     

肾小管上皮细胞损伤在慢性肾脏疾病进展中的作用

肾小管间质病变程度是决定各种肾脏疾病预后的重要因素 ,而肾小管上皮细胞的损伤和损伤反应可进一步加重肾间质病变。疾病状态时在缺氧、蛋白尿及多种炎症 /细胞因子作用下 ,肾小管上皮细胞可活化、增殖 ,并分泌多种炎症因子、趋化因子和血管活性因子进入肾间质 ,加重肾间质的炎症和纤维化进程。受损的肾小管上皮细胞除了发生坏死或凋亡外 ,还可能发生表型转化为肌纤维母细胞进入间质 ,直接参与肾间质纤维化。提示肾小管上皮细胞损伤和损伤后的反应是加重肾间质炎症、纤维化和慢性肾脏持续进展的重要因素     

肾小管上皮细胞损伤相关细胞因子在慢性肾脏病中的研究进展

慢性肾脏病（chronic kidney disease,CKD）是由多种原因引起的慢性的肾脏结构和功能不可逆改变,其最常见的病理表现是肾纤维化。研究显示,在CKD发生过程中,损伤的肾小管上皮细胞可释放多种细胞因子导致细胞外基质沉积,以促进肾纤维化的发生。本综述就近年来有关肾小管上皮细胞损伤相关细胞因子在CKD中的作用进行论述,以期为CKD发生、发展机制的阐明及新治疗策略的制定提供新的思路。     

肾安汤对原发性肾病综合征肾小管的影响

原发性肾病综合征(PNS)系临床常见疾病,其发展和预后不仅与肾小球本身的损害有关,与肾小管间质病变(TIL)也密切相关,而肾小管上皮细胞在肾间质病变的发生和进展中起着重要的作用[1].目前影响肾小管的药物少见报道,为此我们采用肾安汤对PNS患者肾小管的影响进行了临床观察,现报道如下.     

"泰淋方"对慢性肾盂肾炎大鼠肾小管功能的影响

目的:评价"泰淋方"对慢性肾盂肾炎肾小管损伤的保护效应.方法:建立慢性肾盂肾炎大鼠模型,观察造模后及时给予"泰淋方"煎液(C组)对该模型30、60、90、120 d肾小管功能、肾皮质瘢痕发生率、肾功能、24 h尿蛋白定量、病理学的影响;以左旋氧氟沙星(D组)对照.结果:成功建立了CPN大鼠模型:(1)与模型组(B组)相比,C、D组能有效防止模型鼠在第90 d尿NAG/Cr的升高;实验期间各造模组肾功能、24 h尿蛋白与正常组(A组)无差异;(2)与B组相比,C、D组能显著减少模型二级及以上瘢痕率,但均不减少总体瘢痕率;(3)B组造模肾发生典型慢性间质性肾炎表现,对侧肾代偿性增大,C、D组总体病变减轻.结论:"泰淋方"能有效改善CPN大鼠伴随的肾小管功能减退和实质损伤,可能是治疗CPN的一种较好药物.     

Renal Allograft Injury Is Associated with Urinary Tract Infection Caused by Escherichia coli Bearing Adherence Factors

Urinary tract infections are the most common infection in renal transplant patients and Escherichia coli (E. coli) is the most common clinical isolate. Although acute allograft injury (AAI) secondary to urinary tract infection (UTI) has been reported, the incidence of AAI associated with UTI, the virulence factors express by uropathic E. coli and whether virulence factors are associated with renal allograft outcome have not been described. We collected E. coli from our renal transplant patients with UTI, determined O:H serotypes, P and Dr fimbriae expression and the clinical presentation and allograft function during the UTI and post-UTI period. Pyelonephritis occurred in 40% of our patients, 82% of which had AAI (>20% increase in SCr). Sixty-two percent of E. coli isolates that expressed P fimbriae were associated with AAI, whereas only 29% that did not express P fimbriae had AAI (p = 0.03). The pattern of P fimbriae and O serotypes differed from reported isolates, as the P fimbriae PapG class II and the O25 serotype were the most common. Dr adhesin was expressed on 7 isolates, including 2 of 3 with urosepsis. We propose a unique pattern of uropathogenic serotypes and adherence factors contribute to acute allograft injury in renal transplant patients with UTI.     

Effect of External Urinary Collection System on Colonization and Urinary Tract Infections with Pseudomonas and Klebsiella in Men with Spinal Cord Injury

ABSTRACT

Urinary tract infection of men with spinal cord injuries has been associated with a high incidence of colonization of the patients with gram-negative bacilli. We have examined the factors influencing colonization of 119 patients with Pseudomonas and Klebsiella and studied methods of reducing this colonization. The urethra, perineum, rectum, and drainage bag of all patients were cultured on selective media at two week intervals until discharge. The use of the external urinary collection system (EUCS) was discontinued in a group of patients at night, in an attempt to reduce colonization. Pseudomonas and Klebsiella were isolated from one or more body sites in 65 percent and 69 percent of total culture days. The urethra, perineum, rectum, and drainage bags were reservoirs of Pseudomonas and Klebsiella in men with spinal cord injuries, even in the absence of urinary tract infections. The EUCS proved to be an important factor influencing colonization. Pseudomonas and Klebsiella colonization was higher in patients using the EUCS. Removal of the EUCS at night reduced urethral colonization with Pseudomonas, but did not significantly reduce urethral colonization with Klebsiella.

The prevalence of bacteriuria with Pseudomonas and Klebsiella was not significantly influenced by the use of the EUCS.     

Decreased Incidence of Urinary Tract Infections in Patients with Spinal Cord Injury: Effect of Methenamine

ABSTRACT

This study was designed to determine the effect of methenamine on the frequency of urinary tract infections (UTI) in hospitalized patients after spinal cord injury. The study included 56 patients with neurogenic bladder dysfunction treated with intermittent catheterization. A group of 34 patients was treated with methenamine, 1g twice daily; the other group of 22 patients was the control group receiving no antimicrobial therapy. On a weekly basis urine samples from all patients were obtained for urinalysis and culture. A total of 500 urine samples were analyzed. The patients treated with methenamine had 23.4% positive urine cultures which was significantly lower than 57.5% in the untreated control group (p<0.001). Our data suggest that methenamine therapy is an effective prevention of UTI in paralyzed patients with neurogenic bladder dysfunction during the rehabilitation in hospital. (J Am Paraplegia Soc 1991; 14: 52–54)     

"慢性肾衰基本方"含药血清对人肾小管上皮细胞转分化的影响

目的:观察经验方"慢性肾衰基本方"对转化生长因子β1(TGF-β1)所诱导的肾小管上皮细胞(TECs)转分化及细胞外基质分泌的影响,以进一步证实并初步探讨其延缓慢性肾衰竭肾小管-间质纤维化的作用机制.方法:给予家兔中药灌胃3 d后制备"慢性肾衰基本方"含药兔血清,应用不同浓度含药血清处理经TGF-β1诱导活化的HK-2细胞,然后应用免疫细胞化学方法、流式细胞技术测定HK-2细胞α-平滑肌肌动蛋白(α-SMA)的表达率;应用酶联免疫吸附检测法(ELISA)测定培养上清纤维连结蛋白(FN)及Ⅳ型胶原(Col-Ⅳ)水平,并进而计算单个细胞FN及Col-Ⅳ分泌水平.结果:含药兔血清呈剂量依赖方式逆转TGF-β1诱导的HK-2细胞α-SMA的表达,并呈剂量依赖方式抑制单个细胞FN及Col-Ⅳ的分泌.结论:"慢性肾衰基本方"至少部分是通过抑制肾小管上皮细胞转分化及细胞外基质的过度分泌而对防治肾小管-间质纤维化发挥作用.     

Effect of Oral Ciprofloxacin on Bacterial Flora of Perineum,Urethra, and Lower Urinary Tract in Men with Spinal Cord Injury

Abstract

A study was performed in 25 men with spinal cord injuries undergoing intermittent catheterization whose urine had > 1Cf’ bacterial colonies/ml to determine efficacy of ciprofloxacin in eradicating susceptible organisms from urine, urethra, and perineum. Cultures were obtained prior to, during, and 5 to 7 days after administration of 500 mg twice daily for 10 days. Organisms in urine were also present in the urethra and/or perineum in 20 cases. Susceptible bacteria disappeared from urine in all subjects; but at follow-up 12 had cultures positive for ciprofloxacin-resistant Gram-positive cocci, including 1 with methicillin-resistant Staphylococcus aureus (MRSA), and 2 with ciprofloxacin-resistant Acinetobacter sp. Treatment significantly reduced Gram-negative bacilli in perinea and urethras, but ciprofloxacin-susceptible organisms were replaced by resistant staphylococci, including MRSA, enterococci, and Acinetobacter sp. We support use of ciprofloxacin for treatment of urinary tract infections in persons with spinal cord injury, but in view of supercolonization with resistant organisms, the drug should be reserved for symptomatic persons not likely to respond to other oral agents.     

丹参对马兜铃酸致肾小管上皮细胞损害的保护作用研究

目的:探讨丹参对马兜铃酸(aristolochic acid,AA)所致肾小管上皮细胞损害的保护作用.方法:以95%DMEM培养液加5%小牛血清培养肾小管上皮细胞株(NRK-52E),加入不同浓度的丹参和马兜铃酸,采用MTT法来观察肾小管上皮细胞存活以及生长的状况;用碘化丙啶(PI)染色方法确认细胞凋亡的发生.结果:马兜铃酸浓度超过10 mg/ml时肾小管上皮细胞的活力显著抑制(P＜0.05).以丹参3.0、15、30、60 mg/ml处理后的肾小管上皮细胞再加入AA(10 mg/ml浓度),则肾小管上皮细胞的活力明显增加,且随着丹参浓度的增加其作用愈趋明显(P＜0.01),丹参明显抑制AA所造成肾小管上皮细胞的凋亡(P＜0.01).结论:丹参(3.0、15、30、60 mg/ml)通过减少马兜铃酸致肾小管上皮细胞的凋亡,可明显保护肾小管上皮细胞,且其作用随着丹参浓度的增加而加强.     

长效抗菌材料“洁悠神”对留置导尿管伴随性尿路感染预防的研究

目的:应用具有物理抗菌功能的分子膜性结构材料喷涂在在导尿管表面和尿道口,观察其能否降低留置导尿管伴随性尿路感染(CAUTI)的发生。方法:60例经尿道前列腺电切术(TURP)术后留置导尿管的男性患者,年龄68~79岁。随机分为对照组30例和用药组30例。对照组,按常规行尿道口护理,2次/d;用药组,按常规行尿道口护理后,加用“洁悠神”喷洒于导尿管与尿道口,2次/d。观察两组患者置留导尿管后第3、5、7 d膀胱内尿液标本的细菌培养结果并比较。结果:用药组置管期间尿培养尿路感染病例数显著低于对照组(P<0.01)。结论:对留置导尿管的患者使用长效抗菌材料"洁悠神”进行导尿管表面和尿道口喷洒,可形成一层物理抗菌分子膜,阻止细菌生物膜的形成,有效降低CAUTI的发生。     

Impact of Perioperative Urinary Tract Infection on Surgical Site Infection in Patients Undergoing Primary Hip and Knee Arthroplasty

BackgroundThe literature lacks clear consensus regarding the association between postoperative urinary tract infection (UTI) and surgical site infection (SSI). Additionally, in contrast to preoperative asymptomatic bacteriuria, SSI risk in patients with preoperative UTI has been incompletely studied. Therefore, our goal was to determine the effect of perioperative UTI on SSI in patients undergoing primary hip and knee arthroplasty.MethodsUsing the National Surgical Quality Improvement Program database, all patients undergoing primary hip and knee arthroplasty were identified. Univariate and multivariate regressions, as well as propensity matching, were used to determine the independent risk of preoperative and postoperative UTI on SSI, reported as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsPostoperative UTI significantly increased the risk for superficial wound infection (OR 2.147, 95% CI 1.622-2.842), deep periprosthetic joint infection (PJI) (OR 2.288, 95% CI 1.579-3.316), and all SSIs (superficial and deep) (OR 2.193, 95% CI 1.741-2.763) (all P < .001). Preoperative UTI was not associated with a significantly increased risk of superficial infection (P = .636), PJI (P = .330), or all SSIs (P = .284). Further analysis of UTI present at the time of surgery using propensity matching showed no increased risk of superficial infection (P = 1.000), PJI (P = .624), or SSI (P = .546).ConclusionPostoperative UTI was associated with SSI, reinforcing the need to minimize factors which predispose patients to the risk of UTI after surgery. The lack of association between preoperative UTI and SSI suggests that hip and knee arthroplasty can proceed without delay, although initiating antibiotic treatment is prudent and future prospective investigations are warranted.