581例泌尿生殖道支原体、衣原体感染耐药性分析及对策

目的观察581例泌尿生殖道支原体、衣原体感染情况,分析其对抗菌药物的耐药性并提出治疗对策。方法采用单克隆抗体胶体金法检测衣原体抗原,采用培养法检测支原体及其药物敏感试验。结果581例标本检出沙眼衣原体（Ct）阳性42例,阳性率为7.2%;检出支原体阳性239例,阳性率为41.1%,其中解脲脲支原体（Uu）阳性率为28.4%（165例）,人支原体（Mh）阳性率为3.1%（18例）,Uu＋Mh混合感染阳性率为6.7%（39例）,Uu＋Ct混合感染阳性率为2.9%（17例）;支原体药敏试验结果显示,Uu对红霉素、罗红霉素耐药率分别为64.8%、62.6%,Mh也呈同样趋势,两种支原体合并感染的耐药率升高;多西环素、米诺环素、交沙霉素有较高的抑菌能力。结论随着支原体感染病例不断增多,出现多重耐药现象,临床应参照药敏试验结果选用抗菌药物,并进行足量、足疗程治疗,以减少耐药菌株的产生,多西环素、米诺环素、交沙霉素可作为临床支原体感染首选药。     

沙眼衣原体感染与输卵管性不孕的相关性研究

目的:探讨血清沙眼衣原体(CT)及其热休克蛋白60(C-HSP60)抗体反应与输卵管性不孕(TFI)的关系。方法:检测了60例TFI患者(TFI组)和30例正常生育妇女(对照组)血清CT抗体。用基因工程的方法重组C-HSP60,以纯化后的C-HSP60蛋白为抗原,采用酶联免疫吸附法(ELISA),检测二组对象血清C-HSP60抗体水平。结果:TFI组和对照组血清沙眼衣原体IgG抗体阳性率分别为73.22%和43.33%,组间有显著性差异(P<0.05);TFI组C-HSP60IgG抗体阳性率为46.67%,高于对照组阳性率6.67%,差异有统计学意义(P<0.05)。TFI组中28例C-HSP60IgG抗体阳性者与32例阴性者相比,阳性者的输卵管损害程度高于阴性者(P<0.01),而阴性者的盆腔粘连程度则较阳性组严重(P<0.01)。结论:女性生殖道沙眼衣原体感染是导致TFI的重要原因,C-HSP60与其发病机理有非常密切的关系。     

不孕和反复自然流产患者解脲支原体及沙眼衣原体感染的分析

目的研究原发性不孕症、继发性不孕症及反复自然流产与解脲支原体（UU）、沙眼衣原体（CT）感染的相关性。方法收集原发性不孕、继发性不孕、曾多次自然流产病例及有生育能力健康女性（对照）之宫颈拭子，用PCR方法作UU及CT DNA定量检测后比对分析。结果原发性不孕、继发性不孕、反复自然流产及对照组的UU、CT及CT＋UU阳性率分别为：48．9％、44．3％、17．0％，52．4％、47．6％、21．4％，51．8％、46，4％、19．7％及10．0％、6.7％、0．00％。原发性不孕症、继发性不孕症及反复自然流产组的UU和CT阳性率、CT＋UU混合感染率均明显高于对照组（P〈0．01或0．05），而3者之间相比无明显差异。对于UU和／或CT阳性的患者经治疗后，原发性不孕症、继发性不孕症及反复自然流产组分别有19，3％、21．4％及23．2％妊娠并生育，三者相比差异无统计学意义。结论UU、CT感染是引起不孕症及自然流产的重要病因之一。     

司帕沙星治疗非淋球菌性尿道炎66例

目的：评价司帕沙星对非淋球菌性尿道炎中支原体、衣原体感染的疗效。方法：６６例非淋球菌性尿道炎病人中支原体感染５１例,衣原体感染１５例（男性３９例,女性２７例;年龄３２ａ±ｓ９ａ）。用司帕沙星２００ｍｇ,ｐｏ,ｑｎ×６ｄ。结果：对支原体感染有效率为９１％,痊愈率为６９％。衣原体感染有效率为９３％,痊愈率为７３％。３６例病人的血药浓度在０．３９～１．８ｍｇ／Ｌ之间。结论：司帕沙星治疗支原体、衣原体感染疗效好、不良反应少、服用方便。     

Implementation of a pilot programme for screening for chlamydial infection in general practice

Objectives: To determine whether opportunistic screening for Chlamydia trachomatis, based on a selective screening algorithm, is possible in general practice in Belgium; to assess feasibility of the screening strategy with respect to workload, acceptability, and organisational aspects.

Methods: Implementation of a pilot screening programme by 37 GPs for a period of 15 weeks. GPs’ screening practices were registered and compared with the guidelines they had received. Outcome measures were: the number of patients included in the risk assessment, uptake of screening by eligible patients, prevalence of previously unidentified infection, and uptake of treatment. After the study period GPs evaluated a number of feasibility issues on a scoring form.

Results: 326 women underwent the risk assessment and 214 were tested by an amplification assay on a urine sample. Prevalence in women at risk was 6.4%. Overall effective screening rate was 77.6%; 9 of 11 positives took up treatment. Participating GPs found the strategy feasible and perceived that it was well accepted by their patients.

Discussion: The screening strategy was easily implemented by most GPs but some of them dropped out. The guidelines were followed relatively well and there were no major logistic problems. The uptake of treat ment was suboptimal. Efforts must be made to stimulate and educate more GPs to perform screening; laboratory and storage conditions should be optimised; refunding criteria should be revised; and overscreening must be avoided.     

沙眼衣原体垂直传播基因水平的快速检测

应用细胞培养法对８６名孕妇及其新生儿进行沙眼衣原体（ＣＴ）的分离，然后采用聚合酶链反应（ＰＣＲ）结合限制性片段长度多态性（ＲＦＬＰ）分析法，对ＣＴ阳性的母婴标本进行基因鉴定。结果显示，８６例孕妇ＣＴ阳性２０例，阳性孕妇的亲手儿有８例感染，垂直传播率４０．０％。８对母婴相对标本鉴定后证实每对母婴感染的ＣＴ基因型一致。提示ＣＴ有很高的垂直传播率，应早期进行孕期筛查，降低新生儿ＣＴ感染率。     

Dilated cardiomyopathy associated with Chlamydia trachomatis infection

A 26-year-old man was admitted to hospital with acute myocarditis complicated by congestive heart failure, and atrial and ventricular arrhythmias. Detailed investigations to determine the aetiological factors involved yielded negative results, except for serological evidence of infection with Chlamydia trachomatis. During the follow-up period, dilated cardiomyopathy developed. To the best of our knowledge a similar case has not been reported previously.     

Chlamydia trachomatis in Andrologic Patients – Direct and Indirect Detection

Background: Chlamydia trachomatis is considered to be the most common sexually transmitted disease in Germany. It is currently unclear whether chlamydial infection causes pathological conditions of the male accessory glands with consequences for male infertility. Patients and Methods: Within the framework of several prospective studies the association between sperm quality, male accessory gland function and infection with C. trachomatis was investigated in men of couples with unexplained infertility. Chlamydial infection was determined by serologic methods and by proof of Chlamydia-specific DNA. As a marker of infection the direct determination of granulocytes in the ejaculate or the measurement of the polymorphonuclear (PMN) elastase concentration was used. The male accessory gland function was evaluated using the markers fructose, citric acid and α-glucosidase in the seminal plasma. Results: Chlamydia-specific DNA in the ejaculate was present in between 3–5% of the subjects, which corresponds to it s prevalence in the normal population. Chlamydia IgA antibodies were demonstrated with a frequency of 38% in seminal plasma (n = 834) using a genus-specific test (rELISA). Using other species-specific tests (MIF, SeroCT, IgA pELISA and ImmunoComb), Chlamydia IgA antibodies were found at frequencies of between 8 and 22%. Conclusion: Only in a few individual cases was it possible to show a connection between reduced sperm quality, disturbed male accessory gland function and indication of infection with Chlamydia, bacteria or Ureaplasma. Received: May 23, 2000 · Revision accepted: December 20, 2000     

淋球菌、支原体和沙眼衣原体在急性尿道炎中的感染分布及耐药性分析

目的了解淋球菌、支原体和沙眼衣原体在急性尿道炎中的感染分布和耐药情况。方法用培养法对淋球菌和支原体进行分离鉴定和药敏试验，用头孢硝噻吩法对淋球菌进行口一内酰胺酶检测，用单克隆抗体胶体金标法测定沙眼衣原体。支原体药敏试验用支原体药敏试剂盒检测，淋球菌药敏试验采用中K—B法。结果在389份尿道口分泌物标本中，阳性分离率为94．6％。淋球菌β-内酰胺酶的产生率为29．0％，对青霉素的敏感率为2．9％，对氧氟沙星和环丙沙星的敏感率为6．8％和7．2％，对壮观霉素、头孢菌素和头孢西丁的敏感性均较高。支原体对乙酰螺旋霉素、红霉素、环丙沙星、左氧氟沙星和司巴沙星以及壮观霉素的敏感率均不超过50．0％，而对四环素、强力霉素、罗红霉素、美满霉素、交沙霉素和阿奇霉素的敏感率均超过70．0％。结论急性尿道炎患者主要以淋球菌感染为主，支原体和沙眼衣原体可引起混合感染。监测淋球菌和支原体的耐药性对指导临床合理使用抗生素有重要意义。