解脲支原体、沙眼衣原体感染与男性不育关系病例对照的Meta分析

目的采用Meta分析的方法探讨解脲支原体、沙眼衣原体感染与男性不育的关系.方法采用计算机检索和手工检索相结合的方法,检索2011年12月以前的PUBMED, EMBASE,Cochrane图书馆,CNKI,CBMdisc等国内外数据库,查找解脲支原体、沙眼衣原体感染与男性不育关系的病例对照研究.由两位研究者按照纳入与排除标准进行资料提取和质量评价后,采用RevMan 5.0软件对各研究进行数据合并与分析.结果(1)共纳入5个符合要求的病例对照研究,共包括1068例患者;(2)对所纳入的研究进行质量评分,结果质量均4分.(3)单纯解脲支原体感染OR合并值为3.29[95%CI(2.24,4.82),P<0.00001],两组差别有统计学意义;(4)单纯沙眼衣原体感染OR合并值为3.43[95%CI(1.92,6.14),P<0.0001],两组差别有统计学意义;(5)解脲支原体合并沙眼衣原体感染OR合并值为4.64[95%CI(1.90,11.37),P=0.0008],两组差别有统计学意义;结论无论是解脲支原体感染,还是沙眼衣原体感染都是影响男性不育的显著危险因素,而当两者合并感染时更易导致男性不育.由于纳入的研究存在选择性偏倚和发表性偏倚的可能性.期待更多进行高质量的相关对照试验,以提供坚实、可靠的证据.     

某地区5306例生育前精液质量与解脲脲原体感染情况探讨

目的探讨上海地区生育前精液质量现状及解脲脲原体(UU)对精子质量的影响。方法收集2014年1月至2015年11月符合标准的5 306例生育前男性行精液检查,按照年龄、UU感染情况进行分组,分析比较各组精液指标。结果精液pH值(7.27±0.14),精液量(3.15±1.42)mL,精子浓度(57.51±40.22)×106/mL,精子总数(172.83±134.90)×106,A级与B级精子总和(38.50±17.54)%,总活力(46.36±20.08)%,活动精子总数(89.86±92.82)×106。20~29岁年龄组男性精子总活动力为(49.60±20.70)%,活动精子总数为(93.40±95.83)×106,大于其余各组。2 311例(43.55%)UU阳性,UU阳性组精子总数、活动精子总数、精子浓度、A级精子率、A+B级精子率、精子总活力、精浆酸性磷酸酶、精浆α-糖苷酶及精浆果糖明显低于UU阴性组(P0.01),UU阳性组精液酸碱度及精浆锌明显低于UU阴性组(P0.05)。结论上海地区生育前男性精液质量不良,UU在生育前检查具有重要的作用。     

STD门诊患者沙眼衣原体、解脲支原体、淋球菌与人乳头瘤病毒感染情况分析

目的 了解本地区STD门诊患者沙眼衣原体(CT)、解脲支原体(UU)、淋球菌(NG)与人乳头瘤病毒(HPV)感染情况,从而指导临床诊断与用药.方法 采用聚合酶链式反应(PCR)结合Taqman技术,对采集自来院就诊STD门诊患者的女性宫颈口分泌物、男性尿道口分泌物及相关尿液标本中的特异性DNA核酸片段进行荧光PCR检测.结果 CT、UU、NG、HPV四种病原体总感染率分别为7.49％、42.92％、3.11％和3.06％,除HPV外其它三种病原菌感染率存在性别差异;其中以UU感染率居首位,女性明显高于男性;二重感染率为5.76％,三重感染率为0.83％,未见四重感染,其中以CT和UU二重感染最常见;不同年龄段感染情况显示,以40岁以下年龄段感染率最高.结论 将HPV纳入泌尿生殖感染检测很重要;通过本研究也发现,无论单一病原体感染还是混合感染,除HPV外均存在明显的性别分布差异,而且两种感染的性别分布相一致;40岁以下年龄段为主要传染源和高危人群,应作为性传播疾病防治工作的重点;双重感染和三重感染较常见,应引起高度重视;目前未发现四重感染.     

除湿化浊汤治疗NGU感染不孕症的研究

目的:研究除湿化浊汤联合西药治疗NGU感染不孕症的临床疗效。方法:选取符合纳入标准的66例UU、CT感染输卵管炎性不孕患者,临床辨证为湿浊内阻型,随机分为中西药治疗组36例和西药对照组30例,观察两组患者临床疗效。结果:中西药治疗组UU、CT感染治疗痊愈率77.8%,妊娠率36.1%;西药治疗组NGU感染治疗痊愈率40%,妊娠率13.3%。两组比较具有显著性差异(P0.05)。结论:湿邪与女性生殖道NGU感染有关,除湿化浊汤联合西药治疗NGU感染的输卵管不孕症效果好。     

东莞地区泌尿生殖道支原体联合培养及药物敏感性的探讨

目的：通过固体和液体联合培养的方法,提高试验准确性,更好地反映药物敏感性。方法把待检标本同时在固体培养基上和液体药敏检测培养基上接种后,统计支原体的检出率并对药敏结果进行分析。结果1570例支原体培养中阳性590例,占37．6％;其中,解脲支原体（Uu）482例,人型支原体（Mh）25例,Uu 与 Mh 混合感染83例,药敏方面3种类型的支原体感染均对交沙霉素、米诺环素、强力霉素敏感性较高,而对大环内酯类和喹诺酮类抗菌药物出现比较明显的耐药。结论东莞地区泌尿生殖系感染主要以 Uu 为主,其次是 Uu 和 Mh 引起的混合感染,单独 Mh 感染较少,而且三者对抗菌药物的敏感性存在一定的差异。     

Ureaplasma: Current perspectives

Ureaplasma species are the most prevalent genital Mycoplasma isolated from the urogenital tract of both men and women. Ureaplasma has 14 known serotypes and is divided into two biovars- Ureaplasma parvum and Ureaplasma urealyticum. The organism has several genes coding for surface proteins, the most important being the gene encoding the Multiple Banded Antigen (MBA). The C-terminal domain of MBA is antigenic and elicits a host antibody response. Other virulence factors include phospholipases A and C, IgA protease and urease. Besides genital tract infections and infertility, Ureaplasma is also associated with adverse pregnancy outcomes and diseases in the newborn (chronic lung disease and retinopathy of prematurity). Infection produces cytokines in the amniotic fluid which initiates preterm labour. They have also been reported from renal stone and suppurative arthritis. Genital infections have also been reported with an increasing frequency in HIV-infected patients. Ureaplasma may be a candidate ‘co factor’ in the pathogenesis of AIDS. Culture and polymerase chain reaction (PCR) are the mainstay of diagnosis. Commercial assays are available with improved turnaround time. Micro broth dilution is routinely used to test antimicrobial susceptibility of isolates. The organisms are tested against azithromycin, josamycin, ofloxacin and doxycycline. Resistance to macrolides, tetracyclines and fluoroquinolones have been reported. The susceptibility pattern also varies among the biovars with biovar 2 maintaining higher sensitivity rates. Prompt diagnosis and initiation of appropriate antibiotic therapy is essential to prevent long term complications of Ureaplasma infections. After surveying PubMed literature using the terms ‘Ureaplasma’, ‘Ureaplasma urealyticum’ and ‘Ureaplasma parvum’, relevant literature were selected to provide a concise review on the recent developments.     

泌尿生殖道感染患者性传播疾病病原体分布及耐药性分析

目的分析医院泌尿生殖道感染患者沙眼衣原体(Ct)、淋菌(NG)、解脲脲支原体(Uu)性传播疾病病原体分布特点,为临床用药提供参考。方法采集2013年1月-2014年5月647例泌尿生殖道感染患者的尿道或宫颈分泌物,采用多重荧光定量PCR(FQ-PCR)技术检测Ct、NG、Uu基因,分析3种病原体分布并进行药敏试验。结果 647份标本中有311份检出病原体,阳性率为48.07%;单一感染204例占65.59%、混合感染107例占34.61%,女性总阳性率为52.57%,高于男性的42.76%,差异有统计学意义(P<0.05);20~40岁患者总阳性率高于其他年龄段患者总阳性率,差异有统计学意义(P<0.05);Ct对氯霉素、多西环素敏感率分别为97.22%、95.83%;NG对阿奇霉素、左氧氟沙星的敏感率均为96.30%;Uu对交沙霉素、米诺环素的敏感率分别为96.55%、95.40%。结论医院泌尿生殖道感染患者Ct、NG、Uu感染率较高,临床应结合3种病原体感染差异及药敏试验,制定治疗方案。     

Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: prevalence and clinical significance

Objective: To determine the frequency and clinical significance of sterile and microbial-associated intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix.

Methods: Amniotic fluid (AF) samples obtained by transabdominal amniocentesis from 231 asymptomatic women with a sonographic short cervix [cervical length (CL) ≤25?mm] were analyzed using cultivation techniques (for aerobic and anaerobic as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency and magnitude of intra-amniotic inflammation [defined as an AF interleukin (IL)-6 concentration ≥2.6?ng/mL], acute histologic placental inflammation, spontaneous preterm delivery (sPTD), and the amniocentesis-to-delivery interval were examined according to the results of AF cultures, PCR/ESI-MS and AF IL-6 concentrations.

Results: Ten percent (24/231) of patients with a sonographic short cervix had sterile intra-amniotic inflammation (an elevated AF IL-6 concentration without evidence of microorganisms using cultivation and molecular methods). Sterile intra-amniotic inflammation was significantly more frequent than microbial-associated intra-amniotic inflammation [10.4% (24/231) versus 2.2% (5/231); p?p?p?Conclusion: Sterile intra-amniotic inflammation is more common than microbial-associated intra-amniotic inflammation in asymptomatic women with a sonographic short cervix, and is associated with increased risk of sPTD (<34 weeks). Further investigation is required to determine the causes of sterile intra-amniotic inflammation and the mechanisms whereby this condition is associated with a short cervix and sPTD.     

生殖支原体感染的临床分布和耐药性分析

生殖支原体的感染在临床上非常常见,其耐药率也受到广泛的关注。本文回顾性分析了502例临床疑似生殖支原体感染患者的临床资料和培养结果。共检出生殖支原体阳性334例,阳性率66.5%,年龄中位数为34岁,其中女性阳性率显著高于男性,比例为17.6∶1。生殖支原体的临床分布中以解脲脲原体为主,检出率为87.7%,男女性别构成比无明显差异。生殖支原体对喹诺酮类和大环内酯类的耐药性较高,对克林霉素的耐药率最高,达到53.5%。其中解脲脲原体对加替沙星、左氧氟沙星、阿奇霉素、克拉霉素和红霉素的耐药率均低于10.0%。而人型支原体或人型支原体与解脲脲原体的混合药敏却表现相反,对阿奇霉素、克拉霉素、红霉素和罗红霉素表现为高度耐药,耐药率均大于60.0%。因此,临床应更加关注支原体培养及药敏结果,合理使用抗生素,延缓抗生素耐药。     

某中医医院连续3年女性生殖系统感染解脲脲原体的耐药性

目的了解某中医医院女性生殖系统解脲脲原体（Uu）感染患者连续3年的耐药现状和变化趋势。方法对该中医医院2011年1月-2013年12月皮肤性病科和妇科门诊及住院女性患者送检的白带及宫颈分泌物标本分离的Uu的耐药性进行回顾性分析。结果共分离Uu 327株,其3年耐药率,除多西环素（5.23%～6.12%）和交沙霉素（0～1.96%）较低外,其余抗菌药物均稍有增高,但差异无统计学意义（P＞0.05）。Uu对氧氟沙星、克拉霉素、司帕沙星的耐药率（42.11%～61.40%）较高,对交沙霉素、多西环素、美满霉素的耐药率（0～13.07%）较低,多药耐药现象较严重。结论该中医医院女性生殖系统感染患者分离的Uu耐药性较高。掌握Uu耐药现状和变化趋势,对于疾病的治疗和控制多药耐药菌株的产生非常必要。