输尿管支架管结壳患者尿液菌群的分布特点

目的探讨输尿管支架管结壳患者尿液菌群的分布特点。方法选取2018年10月至2019年3月在山东省立第三医院、山东大学齐鲁医院、济南市中心医院和济南市济钢医院就诊的35例输尿管支架管置入术后患者。纳入标准:年龄18~65岁;输尿管镜碎石术后留置内支架管4周。排除标准:尿液细菌培养阳性;严重肉眼血尿;近期口服抗生素;存在明显残石患者。本研究采用横断面研究方法(临床研究注册号为ChiCTR1800020025),根据有无支架管结壳将患者分为结壳组23例和无结壳组12例。收集拔管当日患者尿液行细菌16s DNA检测。使用UPARSE、UCHIME和RDP calssifier等软件分析两组患者尿液菌群分布特点,明确两组患者尿液中细菌种类总数、细菌丰度,以及丰度占比较大的细菌类别,比较两组患者尿液细菌种类、数量及细菌丰度的差异,明确结壳组患者尿液中丰度占比较大的细菌菌属。结果两组患者的年龄、性别、体质指数、置管侧别、内支架管型号及结石成分差异均无统计学意义(P>0.05)。16s DNA检测结果显示,结壳组丰度占比>1%的菌属数量为11个,丰度占比>0.01%的菌属数量为74个;无结壳组丰度占比>1%的菌属数量为7个,丰度占比>0.01%的菌属数量为11个,两组丰度占比>1%的菌属数量比较差异有统计学意义(t=5.12,P=0.000)。结壳组中菌属丰度占比前3位分别为乳杆菌属(23.1%)、拟杆菌属(18.8%)和未分级拟杆菌属(17.1%),非结壳组中菌属丰度占比前3位分别是为埃希菌-志贺菌属(32.2%)、肠球菌属(24.9%)和假单胞菌属(18.2%)。两组间差异最大的3种细菌是乳杆菌属(P=0.010),拟杆菌属(P=0.004)和未分级拟杆菌属(P=0.004)。结论支架管结壳患者尿液中细菌种类和数量都明显多于非支架管结壳患者。拟杆菌属细菌在支架管结壳患者尿液中的细菌种类丰度较大。

The distribution characteristics of urine flora in patients with ureteral stent tube crusting

Objective To investigate the distribution characteristics of bacteria in urine of patients with ureteral stent crusting.Methods Thirty-five patients who underwent ureteral stent placement at the Shandong Provincial Third Hospital,Shandong University Qilu Hospital,Jinan Central Hospital,and Jinan Jigang Hospital were selected from October,2018 to March,2019(the clinical study registration number is ChiCTR1800020025).The inclusion criteria were patients who had the stent intubated for 4 weeks after ureteroscopic lithotripsy,aged between 18 and 65 years.Exclusion criteria were patients with positive urine bacterial culture,severe gross hematuria,recent oral antibiotics,and patients with significant residual stones.This clinical study uses a cross-sectional study method,and those patients were divided into crusting group(n=23)and non-crusting group(n=12)according to the presence or absence of stent crusting.On the day of extubation,urine of the patients was collected for bacterial 16s DNA detection.The distribution characteristics of bacteria in urine of the two groups were analyzed using UPARSE,UCHIME and RDP calssifier.The total number of bacteria species,bacterial abundance and bacterial species with large-scale abundance in urine of the two groups were determined.The quantity of bacteria species and bacterial abundance in the urine between the two groups were compared,and the bacterial species with large-scale abundance in urine of the patients with stent crusting were identified.Results There were no significant differences in general information such as age,body mass index,gender,affected side,type of stent tube,and stone composition between the two groups.Using 16s DNA sequencing to detect the bacteria in the urine of the two groups revealed that the number of bacterial species with abundance>1%was 11,and the number of bacterial species with abundance>0.01%was 74 in the crusting group.In the non-crusting group,the number of bacterial species with abundance>1%and>0.01%was 7 and 11,respectively.Compared with the non-crusting group,the number of bacterial species with abundance>1%in the crusting group was significantly larger(t=5.12,P=0.000).In the crusting group,bacterial species with the top three abundance were g_Lactobacillus(23.1%),g_Bacteroides(18.8%)and g_norank_Bacteroides(17.1%).In the non-crusting group,bacterial species with the top three abundance were g_Escherichia-Shigella(32.2%),g_Enterococcus(24.9%)and g_Pseudomonas(18.2%).The three bacteria with the greatest difference between the two groups were g_Lactobacillus(P=0.010),g_Bacteroides(P=0.004)and g_norank_Bacteroides(P=0.004),respectively.Conclusion The species and quantity of bacteria in the urine of patients with stent crusting are both significantly larger than those of patients without stent crusting.Bacteroides with larger-scale abundance in the urine of patients with stent crusting may promote the deposition of crystals on the stent wall through its structure,function and urease positive characteristics.