多种尿液实验室指标辅助诊断细菌性尿路感染的临床效能比较

目的:探讨尿肝素结合蛋白(U-HBP)、尿白细胞介素6(U-IL-6)及尿白细胞计数(U-WBC)辅助诊断细菌性尿路感染(UTI)的临床效能差异。方法:回顾性分析济宁市中医院2017年1月至2019年1月收治的314例细菌性UTI患者(UTI组)、122例非细菌性UTI患者(非UTI组)及80例体检健康者(健康组)的临...     

尝试验检测多囊肾病人尿中内毒素含量的意义

G~-细菌尿路感染(UTI)是多囊肾的严重并发症,而G~-细菌细胞壁成分之一的内毒素在动物实验中有致肾囊腔形成的作用。迄今临床尚未见多囊肾(PKD)病人尿中内毒素含量与肾囊腔形成关系的报道。本文旨在了解鲎试验(LAL)是否较常规的细菌培养及其它微生物方法更敏感地显示或预测UTI。但LAL检测PKD患者尿     

尿路感染的处理

儿童是泌尿道感染(UTI)的高发人群,Sermin A.Saadeh等通过研究来探索UTI的最佳治疗方案。他通过检测脓尿和菌尿样品来诊断UTI,并发现潜在的泌尿系统异常,如膀胱输尿管返流、便秘以及排尿功能障碍都会增加UTI的患病风险。急性肾盂肾炎患者发生肾脏瘢痕化和并发症如高血压、蛋白尿(伴或不伴局灶性节段性肾小球硬化症)以及妊娠相关并发症,     

UF-1000i尿有形成分分析仪细菌检测筛查尿路感染

探讨Sysmex UF-1000i尿有形成分分析仪细菌检测在尿路感染(UTI)筛查中的应用价值,报告如下. 一、对象和方法 以2007年12月至2010年1月疑为UTI的患者538例为研究对象,包括UTI 218例,非UTI 320例.留取清洁中段尿送检.使用Sysmex UF-1000i尿有形成分分析仪、长春迪瑞H-800尿干化学分析仪、美国BD微生物鉴定与药敏系统检测.     

《国际泌尿系统杂志》稿约

急性肾损伤(acute kidney injury,AKI)是多种原因引起肾功能短期内的急剧下降,其病因多样,发病率及死亡率逐年升高.UTI(Ulinastatin,UTI)是从健康成人尿液中提取的尿蛋白酶抑制剂,可以抑制胰蛋白酶、透明质酸酶等多种水解酶活性,减少炎症因子过度释放,清除氧自由基,减轻缺血再灌注损伤.本文就UTI对于各种原因所致AKI的肾脏保护作用及其机制进行综述.     

原发性肾病综合征合并尿路感染的临床特征及耐药性分析

尿路感染(urinary tract infection,UTI)是原发性肾病综合征(primary nephritic syndrome,PNS)患者常见合并症,也是PNS疗效差和病情反复的主要原因.显性感染常被重视,而无症状尿路感染,即无症状性菌尿(asympomatic bacteriuria,ABU)易疏忽遗漏.为了解UTI的临床特征和细菌的种类及耐药情况,减少对不典型UTI的误、漏诊,本文收集我院1998年～2005年322例PNS合并UTI 48例患者进行分析,报告如下.     

肾移植术后60例女性尿路感染的临床分析

目的:探讨肾移植术后女性尿路感染(UTI)的相关影响因素。方法:调查2012年1月~2012年12月在上海长征医院肾移植康复病房收治的肾移植术后UTI女性患者60例,依据年龄段分为低年组和高年组,比较两组患者UTI的临床资料,分析其临床特点,并探讨相关影响因素。结果:78.33%(47/60)患者至少出现UTI1例次;51.67%(31/60)患者UTI临床症状不典型;38.33%(23/60)患者尿标本以大肠埃希菌感染为主,但36.67%(22/60)患者却难以找到致病菌。其中高年组(占78.33%,47/60)比低年组(占21.67%,13/60)UTI发生率高,差异有统计学意义(P0.05)。进一步分析发现,在高年组UTI中,糖尿病和移植肾失功发生率均高于低年组患者(P0.05)。结论:年龄、糖尿病是肾移植术后女性UTI的重要影响因素,高年组UTI患者易增加移植肾失功的风险。     

尿干化学分析与尿液沉渣检查对尿路感染诊断价值的比较

目的:探讨尿路感染(UTI)检验的较好方法。方法:以UTI诊断的金标准为参照,对124例UTI住院患者中段尿进行尿干化学分析和尿沉渣WBC计数检验,并作对比分析。结果:尿沉渣镜检的灵敏度、阴性预计值、准确率分别为79.6%、88.5%、81.7%,而尿液干化学分析亚硝酸盐(NIT)或WBC的灵敏度、阴性预计值、准确率分别为63.3%、81.2%、76.8%。结论:在UTI的尿筛查试验中,尿沉渣镜检WBC计数比尿干化学分析NIT、WBC的诊断价值为优。     

结石细菌培养在经皮肾镜取石术中的应用价值

目的探讨经皮肾镜取石术(PCNL)术前中段尿培养和术中结石培养的关系以及术中结石培养在PCNL中预防全身炎症反应综合征(SIRS)的应用价值。方法分析2014年7月~2016年7月40例PCNL患者术前中段尿培养和术中结石培养的结果,术后SIRS发生情况,药物的敏感性以及调整抗生素的情况。结果本组40例患者中,术前中段尿培养有菌生长13例,占比32.5%,无菌生长27例,占比67.5%。术中结石细菌培养有菌生长26例,占比65%,无菌生长14例,占比35%。术中结石细菌培养阳性率显著高于术前中段尿培养(P0.05)。术前中段尿和术中结石细菌培养均无细菌生长10例(25%),术前中段尿培养有菌生长而术中结石细菌培养无菌术中4例(10%),术前中段尿培养无菌生长而术中结石细菌培养有菌生长17例(42.5%),术前中段尿培养和术中结石细菌培养均有细菌生长9例(22.5%),其中9例中,有4例分别为不同的细菌。术后发生SIRS 10例。结论术中结石培养比术前中段尿培养更能反应尿路感染情况,对预防和治疗PCNL相关性感染有指导治疗作用。     

结石细菌培养在PCNL术后感染性并发症治疗中的作用

目的探讨结石细菌培养在经皮肾镜取石术(PCNL)后感染性并发症治疗中的作用。方法回顾性分析广州医科大学附属第一医院2016年9月至2018年9月收治的1060例行一期PCNL肾结石患者的临床资料。男614例,女446例。年龄(52.4±12.2)岁。结石负荷(1499.6±1435.3)mm^2。收集清洁中段尿及术中结石标本用于细菌培养鉴定及药敏试验。记录患者膀胱中段尿和结石的细菌培养结果、药敏试验结果、围手术期抗菌药物应用情况以及术后感染发生情况,分析结石细菌培养阳性者与阴性者术后发热和尿源性脓毒血症发生率的差异。结果本研究1060例,膀胱中段尿培养出22种细菌,结石培养出52种细菌。结石细菌培养阳性率高于中段尿[31.8%(337/1060)与20.9%(222/1060),P<0.001]。中段尿和结石中最常见的细菌均为大肠埃希菌,但大肠埃希菌阳性率中段尿高于结石[52.3%(116/222)与43.6%(147/337),P<0.05]。中段尿和结石来源的大肠埃希菌对氨苄西林、头孢唑啉、头孢曲松、头孢噻肟、左氧氟沙星、环丙沙星等耐药率均高于40%,而对亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星等药物耐药率均低于10%,两者的耐药率差异无统计学意义(P>0.05)。术后出现发热111例(10.5%),尿源性脓毒血症22例(2.1%)。结石细菌培养阳性患者术后发热和尿源性脓毒血症的发生率均高于结石细菌培养阴性患者[23.7%(80/337)与4.3%(31/723);4.2%(14/337)与1.1%(8/723),P均<0.05]。术前膀胱中段尿细菌培养阴性患者中,结石细菌培养阳性者的术后发热率高于阴性者[17.9%(30/168)与4.2%(28/670),P<0.05]。结石细菌培养阳性患者中,术后抗菌药物与结石药敏试验结果一致者的术后发热率低于与结石药敏试验不符者[17.5%(22/126)与27.5%(58/211),P<0.05]。结论结石细菌培养阳性率高,细菌菌谱复杂,多重耐药比例高。即使术前中段尿细菌培养为阴性,结石细菌培养阳性仍是PCNL术后感染的危险因素。结石细菌培养结果在PCNL术后感染性并发症治疗中具有重要的指导作用。     

局麻联合强化麻醉下微创经皮肾镜术治疗上尿路结石的临床研究

目的探讨局麻结合强化麻醉对比全麻下微创经皮肾输尿管镜取石术（MPCNL）治疗上尿路结石的临床效果。 方法选取2015年12月至2017年12月间在惠州市第一人民医院择期进行MPCNL手术的上尿路结石患者98例,依据随机数字表法将其分成两组,对照组（49例）患者采取全麻,观察组（49例）患者采取局麻结合强化麻醉;观察患者手术时间、住院时间、双J管留置时间、结石清除率、肾造瘘管留置时间、术后不良反应状况,术前1 d与术后3 d患者血清尿素氮（BUN）、C-反应蛋白（CRP）、血肌酐（Cr）、肿瘤坏死因子α（TNF-α）、β2-微球蛋白（β2-M）及白细胞介素6（IL-6）浓度改变状况。 结果观察组患者手术时间、住院时间低于对照组,差异有统计学意义（P<0.05）,两组患者结石清除率、双J管留置时间和肾造瘘管留置时间差异无统计学意义（P>0.05）;术后3 d两组患者血清CRP、TNF-α及IL-6浓度较术前1 d显著升高,差异有统计学意义（P<0.05）,观察组升高幅度低于对照组,两组患者术后3 d β2-M、Cr及BNU浓度和术前1 d对比3 d两组间对比差异均无统计学意义（P>0.05）;观察组总的不良反应发生率为14.29%,低于对照组的30.61%,差异有统计学意义（P<0.05）。 结论局麻联合强化麻醉下进行MPCNL术可有效降低患者术后不良反应、血清炎症反应及住院时间,但在病例选择上需谨慎,术前准备与术中监护工作要做充分。     

Urinary macrophage migration inhibitory factor in children with urinary tract infection

Macrophage migration inhibitory factor (MIF) plays an essential pathophysiological role in inflammatory reactions. The aim of this study was to investigate the clinical utility of urine MIF (uMIF) level in predicting urinary tract infections (UTI). This multicenter, prospective study was conducted over a 1-year period between March 2008 and March 2009. Sixty patients with symptomatic culture-proven UTI and 29 healthy children were recruited. Urine MIF was measured by enzyme-linked immunosorbent assay. The mean MIF level was found to be significantly higher in the UTI group than in the control group (1082.82 vs. 211.45 pg/ml, p?=?0.0001). Receiver operating characteristic (ROC) analysis revealed that the optimal cut-off uMIF level was 295 pg/ml for uMIF to predict UTI. The sensitivity and specificity of this cut-off level were 91.7% and 69%, respectively. Mean uMIF/creatinine (Cr) was also significantly higher in the UTI group than in the control group (2400.69 vs. 267.56 pg/mgCr, p?=?0.0001). At a cut-off of 815 pg/mgCr for uMIF/Cr, the sensitivity and specificity were 95 and 79%, respectively. The area under curve (AUC) was 0.848 (standard error 0.040, 95% confidence interval 0.756–0.915) for uMIF and 0.889 (0.034, 0.805–0.946) for uMIF/Cr. Urine MIF/Cr was significantly higher in the patients with a positive leukocyte esterase reaction in the urine (p?=?0.047), leukocytosis (p?=?0.0001) and positive C-reactive protein level in serum (p?=?0.003). The uMIF level was not related to leukocytosis, positive CRP level in serum and leukocyte esterase reaction in the urine. Neither uMIF nor uMIF/Cr were correlated to the positive urine nitrite test, pyuria, urine pH and specific gravity (p?>?0.05). These results suggest that urine MIF and uMIF/Cr can be used for the early prediction of UTI in children.     

Urinary markers in the early stage of nephropathy in patients with childhood-onset type 1 diabetes

Background

The aim of this study was to evaluate the association of a urinary tubular marker, liver-type fatty acid binding protein (L-FABP) and an inflammatory marker, serum/urinary YKL-40, with albuminuria in patients with childhood-onset type 1 diabetes (T1D).

Methods

Twenty-nine patients with childhood-onset T1D and 32 controls were enrolled. Serum and urinary concentrations of YKL-40 and urinary concentrations of L-FABP were measured.

Results

The serum levels of YKL-40 were not significantly different between the control group and the patient groups. However, the levels of urinary YKL-40/creatinine (Cr) were higher in the patients, even those with normoalbuminuria than in the controls (p?<?0.001). The levels of urinary L-FABP/Cr were not different between the control group and the patient groups. However, the level of urinary L-FABP/Cr in the microalbuminuria group was higher than that in the normoalbuminuria group (p?=?0.03). There were no associations between the levels of urinary albumin-to-creatinine ratio and urinary L-FABP/Cr or YKL-40/Cr. However, the urinary L-FABP/Cr level was significantly correlated with the hemoglobin A1C level (p?=?0.005) and the urinary YKL-40/Cr level (p?=?0.043).

Conclusions

Urinary L-FABP/Cr and YKL-40/Cr may reflect renal injury in early stages of nephropathy in patients with childhood-onset T1D, even in the normoalbuminuric state.

     

经皮肾镜术前及术后监测降钙素原对感染的早期诊断及尿源性脓毒血症预防的临床意义

目的分析经皮肾镜取石术(PCNL)术前及术后监测降钙素原对感染的早期诊断及尿源性脓毒血症预防的临床意义。方法选取本院于2016年1月至2018年10月间收治的122例肾结石或输尿管上段结石并行PCNL手术治疗的患者,根据其术后是否发生感染将其分为感染组及非感染组,将感染组根据不同感染程度及不同SOFA评分进行分组,比较不同组间的炎症指标。根据ROC曲线分析PCT及CRP的诊断价值。结果术后感染组PCT、CRP、WBC水平均明显高于术前及非感染组术后水平(P<0.05)。不同感染程度患者治疗前的PCT水平比较差异有统计学意义(P<0.05),治疗后血清PCT均较治疗前明显下降,不同感染程度患者治疗后及脓毒症组治疗后的血清CRP均明显低于治疗前,但严重脓毒症及脓毒症休克组患者治疗前后比较差异无统计学意义(P>0.05),根据SOFA评分,术后各组间PCT水平比较差异均有统计学意义(P<0.05),CRP在评分>9分的患者间比较差异无统计学意义(P>0.05)。ROC曲线显示PCT的曲线下面积大于CRP(P<0.05)。结论患者血清PCT水平与PCNL术后感染程度有良好的相关性,动态监测PCT变化对术后早期诊断尿脓毒血症及准确判断其进展有着重要的临床价值。     

腹腔镜腹壁疝修补术联合围手术期康复训练对成人腹壁疝患者术后胃肠功能恢复及复发的影响

目的探讨腹腔镜腹壁疝修补术联合围手术期康复训练对成人腹壁疝患者术后胃肠功能恢复及复发的影响。 方法分析2016年2月至2018年12月在北京怀柔医院就诊的80例腹壁疝患者,根据患者所采取的手术方法分为对照组和观察组,各40例。2组均采用腹腔镜内补片植入术,观察组无康复介入,治疗组采用术前1周、术后3周的康复训练,训练内容包括腹式呼吸训练、腹内外斜肌、腹横肌、多裂肌、盆底肌等核心肌群激活训练。记录手术相关指标及胃肠功能恢复指标;检测并比较2组治疗前后血清白细胞介素-6（IL-6）、C-反应蛋白（CRP）水平;统计术中及术后并发症;随访1年,观察疝复发率。 结果相较于对照组,观察组术后疼痛时间和下床活动时间均缩短（P<0.05）,手术时间和术中出血量无明显差异（P>0.05）;观察组术后首次肠鸣音时间、肛门排气时间和首次排便时间均显著低于对照组（P<0.05）;术后2组IL-6和CRP水平均高于术前（P<0.05）,但观察组IL-6和CRP水平低于对照组（P<0.05）;观察组尿潴留发生率低于对照组（P<0.05）,2组患者的术中出血、肠管损伤、血清肿、慢性疼痛、复发率差异无统计学意义（P>0.05）。 结论腹腔镜腹壁疝修补术联合围手术期康复训练可促进成人腹壁疝患者术后胃肠功能恢复,降低机体炎性反应,且安全性高,降低术后复发率,具有较好的临床推广应用价值。     

YKL-40与IL-6在前列腺癌组织中的表达分析

目的 探讨人软骨糖蛋白-39（YKL-40）与白介素-6（IL-6）在前列腺癌组织中的表达。方法 选取2016年5月至2018年2月在本院接受根治性手术治疗的前列腺癌患者的前列腺组织标本42份纳入实验组,同期选取本院前列腺增生患者手术病理组织38份纳入对照组。分别采取Western blot及荧光PCR法检测两组患者组织标本中的YKL-40与IL-6表达水平,免疫组化法检测其阳性表达率,并分析其与前列腺癌临床病理特征的关系。结果 Western blot结果显示,实验组患者YKL-40、IL-6蛋白相对表达量高于对照组,差异具有统计学意义（P<0.05）;PCR实验结果显示,实验组患者YKL-40、IL-6 mRNA相对表达量高于对照组,差异具有统计学意义（P<0.05）;Ⅲ期、淋巴结转移及病理分级为低分化的前列腺癌患者YKL-40、IL-6阳性表达率高于Ⅰ～Ⅱ期、淋巴无转移以及病理分级为高中分化的前列腺癌患者,差异有统计学意义（P<0.05）;相关分析结果显示前列腺癌组织中YKL-40、IL-6表达呈正相关性（r=0.861,P<0.05）。结论 YKL-40、IL-6蛋白在前列腺癌中表达量较高,且与患者临床病理特征有一定的关联,此两种蛋白可以作为前列腺癌临床筛查标志物推广应用。     

Evaluation of urinary IL-1α and IL-1β in gravid females and patients with bacterial cystitis and microscopic hematuria

Objectives: to determine IL-1α and IL-1β levels in patients with bacterial cystitis, microscopic hematuria, and gravid females relative to a control group of normal subjects. Methods: enzyme immunoassays were used to measure concomitantly urinary IL-1α and IL-1β in clean catch urine samples from normal subjects (n=31) and study patients (n=46). All normal subjects and patients underwent urinalysis, urine culture, and urine creatinine level determination. Since the IL-1α assay was developed for serum, the utility of the assay for urine specimens was unknown. The key parameters of urine collection, processing and sample storage for IL-1α were evaluated in detail. Results: mean values ± SEM (pg/mg) for IL-1α/Cr and IL-1β/Cr were control group (0.25 ± 0.10 and 0.17 ± 0.06), bacterial cystitis (9.97 ± 1.15 and 42.45 ± 1.86), and microscopic hematuria (2.81 ± 0.65 and 2.82 ± 0.70). Differences in cytokine levels between the control group and patients with either bacterial cystitis or microscopic hematuria were statistically significant for both IL-1α/Cr (P<0.026; P<0.007, respectively) and IL-1β/Cr (P<0.0004; P<0.014, respectively). IL-1β/Cr correlates better with pyuria than IL-1α/Cr (P=0.02 vs P=0.44). In gravid females, only IL-1α was significantly elevated relative to non-pregnant females (IL-1β elevation approached statistical significance). Gravid females with positive urine cultures could not be distinguished from those with negative cultures based on either interleukin (P>0.05). Conclusions: Significant elevations of IL-1α and IL-1β occur in patients with bacterial cystitis and microscopic hematuria. Correlation between pyuria and cytokine elevation was stronger for IL-1β than for IL-1α. Changes in IL-1α may reflect changes in the bladder epithelium rather than in the inflammatory leukocytes. The ability of IL-1α and IL-1β to serve as markers for bacterial cystitis in gravid females is diminished due to high basal levels during pregnancy. Received: 30 June 1997 / Accepted: 3 December 1997     

乳腺癌YKL-40表达与预后关系的研究

目的：探讨YKL-40表达水平与乳腺癌预后相关因素的关系。方法：采用免疫组织化学SP法检测60例乳腺癌患者YKL-40表达,比较YKL-40表达与乳腺癌患者年龄、肿瘤直径、淋巴结转移、病理类型及TNM分期间的关系。结果：乳腺癌患者中YKL-40表达水平明显高于对照组（75％VS20％,P〈O．05）。肿瘤直径〉2cm患者YKL-40水平明显高于直径≤2cm组患者（P〈0．05）。随着肿瘤TNM分期进展,血清YKL-40表达水平逐渐升高（P〈O．05）。YKL-40在非浸润性和浸润性导管癌中表达率皆明显高于浸润性小叶癌（P〈O．05）。YKL-40表达阳性患者生存时间短于阴性患者[（36±4．9）月VS（49±7．5）月,P〈O．05],本组平均随访（35．4±2．39）月,YKL-40表达阳性患者病死率为22．2％（10／45）,表达阴性患者病死率为13.3％（2／15）。结论：YKL-40表达与乳腺癌预后相关,可望成为乳腺癌新的肿瘤标志物及治疗靶点。     

彩色多普勒超声结合血清C反应蛋白在腹股沟嵌顿疝中诊断的临床意义

目的分析彩色多普勒超声（以下简称彩超）结合血清C反应蛋白（CRP）在腹股沟嵌顿疝中诊断的临床意义。 方法选择2017年3月至2020年3月于阜阳市第五人民医院收治的60例腹股沟疝患者作为研究对象，每组患者30例。对照组为门诊收治的择期腹股沟疝患者，采用彩超结合CRP诊断；观察组为急诊收治的腹股沟嵌顿疝患者，采用彩超结合CRP诊断。分析2组患者的诊断效能及诊断符合率。 结果观察组患者术前斜疝诊断阳性的CRP水平明显高于对照组（P<0.05）。对照组患者的腹股沟斜疝阳性检出率为80.00%（24/30），稍低于观察组的86.67%（26/30）（P>0.05）。观察组患者的腹股沟斜疝诊断与手术结果相符合的阳性率为100%，稍高于对照组的93.33% （P>0.05）。观察组患者的准确度为100%、特异度为50.00%、灵敏度为92.31%、阴性预测值为50.00%、阳性预测值为92.31%，均稍高于对照组的93.33%、42.86%、86.96%、50.00%、83.33%（P>0.05）。 结论彩超检查可提高腹股沟疝的诊断准确性，还可密切观察病情变化，为临床诊治提供参考依据。CRP作为炎症的一种非特异性指标，对腹股沟嵌顿疝的鉴别诊断提供较好的依据。     

Clinical evaluation of urinary basic fetoprotein and the BTA test for detection of bladder cancer

We compared the results of urinary basic fetoprotein (BFP) and the BTA test with those of urinary cytology in patients with bladder cancer. We also analyzed the urinary BFP and the BTA test results in patients with benign diseases and postoperative bladder cancer with no evidence of recurrence. The cutoff value for urinary BFP was set at 10 ng/ml. Classes 4 and 5 according to urinary cytology were defined as positive. The sensitivity of urinary BFP for Ta, 1 bladder cancer was significantly higher than that of urinary cytology (p < 0.05). The urinary cytology positive rate for Ta, 1 bladder cancer improved when combined with urinary BFP and the BTA test. The urinary BFP positive rate for benign diseases was significantly higher in patients with pyuria than in patients without pyuria (p < 0.05). The BTA test positive rate for benign diseases was higher in patients with pyuria than in patients without pyuria. The urinary BFP and the BTA test positive rates for postoperative bladder cancer with no evidence of recurrence was significantly higher in patients with urinary diversion than in patients without urinary diversion (BFP: p < 0.01, BTA: p < 0.05).