泌尿生殖道解脲支原体检测及药敏分析

目的探讨泌尿生殖道支原体感染情况及其对药物的敏感程度。方法对临床拟诊为非淋菌性尿道炎的606例患者采取尿道口处分泌物或前列腺液(男性)、宫颈口处分泌物(女性)行解脲支原体(Uu)和人支原体(Mh)检测及药物敏感分析。结果606例患者支原体培养阳性399例,占65.8%,单一Uu感染319例,单一Mh感染15例,Uu+Mh混合感染65例;Uu感染与Uu+Mh感染具有不完全相同的耐药谱。结论Uu感染与Uu+Mh感染的耐药谱不同,故临床不但要进行Uu检测,还要进行Mh检测,否则会造成漏诊。     

急性脱髓鞘性脑病临床分析

目的 探讨急性脱髓鞘性脑病的诊断和治疗。方法 对20例病人的临床特点、诊断、治疗方法和疗效进行分析。结果 半数以上患者病前有感染史，中青年多发，意识障碍多见，脑MRI检查均可发现相应病变，治愈好转率达85％。结论 临床表现多样，影像学有助于明确诊断，肾上腺皮质激素治疗疗效佳，预后好。     

宫颈衣原体及支原体检测及耐药分析

目的：了解女性泌尿生殖道沙眼支原体（CT）、解脲衣原体（Uu）与人型支原体（Mh）感染及耐药性的现状,为临床合理使用抗菌药物提供依据。方法：选择妇产科、皮肤性病门诊及住院女性患者1232例,选择10种抗生素,采用抗原抗体快速免疫法检测宫颈分泌物中病原体,液体药敏一体培养基法进行药敏试验。结果：CT阳性111例（9.0%）,Uu阳性509例（41.3%）,Mh阳性68例（5.5%）,CT＋Uu同时阳性45例（3.7%）,Uu＋Mh同时阳性39例（3.2%）;CT＋Uu＋Mh同时阳性7例（0.6%）。交沙霉素、多西环素、克拉霉素耐药率在5%以下,氧氟沙星为38.7%,环丙沙星达82.1%。结论：泌尿生殖道感染支原体、衣原体感染率高,以CT、Uu感染为主;交沙霉素、多西环素、米诺霉素、克拉霉素等抗生素对Uu耐药性低。     

泌尿生殖道支原体感染耐药性分析

目的：了解解脲支原体（Uu）和人型支原体（mh）的感染情况及其对环脂红霉素（ECC）强力霉素（DOX）交沙霉素（JOS）甲砜霉素（THI）克拉霉素（CLA）红霉素（ERY）环丙沙星（CPF）罗红霉素（ROX）可乐必妥（CRA）美满霉素（MIN）阿歧霉素（AZI）司帕沙星（SPA）12种药物的耐药情况。方法：采用珠海浪峰生物技术有限公司生产的支原体培养、鉴别、计数、药敏试剂盒进行试验。结果：488例患者中检出支原体阳性145例占27．7％，其中单一Uu感染82例占56．6％单一mh感染6例占4．1％Uu、mh混合感染57例占39．3％。结论：本地区感染支原体经Uu单独感染及Uu、mh混合感染为主，单独mh感染较少，其耐药性表现为对强力霉素、交沙霉素、克拉霉素等较为敏感，而对阿歧霉素、司帕沙星、环丙沙星不敏感，mh对强力霉素敏感。     

男性不育410例解脲支原体感染的检测与治疗

为了解男性不育患者精液解脲支原体（Uu）感染及临床治疗效果，2007年1月-2009年3月，我们对男性不育410例进行了Uu检测，并对阳性者行药敏试验及治疗，效果满意。现分析报告如下。     

泌尿生殖道支原体检测及药敏结果分析

目的了解解脲脲原体（Uu）和人型支原体（Mh）的感染情况及其对抗生素的敏感性以指导临床合理用药。方法应用法国梅里埃公司IST支原体试剂盒进行支原体鉴定及药敏检测，并对结果进行统计学分析。结果1008例样本中，阳性数为781例，其中Uu阳性572例，占56．o％，Mh阳性40例，占4．0％，Uu＋Mh阳性169例，占16．7%。对9种抗生素强力霉素、交沙霉素、氧氟沙星、红霉素、四环素、环丙沙星、阿齐霉素、克拉霉素和原始霉素的药物敏感率,Uu分别为89．3‰、95．1％、17．5％、64．3‰、84．1％、14．8％、77．8％、90．8％和96．5％，Mh分别为86．0％、78．9％、23．2％、0．0％、73．2％、57．1％、0．0％、7．7‰和83．9‰。与2000-2003年药敏结果比较，2004年阿齐霉素和克拉霉素耐药率显著升高（P〈0．01）。结论支原体感染以uu为主，强力霉素、交沙霉素、克拉霉素、原始霉素对uu的敏感性较好，而克拉霉素、红霉素和阿齐霉素对Mh高度耐药。临床用药应根据支原体的种类和药物敏感性进行选择。     

泌尿生殖道支原体培养及耐药结果分析

目的通过分析我院患者泌尿生殖道支原体感染情况及耐药情况,指导临床合理用药。方法对514例疑似支原体感染患者采用珠海丽拓发展有限公司试剂盒进行支原体培养及药敏试验。结果支原体阳性患者332例检出率64.6%,其中单纯Uu(解脲支原体)感染30.2%,混合感染34.4%;男性支原体阳性检出率35.5%,女性为75.3%。药敏结果显示:敏感性较高的抗生素为强力霉素和美满霉素,耐药性较高的抗生素有诺氟沙星、氧氟沙星、红霉素、司帕沙星、左氧氟沙星、阿奇霉素、罗红霉素。结论泌尿生殖道感染的主要病原菌为Uu或Uu+Mh(人型支原体)混合感染,单纯Mh感染临床少见。支原体耐药情况十分普遍,为减少耐药菌株的产生,临床治疗应尽量进行支原体培养及药敏试验,选用敏感抗生素并足疗程正规使用。     

解脲支原体感染与宫颈糜烂的关系

目的：了解解脲支原体（Uu）感染与宫颈糜烂的关系方法：采用液体培养法对600例宫颈糜烂患者和300例健康对照者进行Uu的检测,并根据宫颈糜烂患者病变程度及病程进行分组研究。结果：宫颈糜烂患者Uu检出率为43.2%明显高于对照组7.7%（P〈0.01）,其中轻度宫颈糜烂患者检出率为6.1%,中度为21.1%,重度45.9%。各组检出率经统计学处理有显著差异（P〈0.05）;宫颈糜烂病程与Uu感染呈正相关,病程〉12月的宫颈糜烂患者的Uu感染率明显升高（P〈0.05）。结论：Uu感染在宫颈糜烂发病中起重要作用;宫颈糜烂病程越长、宫颈糜烂程度越重,Uu感染率越高。     

左氧氟沙星治疗下呼吸道感染40例疗效分析

目的：观察左氧氟沙星治疗下呼吸道感染的临床疗效、细菌清除率和不良反应.方法：40例患者均予左氧氟沙星注射液,感染者每日剂量0.4 g,静注,0.2 g/次,2次/d,疗程7～10 d.结果：0例患者中,治愈32例,好转6例,无效2例,总有效率95%.结论：左氧氟沙星治疗下呼吸道感染疗效确切、不良反应少而轻微,可作为治疗下呼吸道感染的理想用药.     

上饶地区NGU患者支原体与沙眼衣原体感染状况及支原体耐药性分析

目的了解江西上饶地区非淋菌性尿道炎（NGU）患者解脲脲原体（Uu）、人型支原体（Mh）与沙眼衣原体（Ct）感染状况,分析支原体的耐药性,指导本地区临床合理用药。方法 采用支原体的分离鉴定与药敏试剂盒检测拟诊为NGU患者Uu与Mh,同时用实时荧光定量PCR（FQ-PCR）检测Ct,分析NGU病原体的构成比与支原体的耐药性。结果 886例标本中,Uu、Mh与Ct的检出率分别为41.4%、7.7%和14.4%,男性感染率明显低于女性。药敏试验结果显示,Uu、Mh和Uu＋Mh对药物的敏感性最高者为交沙霉素和多西环素,Uu对罗红霉素、氧氟沙星和司帕沙星耐药性高,Mh及Uu＋Mh则对罗红霉素、阿奇霉素和克拉霉素耐药性高。结论本地区NGU病原体构成主要为Uu,治疗本地区泌尿生殖道支原体感染可首选交沙霉素与多西环素。     

Isolation of Chlamydia trachomatis or Ureaplasma urealyticum from the synovial fluid of patients with Reiter's syndrome

BACKGROUND: The aim of this study was to contribute to the insight of the role of the infectious agent in ethiopathogenesis of the Reiter's syndrome development, which could directly influence the choice of treatment of these patients. METHODS: Eighteen patients with urogenital form of the Reiter's syndrome and 16 controls (6 with rheumatoid arthritis and 10 with pigmented villonodular synovitis) were included in the study. In all patients standard laboratory analyses of the blood, urine and stool were made; antibody titer to Chlamydia trachomatis and Ureaplasma urealyticum was determined in synovial fluid and serum; isolation of Chlamydia trachomatis and Ureaplasma urealyticum in urethral, cervical and conjunctival swabs, as well as in prostatic and synovial fluid, was also made. HLA typing was done, too. Chlamydia was isolated in the McCoy cell culture treated with cycloheximide, while Ureaplasma was identified according to its biochemical properties grown on cell-free liquid medium. RESULTS: Chlamydia trachomatis was isolated from the synovial fluid of 4 patients with Reiter's syndrome (22.2%), while Ureaplasma urealyticum was isolated in 7 of them (38.9%). These microorganisms were not found in any synovial fluid of the control group patients. CONCLUSION: Presence of these bacteria in the inflamed joint might be an important factor in etiopathogenesis of this disease, and it supports the hypothesis that arthritis in Reiter's syndrome is probably of the infectious origin.     

Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging

A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflamatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter's syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular disease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration.     

胃食管反流病导致心肺系统急症临床分析

目的探讨因胃食管反流病（GERD）所致心肺系统急症患者的临床特点以及可能的诊疗策略。方法2006年5月-2011年5月间急诊患者37例,男17例,女20例;平均年龄（42．9±11.3）岁;症状包括心前区闷痛9例、胸骨后灼痛11例、胸痛伴左上肢放射痛5例、刺激性剧烈咳嗽3例、慢性咳嗽急性加重4例、急性喘息发作4例、突发呼吸窘迫1例。发病前情况包括饱食饮酒11例、兴奋活动8例、寒冷刺激6例、吸人异味5例、安静休息7例。所有患者来院后均即刻完善病史采集;予以吸氧,监测心率、血压,开放静脉通路,予以解痉、平喘、扩冠,改善微循环,对症治疗;同时完善常规及相关辅助检查。如需要,待症状平稳后,予以复查或进一步完善专科检查以明确诊断。确诊后予以正规治疗并定期经门急诊复查随访。结果 1例患者因声门水肿而接受气管插管及大剂量激素冲击和脱水等治疗后好转。其余患者经及时解痉、平喘、扩冠和改善微循环等治疗后,症状均明显缓解,症状持续时间25min-4h,平均2．5h。所有患者行辅助检查并完善呼吸及循环相关专科检查后排除心肺系统疾病诊断,但患者症状反复发作,后经详细追问病史并完善各项检查,其中30例胃镜检查后确诊为GERD,疾病程度包括Ⅲ级10例（33．3％）、Ⅱ级15例（50％）、Ⅰ级5例（16．7％）。行正规抑酸、促排空及粘膜保护治疗后症状改善明显,经定期复查胃镜显示疾病控制满意,29例患者治愈,5例好转,仅2例高龄患者无效。91．9％的患者随访至今,中位随访时间41个月（15-75个月）,前述心肺系统急症未再次出现。结论GERD引起的心肺系统急症在临床容易误诊误治,且在一定程度上可诱发真正的心肺系统事件发生,应引起临床医生的重视,必要时试验性治疗是可选择的诊治方法之一。     

The scintigraphic investigation of sacroiliac disease.

Bone scintigraphs obtained with both Technetium-99m polyphosphate and Technetium-99m pyrophosphate have been abnormal at the sacroiliac joints of 44 patients with definite ankylosing spondylitis (AS). Because of the normal registration of the sacroiliac joints on bone scintigraphy, it has been necessary to develop a profile-scan technique to quantify the abnormality that proves to be significantly different from the normal finding. In 17 patients with a strong clinical suspicion of AS but normal radiographs, the sacroiliac joints have frequently been abnormal. This finding is meaningful because there is a common occurence in this group of the histocompatibility antigen HL A-B27, known to be a marker of AS. We also note the frequency of abnormal sacroiliac scinitigrams in 26 patients with rheumatoid arthritis and in a group of other diseases-Crohn's disease, uveitis, psoriasis, ulcerative colitis, and Reiter's disease-all of which share some of the manifestations of AS.     

HLA-B27 associated arthropathies

The association between histo-compatibility antigens and disease is reviewed, in particular that between HLA-B27 and spondylitic disorders, i.e., ankylosing spondylitis, Reiter's arthritis, psoriatic arthritis, and ankylosing hyperostosis. We determined whether the presence of HLA-B27 predicted specific radiographic findings and, conversely, whether specific radiographic changes predicted antigenic status. The prevalences of the HLA-B27 antigen in our patients were: ankylosing spondylitis, 100%; Reiter's arthritis, 93%; psoriatic arthritis, 55%; and ankylosing hyperostosis, 12%. The only specific radiographic finding associated with B27 positivity was severe spondylitis in psoriasis.     

女性泌尿生殖道感染患者衣原体检测支原体培养及药敏分析

目的了解大连地区女性泌尿生殖道感染患者衣原体支原体感染及药敏情况。方法回顾性总结分析2008年1月—2009年10月大连医科大学附属第一医院及大连市妇产医院就诊的女性泌尿生殖道感染患者衣原体抗原检测支原体培养及药敏试验结果。衣原体抗原检测采用免疫层析法,支原体鉴定采用培养法,药敏试验采用药敏试剂盒。结果 4368例衣原体抗原检测患者感染沙眼衣原体(CT)152例(3.48%);5530例支原体培养及药敏试验患者支原体感染2729例(49.35%),其中单纯解脲脲原体(Uu)感染率最高占总感染率82.50%。支原体对13种抗菌药敏感性高的是多西环素、美满霉素、交沙霉素;耐药性高的是林可霉素、环丙沙星、罗红霉素。结论女性泌尿生殖道感染患者既有单纯感染又有混合感染,以单纯解脲支原体感染为主,其次为解脲支原体和人型支原体混合感染。临床应根据感染类型及抗菌药敏感性不同选择有效的抗生素进行治疗。     

海岛地区虫咬伤致下肢坏死性筋膜炎治疗策略

目的探讨海岛地区虫咬伤致下肢坏死性筋膜炎的临床特点及治疗方法。方法回顾性分析自2010年1月至2014年12月解放军第四一三医院收治的虫咬伤致下肢坏死性筋膜炎患者的临床资料,分析总结治疗经验。结果本组患者经控制感染,积极行负压治疗及手术,创面全部愈合。结论海岛地区气候易引发虫咬伤,应引起重视预防。采用积极治疗基础疾病,控制感染清创手术,有效避免截肢。     

泌尿生殖道解脲支原体和人型支原体的耐药性分析

目的了解格尔木地区泌尿生殖道解脲支原体（Uu）和人型支原体（Mh）的感染状况及耐药性,指导临床合理用药。方法采用支原体培养、鉴定、药敏-体化试剂盒,对891例泌尿生殖道取材标本进行支原体培养、鉴定及药敏试验。结果 Uu单独阳性率36．29％,Uu＋Mh阳性率10．21％,Mh单独阳性率0．67％,三者阳性率具有显著性差异（P＜0．01）。男、女受检者阳性率分别为37．6％、61．87％,男、女泌尿生殖道支原体感染率有显著性差异（P＜0．01）。药敏试验结果显示：Uu、Mh、uu＋Mh感染对交沙霉索、强力霉素、甲砜霉素敏感性均较高,而对红霉素、斯帕沙星、可乐必妥、环丙沙星具有较高的耐药性。结论 格尔木地区Mh、Uu＋№耐药性比较严重,应引起重视。交沙霉索和强力霉素可作为目前治疗泌尿生殖道Uu、№、Uu＋Mh感染的首选药物。     

激光治疗慢性宫颈炎后愈合不良与非淋菌性感染的关系

目的探讨激光治疗慢性宫颈炎后愈合不良与非淋菌性感染的关系。方法选择经激光治疗后愈合不良的慢性宫颈炎患者64例，愈合良好的患者53例，记录两组患者术前宫颈糜烂面积，激光术后检测宫颈拭子沙眼衣原体、解脲脲支原体。结果愈合不良组衣原体感染率25．0％（16／64），支原体感染率32．8％（21／64）；愈合良好组衣原体感染率3．8％（2／53），支原体感染率11．3％（6／53），两组比较差异有显著意义（P〈0．01）。宫颈感染支原体、衣原体后，宫颈呈中、重度炎症。结论非淋菌性感染影响激光治疗慢性宫颈炎的预后。     

反复性自然流产患者细菌性阴道病及解脲支原体感染状况118例分析

目的了解反复性自然流产患者下生殖道细菌性阴道病及解脲支原体感染情况。方法对118例反复性自然流产患者作为实验组及109例有正常妊娠史的健康体检者作为对照组,进行下生殖道细菌性阴道病及解脲支原体感染检测。结果实验组细菌性阴道病感染28例(23.7%),解脲支原体感染49例(41.5%),二者双重感染25例(21.2%);对照组细菌性阴道病感染13例(11.0%),解脲支原体感染22例(20.2%),二者双重感染9例(8.3%),实验组与对照组比较有统计学意义(P<0.05)。自然流产2次患者细菌性阴道病感染16例(21.0%),解脲支原体感染28例(36.8%),二者双重感染15例(19.7%)。自然流产≥3次患者细菌性阴道病感染13例(28.6%),解脲支原体感染21例(50.0%),二者双重感染10例(23.8%)。随着流产次数的增加解脲支原体感染率上升(P<0.05),细菌性阴道病及二者双重感染率也呈上升趋势,但无统计学意义(P>0.05)。结论下生殖道细菌性阴道病及解脲支原体感染与反复性自然流产之间存在一定相关性,孕前检查要重视筛查细菌性阴道病及解脲支原体感染情况。