反相斑点杂交快速诊断解脲脲原体基因型及其临床意义

目的:建立1个能用于临床标本直接分型的简单、实用、可靠性好的解脲脲原体基因分型方法;揭示正常携带状态及感染状态下解脲脲原体的基因型。方法:设计分型引物,用反相斑点杂交进行解脲脲原体基因型鉴定。结果:病例组与对照组解脲脲原体基因型的检出率差异无统计学意义,总检出率为89.1%。对照组中解脲脲原体以parvum群(微小脲原体)为主(79.3%),其检出率较女性下生殖道感染患者高(P=0.018),而且以其中的1、3、6基因型的单型别为主(82.6%)。病例组解脲脲原体中两群感染(16.2%)较对照组高(6.9%),差异有统计学意义(P=0.033),其中以T960群与1型的多型别感染在病例组较对照组高(P=0.009);在多型别感染中1型的检出率病例组较对照组高(P=0.026),而单型别感染中1型的检出率在对照组高(P=0.000)。结论:反相斑点杂交能进行解脲脲原体基因分型,方法简单、实用,有望发展成为用于临床标本的解脲脲原体分型的1种方法。Parvum群(微小脲原体),尤其是其中的1、3、6的单型别是正常人群携带的可能性较大。女性下生殖道感染患者解脲脲原体的两群感染较正常体检人群高,尤以T960群与parvum群中1型的多型别感染较正常体检人群高,提示T960群有可能和1型起协同作用或独自导致疾病。     

Effects of magnesium hydroxide in renal stone disease

Magnesium is a known inhibitor of the formation of calcium oxalate crystals in the urine and was proposed for prophylactic treatment in renal stone disease as early as the 17th and 18th centuries. We have treated 55 patients with recurrent renal calcium stone disease without signs of magnesium deficiency (normal serum magnesium, urinary magnesium, intracellular magnesium in muscle biopsies, gastrointestinal absorption of 28Mg, and magnesium loading test) from our outpatient stone clinic for up to four years with 500 mg Mg2+, in the form of Mg(OH)2, daily. The mean stone episode rate before therapy was 0.8 stones/year/patient. Forty-three recurrent renal calcium stone-formers without medical therapy served as controls. Serum magnesium increased initially but after one year returned to the pretreatment level. Urinary magnesium excretion increased promptly and remained elevated during the follow-up period. The urinary calcium excretion remained unchanged. The magnesium/calcium ratio in the urine increased and approached a value earlier found in healthy subjects without stone disease. Urinary citrate increased on therapy when analysed after three years of treatment. The mean stone episode rate decreased from 0.8 to 0.08 stones/year on treatment and 85% of the patients remained free of recurrence during follow-up, whereas 59% of the patients in the control group continued their stone formation. Side effects were few. Magnesium treatment in renal calcium stone disease is effective with few side effects. No clinical signs of magnesium excess were observed.     

Effects of magnesium hydroxide in renal stone disease.

Magnesium is a known inhibitor of the formation of calcium oxalate crystals in the urine and was proposed for prophylactic treatment in renal stone disease as early as the 17th and 18th centuries. We have treated 55 patients with recurrent renal calcium stone disease without signs of magnesium deficiency (normal serum magnesium, urinary magnesium, intracellular magnesium in muscle biopsies, gastrointestinal absorption of 28Mg, and magnesium loading test) from our outpatient stone clinic for up to four years with 500 mg Mg2+, in the form of Mg(OH)2, daily. The mean stone episode rate before therapy was 0.8 stones/year/patient. Forty-three recurrent renal calcium stone-formers without medical therapy served as controls. Serum magnesium increased initially but after one year returned to the pretreatment level. Urinary magnesium excretion increased promptly and remained elevated during the follow-up period. The urinary calcium excretion remained unchanged. The magnesium/calcium ratio in the urine increased and approached a value earlier found in healthy subjects without stone disease. Urinary citrate increased on therapy when analysed after three years of treatment. The mean stone episode rate decreased from 0.8 to 0.08 stones/year on treatment and 85% of the patients remained free of recurrence during follow-up, whereas 59% of the patients in the control group continued their stone formation. Side effects were few. Magnesium treatment in renal calcium stone disease is effective with few side effects. No clinical signs of magnesium excess were observed.     

泌尿生殖道解脲脲支原体感染的分子流行病学研究

目的了解粤东地区泌尿生殖道感染人群中解脲脲支原体的感染及其型别分布。方法用液体选择培养基进行临床标本的初筛,再用PCR法进行分群和分型。结果1 790例临床标本中解脲脲支原体阳性670例（37.43%）,对392例阳性培养物进行分群,生物1群阳性率为71.94%;生物2群阳性率为29.85%;对264例单纯生物1群阳性标本进行PCR分型结果血清型1有20例（7.58%）,血清型3或14有139例（52.65%）,血清型6有51例（19.32%）并有大量混合感染;对99例单纯生物2群感染标本的PCR分型结果,基因型3（血清型7、11）最低,基因型1和2感染率较高。结论粤东地区泌尿生殖道感染人群中,解脲脲支原体以生物1群中的血清型3和血清型6单纯感染为主,但不同血清型或基因型在该地区的分布有一定的特征性。     

女性尿路感染者病原学监测

目的了解女性尿路感染者病原学状况. 方法采集76例女性尿路感染者进行了阴道分泌物常规涂片微生物学检查、阴道加德纳菌(Gv)和解脲脲支原体(Uu)核酸检测,并收集中段尿液作常规细菌培养分离鉴定、Gv和Uu核酸检测. 结果76例女性尿路感染者阴道分泌物中共有70例(92.1%)检出病原菌,其中Gv58例(76.3%)、Uu49例(64.5%)、滴虫4例(5.3%)、念珠菌属8例(10.5%);中段尿液中共有65例(85.5%)检出病原菌,其中Gv45例(59.2%)、Uu26例(34.2%)、细菌25例(32.8%);无论阴道分泌物标本还是中段尿液标本存在多种病原菌混合感染. 结论Gv、Uu已是女性尿路感染的重要病原菌.     

临床分离的解脲脲支原体耐药性的变迁

目的了解医院2001~2003年临床分离的解脲脲支原体耐药性的变迁,更好的指导临床合理用药。方法对2001~2003年就诊的可疑非淋菌性尿道炎(宫颈炎)患者进行解脲脲支原体的培养及药敏检测。结果2001年1 386例中解脲脲支原体培养阳性1 003例;2002年1 015例中解脲脲支原体培养阳性801例;2003年908例中解脲脲支原体培养阳性691例;米诺环素和多西环素3年中耐药性均<4%;交沙霉素的耐药性2003年显著上升;大环内酯类罗红霉素和阿奇霉素的耐药性均较高,喹诺酮类药物环丙沙星和氧氟沙星耐药性呈较高水平。结论解脲脲支原体的药物敏感性随时间的变化而变化,定期监测解脲脲支原体的耐药性十分必要。     

解脲支原体感染率及耐药性动态监测

目的:了解该地区2000~2004年间解脲支原体(Uu)年感染率以及对10种抗菌药的耐药率年动态变化。方法:Uu鉴定采用培养法。Uu药敏试验选定罗红霉素、克拉霉素、交沙霉素、氧氟沙星、四环素、可乐必妥、阿齐霉素、红霉素、强力霉素、美满霉素等10种抗菌药,以培养液稀释法进行。结果:2000~2004年,解脲支原体(Uu)的感染率分别为:26.67%、28.16%、29.50%、36.07%、42.40%。Uu对一些抗菌药物的耐药率逐年升高,而对几种抗菌药物其耐药率变化不大。结论2000年同2004年比较,解脲支原体(Uu)的感染率有所升高(P<0.01),Uu对可乐必妥阿齐霉素、罗红霉素、氧氟沙星的耐药率均升高(P<0.01)。2004年对此4种抗菌药已经产生相当程度的耐药。2000~2004年,Uu对交沙霉素、美满霉素、强力霉素的耐药率基本无变化(P>0.05),仍然保持较低的耐药率。2000~2004年,Uu对四环素、红霉素的耐药率变化不明显(P>0.05),仍然居高(>30%)。2004年,Uu对红霉素的耐药率最高(42.73%),对交沙霉素的耐药率最低(4.71%)。     

粵北石灰岩地区泌尿系结石的饮食预防

目的探讨粵北石灰岩地区泌尿系结石患者饮食预防的效果。方法收集1800例泌尿系结石患者的结石标本,根据有无进行结石成分分析试验分为试验组和对照组,试验组900例患者根据病情和结石成分分析结果为其制定饮食预防方案,并进行个性化的饮食指导,对照组900例患者主要根据其病情进行饮食指导,随访时间为6个月-2年。结果试验组复发率为10.10%,对照组复发率为23.55%;试验组明显降低了结石的复发率,两组比较有显著性差异﹙p<0.05),有统计学意义。结论通过结石成分分析结果和患者的病情为其制定个性化的饮食方案,避免了盲目的饮食指导,使饮食宣教做到有理有据;通过饮食干预,使患者尿中成石物质的含量、p H值及结石的形成环境明显改善,可预防或降低泌尿系结石的复发。     

检测不孕症妇女宫颈分泌物、盆腔液解脲支原体和沙眼衣原体的临床意义

目的:探讨检测不孕症妇女体内解脲支原体和沙眼衣原体的临床意义。方法:选择近期在不孕症门诊收治的不孕症妇女90例,另收集120例正常妇女临床文献资料作为对照组。检测两组妇女宫颈分泌物、盆腔液中解脲支原体和沙眼衣原体情况,比较两组妇女UU与CT感染率差异,并分析原发性不孕与继发性不孕感染率差异。结果:90例不孕症妇女宫颈分泌物UU感染检出率为28.9%,显著高于健康对照组的8.3%(P<0.05);继发性不孕妇女宫颈分泌物UU、CT病原体检出率分别为37.7%(23/61)、9.8%(6/61),比原发不孕组显著增高,且继发性不孕妇女盆腔液UU检出率也较原发不孕组明显增高。结论:解脲支原体和沙眼衣原体是导致不孕症发生的重要因素,定期检测解脲支原体和沙眼衣原体具有重要的临床意义。     

上尿路尿酸结石的成分和代谢的分析

目的：分析顺德勒流地区上尿路尿酸结石成分与代谢异常的关系,探讨尿酸结石形成的代谢性因素,为临床预防和治疗上尿路尿酸结石提供新的依据。方法：252例上尿路结石患者中83例尿酸结石,其中64例完整血生化及24h尿分析结果。结果：纯尿酸成分结石占尿酸结石总数的34.9%（29/83）,混合成分结石占65.1%（54/83）。64例有完整血生化及24h尿分析结果患者中代谢异常52例（81.3%）,两种以上代谢异常所占比例为43.8%（28/64）。56例随访10～42个月,平均20个月。无泌尿系结石复发32例,复发24例,无复发组代谢无异常9例,复发组1例（P〈0.05）。结论：确定尿酸结石成分及患者的代谢评价对上尿路尿酸结石的成因、治疗和预防有重要的临床意义。     

不孕不育患者支原体感染情况和耐药率分析

目的探讨本地区不孕不育患者解脲支原体(Ureaplasma urealyticum,UU)和人型支原体(Mycoplasma hominis,MH)感染率和耐药率,以期了解支原体在该人群流行情况和耐药率变化情况,为治疗选择合适的抗菌药物。方法对2012年1月-2013年11月期间济宁市第一人民医院生殖科门诊4 266例不孕不育患者培养法检测UU和MH,并对1 557例阳性标本行体外药敏实验,分析其耐药现状。结果不孕不育患者支原体总感染率为36.5%,UU感染率显著高于MH感染率(P0.01)。男性和女性生殖道支原体感染率分别为31.8%、45.4%,女性支原体感染率显著高于男性(P0.01)。生殖道支原体对喹诺酮类抗菌药物耐药率相对较高,对大环内酯类和四环素类耐药率较低。2013年支原体对12种抗菌药物的耐药率同比多数降低。MH对多数抗菌药物耐药率均较高,对美满霉素、强力霉素药物高度敏感。结论不孕不育患者具有较高的UU和MH感染率,支原体对常用抗菌药物有一定耐药性,临床应根据药敏结果有选择性地使用抗菌药物。     

Fluid intake and epidemiology of urolithiasis

A low urine volume is an important risk factor in urinary stone formation. The present article summarizes available data from epidemiological and clinical studies to elucidate the impact of fluid intake and urine volume on the risk of urinary stone formation and the prevention of stone recurrence. A review of the literature shows that an increased urine volume achieved by a high fluid intake exerts an efficacious preventive effect on the onset and recurrence of urinary stones. A high water intake and urine dilution results in a marked reduction in saturation of lithogenous salts. The type of fluids should be carefully selected to achieve the appropriate change of urine composition depending on stone composition. A sufficient intake of fluid is one of the most important preventive measures for stone recurrence.     

From gene to disease; SLC3A1, SLC7A9 and cystinuria

In total, 1-2% of adults and 6-8% of children suffering from kidney stones have cystinuria, a defect in the transport of amino acids, which leads to high concentrations of cystine in the urine. Two genes have been implicated, solute carrier family 3 (cystine, basic and) neutral amino acid transporter, member 1 (SLC3A1) coding for the protein related to the system bo,+ amino-acid transporter, and solute carrier family 7, member 9 (SLC7A9), coding for the protein bo,+AT. There are three clinically defined types of cystinuria. Type I (autosomal recessive) is characterised by mutations in the SLC3A1 gene; carriers have normal cystine levels in urine. In total 80% of non-type-I patients have a detectable mutation in the SLC7A9 gene. First-degree relatives of a patient with type 2 (dominant) or type 3 (incomplete recessive) cystinuria may have slightly elevated cystine levels in the urine. The early recognition and treatment of cystinuria is important because recurrent stone formation may lead to urinary tract infection and, eventually, renal failure.     

继发不育男性患者泌尿生殖道解脲脲原体基因分型鉴定分析

目的 了解继发不育男性患者泌尿生殖系解脲脲原体(UU)的感染状况.方法 对572例男性继发不育患者取尿道和前列腺分泌物标本进行培养,采用聚合酶链反应(PCR)和基因型分型技术,时其泌尿道生殖系UU进行生物变种和基因型分型鉴定,分析其结果.结果 572例男性继发不育患者,UU培养阳性278例(48.6%);PCR基因扩增检测UU-DNA阳性311例(54.4%).其中生物变种(biovar)1和生物变种2分别为212例(37.1%)和99例(17.3%);基因分型结果:生物变种1血清变种(serovar)1、3/14、6分别为71例(12.4%)、98例(17.2%)、43例(7.5%).生物变种2亚型(subtype)1、2、3分别为32例(5.6%)、51例(8.9%)、16例(2.8%).结论 UU感染是男性继发不育的重要危险因素,MBA多带抗原基因与16S-rRNA基因和尿素酶基因分型鉴定具有简便,快速,敏感,特异之优点.     

新生儿呼吸道解脲支原体的感染情况与药敏分析

目的检测新生儿呼吸道解脲支原体感染情况,并对阳性病例进行药敏分析,为新生儿解脲支原体感染诊治提供基础。方法收集2019年1月-10月在新生儿科住院患儿呼吸道分泌物和全血样品共298例,分别进行荧光定量PCR检测和全血WBC、CRP检测,PCR阳性结果进行支原体培养并做药敏试验。结果新生儿呼吸道解脲支原体阳性检出率为8.39%,新生儿UU阳性组与UU阴性组WBC与CRP比较差异无统计学意义,药敏分析显示解脲支原体对大环内酯类交沙霉素、克拉霉素、红霉素和阿奇霉素敏感率分别为80.0%、98.0%、76.0%和84.0%;对喹诺酮类氧氟沙星和环丙沙星敏感率为4.0%和20.0%;对四环素类强力霉素和四环素敏感率为100.0%;对原始霉素敏感率为100.0%。结论部分解脲支原体可经母体定植于新生儿呼吸道,大环内酯类红霉素对解脲支原体出现少部分中介和耐药现象,但因其安全性高,可继续应用于临床治疗解脲支原体感染。     

Urinary stone disease - assessment and management

Background Urinary stones affect one in 10 Australians. The majority of stones pass spontaneously, but some conditions, particularly ongoing pain, renal impairment and infection, mandate intervention. Objective This article explores the role of the general practitioner in the assessment and management of urinary stones. Discussion The assessment of acute stone disease should determine the location, number and size of the stone(s), which influence its likelihood of spontaneous passage. Conservative management, with the addition of alpha blockers to facilitate passage of lower ureteric stones, should be attempted in cases of uncomplicated renal colic. Septic patients require urgent drainage and antibiotics. Other indications for referral and intervention include ongoing pain, renal impairment and stone size unlikely to pass spontaneously. There are many ways to eliminate stones, but laser lithotripsy is being used with increasing frequency. Up to 50% of people with a first presentation of stone disease will have a recurrence within 5 years. General advice for stone prevention consists of increasing fluid intake, especially water (sufficient to maintain dilute urine output), avoiding added salt and maintaining a well balanced low oxalate diet. Some patients may require a more detailed metabolic assessment and specific dietary advice.     

泌尿生殖道沙眼衣原体感染患者实验室检测分析

目的分析181例实验室诊断沙眼衣原体感染患者的相关实验室检查资料。方法采用细胞培养法进行沙眼衣原体实验室检测,同时检测患者相关性传播疾病的实验室指标。结果沙眼衣原体细胞培养检出率5.45%,患者中单纯由沙眼衣原体感染128例(70.72%),合并解脲脲支原体感染53例(29.28%),亦较少合并生殖器疱疹病毒和真菌感染;沙眼衣原体引起的非淋菌性尿道炎或宫颈炎疾病的治疗主要为大环内酯类、四环素族及喹诺酮类的联合用药,治疗效果未见明显耐药。结论单纯沙眼衣原体感染及其与解脲脲支原体合并感染导致非淋菌性尿道炎或宫颈炎,男性患者亦合并其他性传播疾病,疾病的治疗以联合应用抗菌药物为主。     

Acute Epididymitis: Etiology and Therapy

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of “idiopathic epididymitis” in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.     

非细菌性前列腺炎患者衣原体和支原体检测分析

目的：研究衣原体和支原体是否为非细菌性前列腺炎（nonbacterial prostatitis,NBP)的病原体？方法：采用聚合酶链反应（PCR）技术和细菌培养方法，对43例NBP患者的初段尿、中段尿、前列腺液和按摩后尿液进行解脲支原体和沙眼衣原体及细菌检测。结果：43例中所有标本细菌培养均阴性；初段尿和中段尿标本支原体和衣原体PCR检测均阴性；仅1例前列腺液和按摩后尿液解脲支原体阳性，而沙眼衣原体均阴性。结论：解脲支原体和沙眼衣原体并非NBP的主要致病原，NBP的确切病因有待进一步研究。     

306例泌尿生殖道支原体感染及耐药性调查

目的调查泌尿生殖道解脲脲支原体和人支原体感染及耐药情况,指导临床合理用药。方法对临床收集的306例泌尿生殖道支原体感染患者,进行12种抗菌药物药敏试验并统计结果。结果 306例疑似支原体属感染患者中,总阳性率为63.7%,解脲脲支原体单一感染阳性率为46.4%,解脲脲支原体和人支原体混合感染阳性率为13.1%,人支原体单一感染阳性率为4.2%;药敏试验结果表明,支原体对交沙霉素和多西环素的敏感性较高,为95.4%和93.3%;同时,对环丙沙星和红霉素的耐药性较高,为83.1%和66.1%。结论支原体属,尤其是解脲脲支原体,是女性泌尿生殖道常见的病原体;治疗支原体属感染应选择交沙霉素和多西环素等敏感率高的药物,避免环丙沙星和红霉素等耐药性高的药物。