尿中性粒细胞明胶酶相关脂质运载蛋白对儿童急性肾盂肾炎诊断价值的探讨

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对儿童急性肾盂肾炎（APN）的诊断价值。方法 研究对象为 2016 年 12 月—2017 年 5 月收治的尿路感染（UTI）患儿 104 例,包括急性肾盂肾炎 61 例（APN 组）及下尿路感染 43 例（非 APN 组）,均检测血清 β2 微球蛋白（β2-MG）、胱抑素 C（CysC）、C 反应蛋白（CRP）、降钙素原（PCT）和尿 NGAL 的水平,对比 2 组各指标的水平,并进行统计学分析;采用受试者工作特征（ROC）曲线分析各指标对 APN 的诊断价值。结果 APN 组血 CRP、PCT、β2-MG 及尿 NGAL 的水平均高于非 APN 组,差异有统计学意义（P＜0.05）;血 CysC 水平差异无统计学意义。血 CRP、PCT 及尿 NGAL 诊断儿童 APN 的 ROC 曲线下面积（AUC）分别为 0.838、0.898、0.963;血 CRP 最佳临界值为 22.6 mg/L 时,敏感度为 75.4%,特异度为 83.7%;PCT 最佳临界值为 0.285 μg/L 时,敏感度为 77.0%,特异度为 93.0%;当尿 NGAL 最佳临界值为 473 μg/L 时,敏感度为 82.0%,特异度为97.7%。结论 尿 NGAL 对儿童 APN 具有诊断价值,有助于临床对儿童 APN 的早期识别。     

慢性肾盂肾炎大鼠模型的建立

目的创建一种慢性肾盂肾炎(CPN)大鼠模型.方法分别用108/ml(A组)、106/ml(B组)浓度致病性大肠杆菌(E.coli O111B4)株膀胱内注射,并短暂结扎左侧输尿管,观察7、15、30、60、90d肾脏形态学变化,肾组织及膀胱尿细菌培养,以及30、60、90d尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)/尿肌酐、血肌酐(Scr)、尿素氮(BUN)、24h尿蛋白定量的变化.结果随着感染性炎症的修复,左肾外观有皮质瘢痕及相关肾乳头收缩和肾盏的扩张,镜下慢性肾间质性肾炎改变和纤维化,以A组显著;A、B两组NAG/尿肌酐在第90日明显升高;细胞培养阳性结果主要在左肾和尿;其余项目与C组无差异.结论短暂结扎单侧输尿管和膀胱内接种一定剂量E.coli O111B4能够制备典型的CPN大鼠模型,以108/ml浓度为适宜.     

Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients

C. Rafat, S. Vimont, P.Y. Ancel, Y.C. Xu‐Dubois, L. Mesnard, N. Ouali, M. Denis, A. Vandewalle, E. Rondeau, A. Hertig. Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients
Transpl Infect Dis 2011: 13: 344–352. All rights reserved Abstract: Background. Urinary tract infections (UTIs), the most common form of bacterial infection in kidney transplant recipients, recently have been demonstrated to be detrimental for long‐term graft outcome. Therefore, reinforcing antibiotic prophylaxis might be vital, in addition to basic hygiene recommendations, surgical care, and prophylaxis by trimethoprim–sulfamethoxazole. Methods. In 2006, a Legionella pneumophila contamination of our department's water pipes meant that all the patients undergoing renal transplantation underwent a 1‐month regimen of ofloxacin (OFLO) (200 mg every other day). We took this opportunity to measure the incidence of UTI, including acute pyelonephritis (APN), in 100 consecutive patients transplanted before (n=50) and after (n=50) this treatment decision was reached. We also studied the antimicrobial resistance profiles in our department and in the rest of the hospital. Results. No patient developed Legionnaire's disease. A dramatic decrease in the incidence of UTI (?63%) was also seen in patients undergoing OFLO treatment. Logistic regression analysis demonstrated that the use of OFLO was independently associated with a reduction in UTI (odd ratio [OR]=0.31%, 95% confidence interval [CI] 0.11–0.84, P=0.02) and APN (OR=0.21%, 95% CI 0.07–0.98, P=0.045). This protection was sustained during the whole first year post transplantation. As for resistance rates, we observed a decrease in the susceptibility of Pseudomonas aeruginosa to ciprofloxacin in our nephrology department, compared with that observed in the rest of the hospital. The incidence of multi‐resistant bacteria was stable. Discussion. Our unintentional extension of prophylactic antibiotherapy with OFLO gave rise to a dramatic decrease in the 1‐year incidence of UTI and APN in kidney recipients. Emergence of resistant strains is, however, a major concern.     

Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes

Objective

To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis.

Study design

A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders.

Results

Out of 219,612 singleton deliveries in 1988–2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p < 0.001), younger maternal age (26.3 ± 6.0 vs. 28.6 ± 5.8 years, p < 0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p < 0.001), placental abruption (3.6% vs. 0.7%, p < 0.001), low 1 min Apgar scores (10.3% vs. 6.0%, p < 0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p < 0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p < 0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4–2.9; p < 0.001), UTI (OR 10.3; 95% C.I 4.8–22.1; p < 0.001) and younger maternal age (OR 0.96; 95% C.I 0.93–0.99; p = 0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7–3.9; p < 0.001).

Conclusion

Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery.     

The climate impact on female acute pyelonephritis in Taiwan: A population-based study

Objective

Urinary tract infection (UTI) is the main reason of community-acquired infection which causes large losses in social economy. The individual as well as climate factors make changes on the incidence. Acute pyelonephritis (APN) is one of the most serious UTI in female. The object of our study is to analyze whether climate factors will have effect on the incidence of female APN in Taiwan.

肾舒颗粒治疗慢性肾盂肾炎46例

目的:探讨肾舒颗粒治疗慢性肾盂肾炎(CPN)的临床疗效及作用机制.方法:93例CPN患者按随机按数字法分为对照组47例和观察组46例.两组均采用西医常规序贯抑菌疗法,观察组在治疗的基础上加用肾舒颗粒,4 g/次,3次/d,开水冲服,若急性发作期改为8 g/次,3次/d.两组疗程均为12周.观察尿频、尿急、尿痛及腰痛等症状变化情况,检测尿液,进行清洁中段尿细菌定量培养,检测血清免疫球蛋白(IgA,IgG,IgM)及尿微量白蛋白(尿ALB)、尿β2-微球蛋白(尿β2-MG)、尿N-乙酰-β-氨基葡萄糖苷酶(尿NAG),记录6个月随访期内急性发作例数及发作频次.结果:观察组总有效率100％,优于对照组的85.1％(P＜0.05);治疗后观察组血清IgA和IgG水平均上升且高于对照组(P＜0.05);治疗后观察组尿频、尿急、尿痛及腰痛症状评分低于对照组(P＜0.01);观察组尿ALB,β2-MG,NAG水平均低于对照组(P＜0.01);观察组复发率、复发频次分别为32.6％和56.5％,均低于对照组的59.6％和102.1％ (P ＜0.05,P＜0.01).结论:肾舒颗粒治疗CPN临床疗效显著,并能减少CPN复发率.肾舒颗粒还能提高CPN免疫功能,改善肾小管功能,值得进一步研究.     

肾舒颗粒联合头孢哌酮钠舒巴坦钠治疗慢性肾盂肾炎的临床研究

目的探讨肾舒颗粒联合头孢哌酮钠舒巴坦钠治疗慢性肾盂肾炎的临床疗效。方法选取2015年3月—2016年3月在江油市人民医院接受治疗的慢性肾盂肾炎患者90例,随机分组法分为对照组和治疗组,每组各45例。对照组静脉滴注注射用头孢哌酮钠舒巴坦钠,2 g加入到0.9%氯化钠注射液100 m L中,2次/d。治疗组在对照组基础上口服肾舒颗粒,2袋/次,3次/d。两组患者均治疗14 d。观察两组的临床疗效,比较两组的临床症状评分和相关指标情况。结果治疗后,对照组和治疗组的总有效率分别为82.22%、95.56%,两组比较差异有统计学意义(P0.05)。治疗后,两组尿频、尿急、尿痛和腰痛评分均明显下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的下降程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组白蛋白(ALB)、β2-微球蛋白(β2-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)和转化生长因子-β1(TGF-β1)均明显下降,而免疫球蛋白A(Ig A)和免疫球蛋白G(Ig G)均明显上升,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论肾舒颗粒联合头孢哌酮钠舒巴坦钠治疗慢性肾盂肾炎具有较好的临床疗效,能改善临床症状,调节肾功能,具有一定的临床推广应用价值。