泌尿生殖系结核患者结核分枝杆菌菌型鉴定及其尿液吲哚胺2,3-双加氧酶表达的实验研究  

Experimental study for the identification of the types of tubercle bacillus and its indoleamine 2,3-dioxygenase expression in the urine of patients with genito-urinary tuberculosis

作　　者：陈安健[1] 张江容[1] 梁国标[1] 陈玲[1] 张能[1] 王远亮[1] 王欣[1] 陈宗平[1] 罗旭[1] 梁天才[1] 杜洋[1] 郭亚楠[1] 庄永祥[1] 暴丁溯[1] 

机构地区：[1]贵州省遵义医学院附属医院泌尿外科,563003

出　　处：《中华泌尿外科杂志》2015年第12期917-920,共4页Chinese Journal of Urology

摘　　要：目的 对泌尿生殖系结核患者的结核分枝杆菌行菌型鉴定及药敏试验,明确该类患者中是否存在多耐药结核分枝杆菌、耐多药结核分枝杆菌（multidrug-resistant tuberculosis,MDR-TB）及非结核分枝杆菌（nontuberculosis mycobacteria,NTM）;检测其尿中吲哚胺2,3-双加氧酶（indoleamine 2,3-dioxygenase,IDO）的表达情况,初步探讨泌尿系结核患者的免疫功能状况.方法 回顾性分析2011年11月至2014年12月收治的65例泌尿生殖系结核患者的资料,男30例,女35例.年龄18-62岁,平均40岁.肾结核60例,附睾结核5例.无菌收集患者晨尿/24 h尿沉渣（65例）,以及脓液（肾穿刺液及附睾脓肿穿刺液,9例）和/或手术切除的病变组织（肾组织及附睾组织,17例）后行分枝杆菌培养,阳性者行菌型鉴定和药敏试验.选取25例尿抗酸杆菌阳性或临床高度可疑患者为结核组;25例尿石症患者为结石组,其中单纯输尿管结石9例（右侧5例,左侧3例,双侧1例）,单纯肾结石11例（左侧5例,右侧3例,双侧3例）,肾结石合并输尿管结石5例（肾结石合并同侧输尿管结石3例,一侧肾结石、对侧输尿管结石2例）,所有患者均有不同程度肾积水;25例健康青年男性为正常组.采用双位点夹心酶联免疫吸附法检测3组尿液中IDO的表达情况.结果 本组65例中,细菌培养阳性14例,包括耐药结核分枝杆菌9例（其中单耐药结核分枝杆菌4例,多耐药结核分枝杆菌4例,MDR-TB 1例）;NTM 1例;余4例对抗结核药物敏感,其中人型结核分枝杆菌3例,牛型结核分枝杆菌1例.结核组、结石组、正常组的IDO表达量分别为0.10±0.01、0.12±0.02、0.13±0.02,组间差异有统计学意义（F=5.135,P ＜0.05）;结核组IDO表达量低于结石组,但差异无统计学意义（P＞0.05）;结核组IDO表达量明显低于正常组,差异有统计学意义（P＜0.05）;结石组IDO表达量低于正常组,但差异无统计学意义（P＞0.05）.结论 泌尿生Objective To determine whether multidrug-resistant tuberculosis （MDR-TB）and nontuberculosis mycobacteria（NTM） were exist in patients with genitor-urinary tuberculosis by identify the types of mycobacterium tuberculosis with drug sensitive test,and to preliminarily discuss the immunological function status of the patients with urinary tuberculosis by detect the expression of indoleamine 2,3-dioxygenase（IDO） in their urine.Methods Morning urine or 24 hour urinary sediment （65 cases）,puncture fluid from kidney or abscess of epididymis （9 cases） and resected tissue from kidney or epididymis （17 cases） in the 65 patients with genito-urinary tuberculosis were collected in the Affiliated Hospital of Zunyi Medical College from November 2011 to December 2014.All samples underwent mycobacterial culture,and identification of the bacterial types and drug sensitive test were performed on the positive cases.The expression of indoleamine2,3-dioxygenase （IDO） level in urine was detected by ELISA in 25 cases with genito-urinary tuberculosis,25 cases with urinary calculus and 25 normal male people,respectively.Results 14 cases were positive in all 65 patients,while 9 cases were drug resistant mycobacterium tubercle bacillus （4 single-drug resistant,4 multi-drug resistance and one MDR-TB）,one case was NTM and the other 4 cases were sensitive to antituberculosis drugs （3 human-type mycobacterium tubercle bacillus,one mycobactcrium bovis）.The expression of urinary IDO in the urinary tuberculosis group （0.10-0.01）,urinary calculi group （0.12 ＆#177;0.02） and the normal group （0.13 ＆#177;0.02） were significantly different （F =5.135,P 〈 0.05）.The expression of IDO in the urinary tuberculosis group was lower than the urinary calculus group,but with no significant differences （P 〉 0.05）;the expression of IDO in the urinary tuberculosis group was much lower than the normal group,with significant differences （P 〈 0.05）;the expression of IDO in the urinary calculus group wa

关 键 词：泌尿生殖系结核 耐药分枝杆菌 吲哚胺2 3-双加氧酶 

分 类 号：R527[医药卫生—内科学]