膀胱癌术后合并尿路感染者病原学分布、炎症因子及免疫功能分析  

Analysis of pathogen distribution, inflammatory factors, and immune function in patients with a urinary tract infection after surgery for bladder cancer

作　　者：梁冰 罗后宙 汪溢[1] 王玉丰[2] LIANG Bing;LUO Hou-zhou;WANG Yi;WANG Yu-feng(Urology, Third People's Hospital of Hainan,Sanya,Hainan, China 572000;Clinical Laboratory, Third People's Hospital of Hainan,Sanya,Hainan, China 572000)

机构地区：[1]海南省第三人民医院泌尿外科,海南三亚572000 [2]海南省第三人民医院检验科,海南三亚572000

出　　处：《中国病原生物学杂志》2019年第6期705-709,共5页Journal of Pathogen Biology

摘　　要：目的探讨膀胱癌术后合并尿路感染者病原学分布及其对炎症因子水平及免疫功能的影响。方法选择海南省第三人民医院2016年3月~2017年9月泌尿外科82例膀胱癌术后合并尿路感染患者作为观察组,选择膀胱癌术后未感染者42例为对照组,检测两组患者红细胞免疫功能及炎症因子的水平并进行比较分析;取尿液进行病原菌培养及药敏试验,分析尿路感染相关影响因素。结果 NTER、ATER、ETER及DTER观察组患者分别为(1.35±0.21)%、(51.46±5.61)%、(32.29±3.34)%、(29.37±3.27)%,对照组分别为(2.26±0.35)%、(63.11±6.42)%、(46.24±5.13)%、(38.66±3.99)%,差异均有统计学意义(P<0.05);IL-1β、IL-6、PGE2及TNF-α对照组分别为(2.67±0.38) pg/ml、(7.69±0.74)pg/ml、(141.23±14.55) pg/ml、(1.19±0.14) ng/ml,对照组分别为(1.25±0.27) pg/ml、(2.95±0.31) pg/ml、(105.29±11.02) pg/ml、(0.81±0.09) ng/ml,差异均有统计学意义(P<0.05)。82例患者中段尿共分离培养出94株病原菌,其中革兰阴性菌占74.47%,以大肠埃希菌(占24.47%)、肺炎克雷伯菌(占14.89%)和阴沟肠杆菌(占13.83%)居多;革兰阳性菌占25.53%,以尿肠球菌(占9.57%)、链球菌属(占7.45%)为主。大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌对美罗培南、亚胺培南及阿米卡星敏感性较高(耐药率为0~7.69%),而对氨苄西林和氟喹诺酮类药物耐药性较高(耐药率为46.15%~100.00%)。其中尿肠球菌、链球菌属及金葡萄球菌属尿肠球菌、链球菌属及金葡萄球菌属呋喃妥因、万古霉素敏感(耐药率为0-11.11%),对红霉素、青霉素、环丙沙星耐药性较高(耐药率为50.00%~100.00%)。多元Logistic回归分析显示,年龄≥65岁、手术时间长(>90 min)、糖尿病及术前因尿潴留行导尿术均是膀胱癌术后尿路感染的独立危险因素(P<0.05)。结论膀胱癌术后感染者免疫功能较低,体内存在微炎症。感染病原菌以革兰阴性菌为主,年龄≥65岁、手术时间长(>9Objectives To investigate the pathogen distribution, inflammatory factors, and immune function of patients with a urinary tract infection after surgery for bladder cancer. Methods Clinical data on 82 patients with a urinary tract infection after urinary surgery from March 2016 to September 2017 were collected. These patients served as the observation group. Forty-two patients with bladder cancer without an infection served as the control group. RBC counts, immune function, and levels of inflammatory factors were compared between the two groups. Urine was taken for pathogen culture and drug susceptibility testing, and relevant factors influencing the development of an infection were analyzed. Results The levels of NTER, ATER, ETER, and DTER in the observation group were significantly lower than those in the control group, and the levels of IL-1β, IL-6, PGE2, and TNF-α were significantly higher than those in the control group(P<0.05). A total of 94 pathogens were isolated from mid-stream urine samples from 82 patients. Most of the strains(74.47%) were Gram-negative bacteria. The most prevalent Gram-negative bacteria were Escherichia coli(24.47%), Klebsiella pneumoniae(14.89%), and Enterobacter cloacae(13.83%). Gram-positive bacteria accounted for 25.53% of the isolated strains;most were Enterococcus faecium(9.57%) and Streptococcus(7.45%). E. coli, K. pneumoniae, and E. cloacae are more sensitive to meropenem, imipenem and amikacin but more resistant to ampicillin and fluoroquinolones. E. faecium, Streptococcus, Staphylococcus aureus, Enterococcus, Staphylococcus and S. aureus were sensitive to nitrofurantoin and vancomycin(resistance: 0-11.11%) but highly resistant to erythromycin, penicillin, and ciprofloxacin(resistance: 50.00% to 100.00%). Multiple logistic regression analysis indicated that being over the age of 65, a long operating time, having diabetes, and preoperative catheterization due to urinary retention were independent risk factors for infection in patients with bladder cancer. Conclusion Patients

关 键 词：膀胱癌 尿路感染 红细胞免疫 炎症因子 因素 

分 类 号：R378[医药卫生—病原生物学]