肾移植术后长期患者尿液支原体与细菌分布及危险因素分析  

Mycoplasma and bacteria and risk factors of urinary track infection in long-term follow-up of kidney transplant recipients

作　　者：闵敏 李上根 杨卫华 周运恒 Min Min;Li Shanggen;Yang Weihua;Zhou Yunheng(Department of Kidney Transplant Rehabilitation,Zhabei Central Hospital of Jing'an District,Shanghai 200070,China;Department of Clinical Laboratory,Zhabei Central Hospital of Jing'an District,Shanghai 200070,China)

机构地区：[1]上海市静安区闸北中心医院肾移植康复科,上海200070 [2]上海市静安区闸北中心医院检验科,上海200070

出　　处：《中华检验医学杂志》2025年第3期337-345,共9页Chinese Journal of Laboratory Medicine

摘　　要：目的分析肾移植术后长期患者尿路感染的临床特点、支原体和细菌的分布以及危险因素。方法采用回顾性病例对照研究方法,选取上海市静安区闸北中心医院2023年1月1日到2024年7月31日疑似尿路感染的402例肾移植后1年以上患者为研究对象,采用专用培养基对尿液进行支原体和细菌培养鉴定,分为细菌感染组(67例)、支原体感染组(56例)和非尿路感染组(288例),对感染组按照移植后时间进行分组,并检测感染时的肾功能主要指标和尿微量白蛋白(U-mALB),收集其临床相关资料,采用单因素比较法和多因素Logistic回归法分析引起尿液支原体和细菌感染的危险因素。结果402肾移植术后患者中,支原体阳性56例,阳性率为13.9%,其中脲原体46例,阳性率为11.4%;细菌阳性67例,阳性率为16.7%,排名前三的细菌是:大肠埃希菌(27例,6.7%)、肺炎克雷伯菌(10例,2.5%)和粪肠球菌(10例,2.5%)。支原体感染率在移植后1~<5年为26.8%(11/41),5~<10年为15.8%(18/114),10~<20年为11.6%(22/190),20年及以上为8.8%(5/57),不同时间段之间的差异具有统计学意义(P<0.05)。单因素分析结果显示,性别(χ^(2)=8.21,P=0.004)、年龄(χ^(2)=3.96,P=0.001)、移植后时间(χ^(2)=2.83,P=0.005)和U-mALB水平(χ^(2)=3.06,P=0.002)是术后支原体感染的危险因素(P<0.05);性别(χ^(2)=9.41,P=0.003)、合并糖尿病(χ^(2)=4.42,P=0.035)、尿素氮(Z=2.68,P=0.007)、肌酐(Z=2.81,P=0.005)、胱抑素C(Z=3.87,P=0.001)、估算肾小球滤过率(Z=3.83,P=0.001)和U-mALB水平(Z=3.33,P=0.001)与细菌感染发生有关(P<0.05)。多因素分析结果显示患者女性(OR=2.81,95%CI 1.49~5.31,P=0.001)和年龄减小(OR=0.95,95%CI 0.92~0.98,P=0.001)是引起支原体感染的独立危险因素(P<0.05);女性(OR=2.98,95%CI 1.58~5.64,P=0.001)和合并糖尿病(OR=2.06,95%CI 1.12~3.76,P=0.019)是引起细菌感染的独立危险因素。结论肾移植术后长期患者尿路感染以脲原体和革兰阴性菌为主,其中移�Objective To analyze the clinical characteristics,distribution of Mycoplasma and bacteria,and risk factors associated with long-term urinary tract infection(UTI)in patients after kidney transplantation(KT).Methods A retrospective case-control study was conducted involving a total of 402 inpatients who underwent KT and were suspected of having UTI from January 1,2023 to July 31,2024 at Zhabei Central Hospital in the Jing′an District,Shanghai.Pathogen distribution including Mycoplasma and bacteria,was assessed through cultures of midstream urine samples using specialized medium.The patients were categorized into three groups:the bacterial infection group(67 cases),Mycoplasma infection group(56 cases)and non-UTI group(288 cases).Subsequently,the infection group was further divided into sub-groups according to the time after transplantation.Renal function indexes and urine microalbumin(U-mALB)at the time of infections were measured,and the clinical data of inpatients were collected.Risk factors associated with urinary Mycoplasma and bacterial infections were identified using both univariate comparison methods and multivariate logistic regression analysis.Results Among the 402 KT recipients,56 patients were found to have Mycoplasma isolated,resulting in an infection rate of 13.9%.Additionally,Ureaplasma spp.Was identified in 11.4%(46/402)patients.About 16.7%(67/402)patients exhibited with bacteria infection,and the most common pathogens were Escherichia coli(27/402,6.7%),followed by Klebsiella pneumoniae(10/402,2.5%)and Enterococcus faecalis(10/402,2.5%).There was significant difference about the infection rate of Mycoplasma among the different periods after transplantation(P<0.05):1-<5 years at 26.8%(11/41),5-<10 years at 15.8%(18/114),10-<20 years at 11.6%(22/190),above 20 years at 8.8%(5/57).Monofactorial analysis showed that gender(χ^(2)=8.21,P=0.004),age(χ^(2)=3.96,P=0.001),post-transplant duration(χ^(2)=2.83,P=0.005)and U-mALB level(χ^(2)=3.06,P=0.002)were associated risk factors for Mycoplasma infection(P

关 键 词：肾移植 尿路感染 支原体 细菌 危险因素 

分 类 号：R699.2[医药卫生—泌尿科学]