内毒素测定评价预防性抗生素在前列腺穿刺活检中的应用价值

Investigation of Infection Risk and the Value of Antibiotic Prophylaxis during Transrectal Biopsy of the Prostate by Endotoxin Determination

目的 :探讨内毒素 (ET)测定在评价经直肠前列腺穿刺活检的感染危险性和预防性抗生素中的应用价值。方法 :4 8例患者随机分成无预防性处理组 (A组 ,12例 )、预防性抗生素组 (B组 ,13例 )、术前灌肠组 (C组 ,12例 )和联合处理组 (D组 ,11例 )共 4组 ,穿刺前、后分别留取血液和尿液 ,用于细菌培养和ET测定。其中ET采用鲎试验的偶氮显色法 (LQACT)测定。 结果 :前列腺穿刺前、后各组血清ET浓度变化和血培养结果无统计学意义 (P >0 .0 5 ) ;A和B组穿刺后尿ET明显升高 (P <0 .0 5 ) ,而C和D组无明显升高 (P >0 .0 5 ) ;A和B组穿刺后尿培养细菌阳性率明显增高 (P <0 .0 5 ) ,而C和D组无明显增高 (P >0 .0 5 )。 结论 :前列腺穿刺活检引起内毒素血症可能性很小 ;术前灌肠和 /或联合预防性抗生素可减少前列腺穿刺引起尿路感染 ;血液、尿液ET测定对经直肠前列腺穿刺活检所致感染的诊断意义较大。

Objective: To clarify the value of endotoxin determination in evaluating the infection risk and antibiotic prophylaxis during transrectal biopsy of the prostate. Methods: Forty-eight patients were divided into four groups randomly. Group A (12 patients) were not treated before biopsy. Group B(13 patients)received antibiotic prophylaxis therapy. Group C (12 patients) underwent clusis. Group D (11 patients) received combined treatment. Urine and blood samples of the patients were obtained before and after prostatic biopsy. All samples were cultured for bacteria and investigated for endotoxin concentration by limulus quantitative azo color test.Results: No significant difference in either serum endotoxin or blood bacterial cultures was noted before and after prostatic biopsy( P < 0.05 ) in all the groups. A significant increase was observed in urine endotoxin after biopsy compared with that before biopsy in Groups A and B ( P < 0.05 ). There was no significant increase in urine endotoxin after biopsy compared with that before biopsy in Group C and D. The positive incidence of urine bacterial culture was significantly increased ( P < 0.05 ) in patients of Group A and B. Conclusion: Circulation infection risk following prostatic biopsy was low. Changes of urinary infection were fewer in patients who had undergone clusis and/or antibiotic prophylaxis than in those who had received no or only antibiotic prophylaxis therapy. Endotoxin determination in urine is a reliable,sensitive and simple method for diagnosis of bacterial infection in patients undergoing transrectal biopsy of the prostate.