难治性慢性前列腺炎患者前列腺液的病原微生物研究

Investigation of microorganisms in EPS from patients with chronic prostatitis

目的探讨难治性慢性前列腺炎患者前列腺内的病原微生物种类并与正常男性比较。方法未婚无性经历男性20例和难治性慢性非细菌性前列腺炎11 1例,其中Ⅲ_A 58例,Ⅲ_B 53例。采用普通细菌培养及解脲脲原体(UU)培养、沙眼衣原体(CT)检测;特异性PCR检测包括淋病奈瑟菌(NG)、结核分枝杆菌(TB)、UU、CT、人类乳头瘤状病毒总型(HPV)、疱疹Ⅱ型病毒(HSV-2)、巨细胞病毒(CMV);以及细菌16S rDNA检测及PCR测序和克隆测序。结果正常人群病原学检测均阴性;前列腺炎患者有多种微生物发现。UU阳性率41.4%(46/1 11),CT阳性率23.4%(26/11 1)。病毒感染率分别为HSV-2 13.5%(1 5/111),HPV 1 2.6%(14/11 1),CMV 20.7%(23/11 1),NG 0.9%(1/111),无结核感染发现。前列腺炎EPS细菌1 6S rDNA阳性率为55.9%(62/11 1),其中Ⅲ_A型、Ⅲ_B型阳性率分别为:58.6%(34/58)、52.8%(28/53)。62例16S rDNA阳性标本有26例可以测序鉴定出细菌种属,分属多种不同的微生物种类。白细胞计数和卵磷脂小体计数与EPS的UU、CT、CMV、HSV-2和16S rDNA无相关性,而白细胞计数与HPV分离率呈正相关,卵磷脂小体计数与HPV分离率呈负相关。结论难治性慢性前列腺炎患者前列腺内微生物种类繁多,Ⅲ型亦有病原体存在,但普通细菌培养多阴性。推测UU、CT、CMV、HPV、HSV-2和一些难以检测的细菌可能参与了前列腺炎的致病过程,其中,HPV与前列腺的炎症程度相关联。

Objective To investigate the microorganisms in EPS of patients with chronic prostatitis and normal young male adults. Methods Total of 111 patients with type Ⅲ chronic prostatitis and 20 normal young male adults were enrolled in the study, the collected expressed prostatic secretion （EPS） samples from the study patients were subjected to urological evaluation including routine microscopic examination of EPS, bacteria culture, mycoplasma culture and chlamydiosis culture. Arbitrary PCR were performed to confirm Neisseria gonorrhoeae, Mycobecterium Tuberculosis, Mycoplasma, Chlamydiosis, viruses including HPV, HSV-2 and CMV; and universal primers PCR was carried out to detect 16S rDNA of bacteria, PCR and clone sequencing were followed. Results For patients with chronic type III prostatitis, the positive rate of Ureaplasma urealyticum （UU）in EPS was 41.4% （46/111）, and the positive rate of chlamydia trachomatis （CT） was 23.4% （26/111）. Infection rates of HSV-2, HPV and CMV were 13.5% （15/111）, 12.6% （14/111） and 20.7% （23/111） respectively. Total positive rate of bacteria 16S rDNA in samples was 55.9%（62/ 111）, patients with type Ⅲa and type ⅢB prostatitis accounted for 58.6% （34/58） and 52.8% （28/53）, respectively.