慢性细菌性前列腺炎病原菌分布及炎性因子、血管细胞黏附分子-1和血管活性肠肽变化研究

Study on the distribution of pathogenic bacteria in chronic bacterial prostatitis and the mechanism of prostatic inflammation, vascular cell adhesion molecule-1 and vasoactive intestinal peptide expression

目的探讨慢性细菌性前列腺炎(CBP)病原菌分布及前列腺液炎性因子、血管细胞黏附分子-1(VCAM-1)和血管活性肠肽(VIP)表达。方法选择温州医科大学附属第二医院于2012年1月至2017年12月期间收治的CBP患者412例作为研究组,年龄范围为20~50岁、年龄(37.42±4.31)岁,平均体重指数(BMI)为(24.08±1.45) kg/m^2,病程6个月~47个月、平均病程(21.42±2.41)个月;另选择同期健康体检者120作为对照组,年龄范围为20~50岁、年龄(36.19±4.23)岁,平均BMI为(24.25±1.56) kg/m^2,分析CBP患者病原菌分布特点和耐药性情况,以及两组炎性因子、VCAM-1和VIP表达。应用SPSS 22.0统计软件分析,符合正态分布的计量数据以均值±标准差(Mean±SD)表示,对于计数资料采用例数或率表示,样本率的比较采用χ2检验,两组组间或组内计量资料组间比较采用t检验。结果412例CBP患者培养出病原菌368株,其中革兰阳性菌212株、革兰阴性菌144株、真菌12株;革兰阳性菌中,主要为金黄色葡萄球菌92株占25.00%、溶血性葡萄球菌60株占16.30%;革兰阴性菌中,主要为大肠埃希菌68株占18.48%、肺炎克雷伯菌48株占13.04%;主要革兰阳性菌中,金黄色葡萄球菌对青霉素耐药率较高为78.26%,溶血性葡萄球菌对红霉素耐药率较高为80.00%;主要革兰阴性菌中,大肠埃希菌对氨苄西林和头孢他啶耐药率较高,分别占88.24%和76.47%;肺炎克雷伯菌对头孢吡肟和氨苄西林耐药率较高,分别占83.33%和75.00%。研究组前列腺液白细胞介素(IL)-8[(4.72±1.27)μg/L]、IL-10[(159.84±24.36) ng/L]和肿瘤坏死因子(TNF)-α[(65.41±8.97) ng/L]水平高于对照组[(1.39±0.42)μg/L、(84.21±12.39) ng/L和(10.20±1.42) ng/L],差异有统计学意义(t=28.260、32.782, P<0.05)。研究组前列腺液VCAM-1[(84.21±16.59)μg/L]和VIP[(46.32±8.24) ng/L]水平高于对照组[(46.13±8.35)μg/L]和[(23.81±3.46) ng/L],差异有统计学意义(t=24.377、29.170,P<0.05)。结论CBP患者病原菌以革兰阳性菌为主,存在明显的炎性反应,且VCAM-1和VIP呈高表达,应按照耐药性合理应用抗菌药物。

Objective To investigate the distribution of pathogenic bacteria in chronic bacterial prostatitis, the inflammatory mechanism of prostatic fluid, the expression of vascular cell adhesion molecule-1 (VCAM-1) and vasoactive intestinal peptide (VIP). Methods A total of 412 chronic bacterial prostatitis (CBP) patients who were admitted to the hospital in January 2012-2017 December were selected as the research group, and the other 120 in the December January 2012-2017 were selected as the control group. The distribution and drug resistance of pathogenic bacteria in CBP patients and the expression of two groups of inflammatory factors, VCAM-1 and VIP were analyzed. Results The 412 cases of CBP were isolated from 368 bacterial strains, including 212 strains of gram positive bacteria, 144 strains of gram negative bacteria, 12 strains of fungi;gram positive bacteria, mainly for 92 strains of Staphylococcus aureus accounted for 25.00%, 60 strains of Staphylococcus haemolyticus accounted for 16.30%;gram negative bacteria, mainly for 68 strains of Escherichia coli accounted for 18.48%, 48 strains of Klebsiella pneumonia accounted for 13.04%. Among the main Gram-positive bacteria, the high resistance rate of Staphylococcus aureus to penicillin was 78.26%, and the high rate of erythromycin resistant Staphylococcus was 80.00%. Among the main gram negative bacteria, Escherichia coli had higher resistance rates to ampicillin and ceftazidime, accounting for 88.24% and 76.47% respectively, and Klebsiella pneumoniae had a higher resistance rate to cefepime and ampicillin, accounting for 83.33% and 75.00% respectively. The levels of IL-8 [(4.72±1.27)μg/L], IL-10 [(159.84±24.36) ng/L] and TNF-α[(65.41±8.97) ng/L] in prostatic fluid of the study group were higher than those of the control group [(1.39±0.42)μg/L,(84.21±12.39) ng/L] and[(10.20±1.42) ng/L], with significant differences (t=28.260, 32.782, P<0.05). The levels of VCAM-1 [(84.21±16.59)μg/L] and VIP [(46.32±8.24) ng/L] in prostatic fluid of the study group were higher than those of the control group [(46.13±8.35)μg/L] and [(23.81±3.46) ng/L], with significant difference (t=24.377, 29.170, P<0.05). Conclusion Gram positive bacteria were the main pathogens in CBP patients. There were obvious inflammatory reactions, and VCAM-1 and VIP were highly expressed. They should be rationally applied according to drug resistance.