前列腺增生术后尿路感染病原菌及表面活性蛋白A/D水平

Distribution of urinary tract infection pathogens and surfactant protein A/D level in patients with urinary tract infection after prostatic hyperplasia

目的探讨前列腺增生术后尿路感染患者表面活性蛋白A/D(SP-A/D)改变及其与T细胞免疫的关系。方法选择海口市第三人民医院泌尿外科2016年5月-2020年5月收治进行前列腺增生手术患者作为研究对象,选取术后尿路感染与未感染者各55例。对尿路感染病原菌分布进行调查;采用酶联免疫吸附法检测尿液中SP-A、SP-D蛋白水平,采用流式细胞术检测外周血中CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)水平。结果55例尿路感染患者经培养共分离出病原菌60株,其中革兰阴性菌43株,占71.67%,革兰阳性菌17株,占28.33%,大肠埃希菌检出率较高,共23株,占38.33%;感染组SP-A、SP-D、CD_(8)^(+)高于非感染组,CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于非感染组,差异具有统计学意义(P<0.05)。重度组SP-A、SP-D、CD_(8)^(+)及IPSS评分高于中度组及轻度组,CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于中度组及轻度组,中度组SP-A、SP-D、CD_(8)^(+)及IPSS评分高于轻度组,CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于轻度组,差异均具有统计学意义(P<0.05);ROC分析结果显示,尿液SP-A、SP-D及IPSS评分对前列腺增生术和尿路感染的诊断价值曲线下面积分别为0.715、0.732、0.682,指标联合时曲线下面积为0.785,均具有统计学意义(P<0.05)。结论尿液SP-A、SP-D水平可反映前列腺增生术后尿路感染及T细胞免疫状态,对于判断尿路感染有一定临床价值。

OBJECTIVE To investigate the changes of surface active protein A/D(SP-A/D)in patients with urinary tract infection after prostatic hyperplasia and its relationship with T cell immunity.METHODS The patients who admitted to the Department of Urology of Haikou Third People’s Hospital and performed prostate hyperplasia surgery from May 2016 to May 2020 were recruited as the research subjects,and divided into 55 cases of postoperative urinary tract infection patients and 55 cases of uninfected patients.The distribution of pathogenic bacteria of urinary tract infection was investigated;enzyme-linked immunosorbent assay was used to detect the levels of SP-A and SP-D protein in urine,and the levels of CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+) in peripheral blood were detected by flow cytometry.RESULTS A total of 60 pathogens were isolated from 55 patients with urinary tract infections,including 43 gram-negative bacteria,accounting for 71.67%,and 17 gram-positive bacteria,accounting for 28.33%.The detection rate of Escherichia coli was relatively high(23 strains,accounting for 38.33%).The SP-A,SP-D,CD_(8)^(+) and IPSS scores in the infected group were significantly higher than those in the non-infected group,and the scores of CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+) were significantly lower than those in the non-infected group(P<0.05).The SP-A,SP-D,CD_(8)^(+) and IPSS scores in the severe group were significantly higher than those in the moderate group and the mild group;CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+) were significantly lower than those in the moderate group and the mild group.SP-A,SP-D,CD_(8)^(+) and IPSS scores in the moderate group were higher than those in the mild group and CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+) were significantly lower than those in the mild group(P<0.05).ROC analysis showed that the area under the curves of urine SP-A,SP-D and IPSS scores for the diagnosis of prostate hyperplasia and urinary tract infection were 0.715,0.732,0.682,respectively,and the AUC of the combination diagnosis was 0.785.All of them showed difference significant(P<0.05).CONCLUSION Urine SP-A and SP-D levels can reflect urinary tract infection and T cell immune status in patients after prostatic hyperplasia,and have certain clinical value for diagnosis of urinary tract infection.