难治性前列腺炎患者感染病原菌特征及血清免疫炎症反应相关因子MIP-1α、IL-8、COX-2水平检测意义

Characteristics of pathogenic bacteria in patients with refractory prostatitis and detection significance of serum immune-inflammatory response-related factors MIP-1α,IL-8 and COX-2 levels

目的:探究难治性前列腺炎患者感染病原菌特征,并检测血清免疫炎症反应相关因子巨噬细胞炎性蛋白1α(MIP-1α)、IL-8、环氧合酶-2(COX-2)水平。方法:选取2018年10月至2020年6月郑州市第九人民医院门诊及郑州市中心医院男科门诊收治的87例难治性慢性前列腺炎患者作为观察组,另选取87例体检健康者作为对照组。分析难治性前列腺炎患者感染病原菌特征,比较两组血清MIP-1α、IL-8、COX-2水平及不同疗效、两组患者临床资料、治疗前后血清MIP-1α、IL-8、COX-2水平,分析血清MIP-1α、IL-8、COX-2差值与病程、慢性前列腺炎症状评分(NIH-CPSI)、最大尿流速的相关性及血清MIP-1α、IL-8、COX-2差值与难治性前列腺炎患者疗效的关系,并评价血清MIP-1α、IL-8、COX-2差值对难治性前列腺炎患者疗效的评估价值。结果:87例难治性前列腺炎患者前列腺液标本中均存在细菌感染,且9例患者同时伴有支原体感染。87例难治性前列腺炎患者前列腺液标本中共分离出338株病原菌,其中革兰阳性菌230株(68.05%);革兰阴性菌108株(31.95%);观察组血清MIP-1α、IL-8、COX-2水平均高于对照组,差异有统计学意义(P<0.05);不同疗效患者病程、NIH-CPSI评分、最大尿流速、治疗后MIP-1α、IL-8、COX-2水平及治疗前后MIP-1α、IL-8、COX-2差值比较差异有统计学意义(P<0.05);难治性前列腺炎患者血清MIP-1α、IL-8、COX-2治疗前后差值与病程、NIH-CPSI评分呈正相关,与最大尿流速呈负相关(P<0.05);血清MIP-1α、IL-8、COX-2治疗前后差值与难治性前列腺炎患者疗效显著相关(P<0.05);血清MIP-1α、IL-8、COX-2治疗前后差值评估难治性前列腺炎患者疗效的AUC值分别为0.856、0.819、0.788,联合评估AUC值最大,为0.903。结论:难治性前列腺炎患者感染病原菌以革兰阳性菌为主,且血清MIP-1α、IL-8、COX-2明显升高,与病情演变密切相关,可用于评估临床疗效,为后续治疗提供依据。

Objective:To investigate the characteristics of infectious pathogens in patients with refractory prostatitis,and to detect serum levels of factors related to immune inflammatory response such as macrophage inflammatory protein 1α(MIP-1α),IL-8 and cyclooxygenase-2(COX-2).Methods:A total of 87 patients with refractory chronic prostatitis who were diagnosed and treated in the Outpatient Department of Zhengzhou Ninth People's Hospital and Andrology Outpatient Department of Zhengzhou Central Hospital from October 2018 to June 2020 were selected as observation group,and 87 healthy subjects were selected as control group.Analyzed characteristics of infectious pathogens in patients with refractory prostatitis,compared serum MIP-1α,IL-8,COX-2 levels and the dif-ferent efficacy of the two groups,clinical data of the two groups of patients,serum MIP-1α,IL-8,COX-2 levels before and after treat-ment,and to analyze the correlation of the difference of serum MIP-1α,IL-8,COX-2 and the duration of the disease,the National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI),maximum urinary flow rate and the relationship between serum MIP-1α,IL-8,COX-2 diffe-rence and the efficacy of patients with refractory prostatitis,and to evaluate the assessment value of serum MIP-1α,IL-8,COX-2 difference on the efficacy of patients with refractory prostatitis.Results:Bacterial infection was present in 87 specimens of prostatic fluid from patients with refractory prostatitis,and 9 patients had concomitant mycoplasma infection.From the prostatic fluid samples of 87 patients with refractory prostatitis,a total of 338 pathogenic bacteria were isolated,including 230 gram-positive bacteria,accounting for 68.05%;108 gram-negative bacteria,accounting for 31.95%;serum MIP-1α,IL-8,COX-2 levels in observation group were higher than that in control group,the difference was statistically significant(P<0.05);the course of disease,NIH-CPSI score,maximum urinary flow rate,levels of MIP-1α,IL-8,COX-2 after treatment,and the difference of MIP-1α,IL-8,COX-2 before and after treatment were compared in patients with different curative effects,and the difference was statistically signifi-cant(P<0.05);the difference between serum MIP-1α,IL-8 and COX-2 in patients with refractory prostatitis before and after treat-ment was positively correlated with disease course and NIH-CPSI score,while negatively correlated with maximum urinary flow rate(P<0.05);the differences of serum MIP-1α,IL-8 and COX-2 before and after treatment were significantly correlated with curative effect of patients with refractory prostatitis(P<0.05);AUC values of serum MIP-1α,IL-8 and COX-2 before and after treatment to evaluate the efficacy of refractory prostatitis patients were 0.856,0.819 and 0.788,respectively,and the combined AUC value was the largest,which was 0.903.Conclusion:Pathogenic bacteria in patients with refractory prostatitis are mainly gram-positive bacteria,and the serum MIP-1α,IL-8 and COX-2 are significantly increased,which are closely related to the evolution of the disease.They can be used to evaluate clinical efficacy,and provide information for subsequent treatment.