Clinical Investigation on the Correlation between Lower Urinary Tract Infection and Cystitis Glandularis

Summary: In order to study the association between lower urinary tract infection and cystitis glandularis (CG), 120 cases of CG were diagnosed by cystoscopic biopsy in the suspicious foci of the bladder. Among them, 72 cases were subjected to bacterial counting culture of urine and microscopic examination of urinary sediment, and 60 cases to fluorescence quantitative polymerase chain reaction (FQ-PCR) assay to detect HPV, CMV and HSV DNA in urine samples. In the 72 cases of CG, the positive rate of bacterial counting culture of urine was 15.3 % (11/72), and gray zone rate was 18.1 % (13/72). 31.9 % (23/72) patients were positive in bacterioscopy of urinary sediment. There was statistically significant difference as compared with the control group (P<0.01). Only 4 of 60 urine samples were positive by FQ-PCR in detection of the three viruses mentioned above with the positive rate being 6.67 %. Compared with the control group, there was no significant difference (P>0.05). It was concluded that the genesis of CG was closely correlated with the chronic lower urinary tract infection, especially caused by Esch coli.

Urine microscopy and neutrophilelymphocyte ratio are early predictors of acute kidney injury in patients with urinary tract infection

Objective:Urinary tract infection(UTI)is a common cause of morbidity and hospitalisation in the population worldwide.Upper UTI is indolent and causes subclinical acute kidney injury(AKI)resulting in preventable cause of scarring of renal parenchyma.We explored urinary and serum levels of kidney injury molecule-1(KIM-1),haematological parameters and quantitative urine microscopy parameters to predict kidney injury.Methods:Neutrophilelymphocyte ratio(NLR)is obtained by dividing absolute neutrophil count with absolute lymphocyte count.Quantitative urine sediment microscopy was performed and correlated with clinical,biochemical and haematological findings to predict AKI in patients with UTI.Quantitative ELISA was performed for serum and urine levels of KIM-1.Seventy two adult patients with UTI were enrolled,45 of whom had AKI while 27 were in the non-AKI group.Results:NLR(p=0.005)and renal tubular epithelial cell-granular cast score in quantitative urine microscopy(p=0.008)are strong predictors of AKI in patients with UTI while rest of quantitative urine microscopy parameters and serum and urinary levels of KIM-1 molecule were not found to be useful in prediction of AKI.Conclusion:NLR in haemogram is a novel and useful biomarker for predicting AKI in patients with UTI.

Stroke Severity Is the Major Player in Post-Stroke Urinary Tract Infection in Patients with First Ever Ischemic Stroke

Background: Urinary tract infections UTIs occur repeatedly after stroke and are related to bad outcomes with increased rates of deterioration in neurological state during hospitalization, death or long term disability as well as increased length of hospitalization. Factors found to predict UTI include stroke severity, depressed consciousness level, increased post-void residual urine volume, and diabetes mellitus. Stroke severity appears to be the most important predictor of infection risk. We aimed to determine the risk factors associated with UTI after acute stroke, and its association with outcome. Subjects and Methods: This is prospective cohort study. We analysed clinical data of 100 patients with first ever ischemic stroke. We assessed risk factors for UTI, as well as clinical outcome. Results: Urinary tract infection was found in 72% of our subjects. On univariate analysis, patients with UTI were more likely to have had a more severe stroke, more likely to be catheterized and more likely to have a higher serum creatinine level. The multivariate analysis revealed that greater stroke severity was independently associated with increased risk of developing UTI. Greater stroke severity measured by CSS was independently associated with unfavorable outcome on discharge. Conclusion: UTI is common after acute stroke. It is associated with more severe stroke.

Study of Lipocalin-2 Associated with Neutrophilic Gelatinases (uNGAL) in the Urine in Children with the Microbial Inflammatory Diseases of Kidneys and Urinary Tract

Purpose of the study: Research of the clinical and diagnostic significance of determination of Lipocalin-2 associated with neutrophilic gelatinases (uNGAL) in the urine of children with urinary tract infection (UTI) and pyelonephritis. Materials and methods: We examined 30 children with acute pyelonephritis and UTI aged 1 to 16 years (average age 7.32 ± 4.52) including 26 girls and 4 boys. Verification of the diagnosis was conducted on the basis of clinical and laboratory data, medical history and instrumental examination of patients. All children were divided into 2 groups: 1st group—15 children with acute pyelonephritis, 2nd group—15 children with urinary tract infection. uNGAL was measured in the urine by enzyme-linked immunosorbent assay (EISA) (BioVendor Laboratoty Medicine). Results: It is found, that the urine level of NGAL depends on the damage degree of renal parenchyma. The correlation of medium strength was found between the excretion level of uNGAL during the acute period of pyelonephritis and the detection of renal scars according to the DMSA-nephroscintigraphy data. In the group of children with the acute pyelonephritis the direct correlation of medium strength was found between the excretion level of uNGAL/creatinine and leukocytosis value and also with the CRP blood level. Conclusion: The results allow us to recommend the determination of the excretion level of uNGAL/creatinine as an additional non-invasive marker for the early detection of renal parenchyma injury.

Efficacy of Nonsteroidal Anti-inflammatory Drugs for Treatment of Uncomplicated Lower Urinary Tract Infections in Women:A Meta-analysis

Urinary tract infections(UTIs)are among the most frequent causes for antibiotic prescription and;therefore,alternative treatment options for UTIs can potentially reduce antibiotic usage and development of resistance.To evaluate the efficacy of nonsteroidal antiinflammatory drugs(NSAIDS)for the treatment of uncomplicated lower UTIs in women,this study implemented a meta-analytic approach to evaluate the results of available randomized clinical studies from online databases.A total of four trials involving 1144 patients with uncomplicated lower UTIs were included in the final evaluation.Results showed that symptom resolution at Day 3-4 in the NSAIDs group was significantly lower than that in the antibiotics group[pooled odds ratio(OR)=0.41,95%confidence interval(CI):0.23-0.74,P<0.05].However,there was no significant difference between the NSAIDs and antibiotics groups in symptom resolution at Day 7(pooled OR=0.43,95%CI:0.17-1.06,P=0.07),secondary antibiotic treatment rate at Day 28-30(pooled OR=1.15,95%CI:0.16-7.98,P=0.89)and adverse events rate(pooled OR=1.09,95%CI:0.61-1.96,P=0.77).Therefore,this metaanalysis suggests that,although inferior to antibiotics in fast symptom resolution,symptomatic treatment with NSAIDs can be considered as an alternative treatment option for uncomplicated lower UTIs in women.However,given the low number of randomized controlled trials that met inclusion criteria in this meta-analysis,efficacy of NSAIDs for treatment of uncomplicated lower UTIs should be further evaluated in more comprehensive clinical studies.

Lung Function in Wheezing Infants after Acute Lower Respiratory Tract Infection and Its Association with Respiratory Outcome

Background： Wheezing is common in early childhood and remains an important health concern. The aim of this study was to assess the lung function of wheezing infants and to investigate the relationship between lung function and respiratory outcome. Methods： Infants 〈2 years of age with acute lower respiratory tract infection （ALRTI） who had undergone lung function tests were included in the study. They were assigned to wheeze or no wheeze group based on physical examination. Infants without any respiratory diseases were enrolled as controls. Lung function was measured during the acute phase and 3 months after ALRTI. One-year follow-up for infants with ALRTI was achieved. Results： A total of 252 infants with ALRTI who had acceptable data regarding tidal breathing were included in the final analysis. Compared with the control and the no wheeze groups, infants in the wheeze group had significantly decreased time to peak tidal expiratory flow as a percentage of total expiratory time （TPTEF/TE） （20.1 1 6.4% vs. 34.4 ± 6.2% and 26.4 ±8.3%, respectively, P 〈 0.0001） and significantly increased peak tidal expiratory flow （PTEF） （90.7 ± 26.3 ml/s vs. 79.3 ± 18.4 ml/s and 86.1 ± 28.0 ml/s, respectively, P 〈 0.01）, sReff and Reff. The infants in the wheeze group still had lower TPTEF/TE and volume to peak tidal expiratory flow as a percentage of total expiratory volume （VPTEF/VE） than the no wheeze infants 3 months after the ALRT1. Moreover, there was a significant inverse relationship between TPTEF/TE, VPTEF/VE, and the recurrence of wheezing and pneumonia. Conclusions： Impaired lung function was present in wheezing infants with ALRTI and the deficits persisted. In addition, the lower level of TPTEF/TE and VPTEF/VE was a risk factor for poor respiratory outcome.

Clinical characteristics and molecular epidemiology of human metapneumovirus in children with acute lower respiratory tract infections in China, 2017 to 2019: A multicentre prospective observational study

Human metapneumovirus(HMPV) infection is one of the leading causes of hospitalization in young children with acute respiratory illness. In this study, we prospectively collected respiratory tract samples from children who were hospitalized with acute lower respiratory tract infection in six hospitals in China from 2017 to 2019. HMPV was detected in 145 out of 2733 samples(5.3%) from the hospitalized children. The majority of HMPV-positive children were under the age of two(67.6%), with a median age of one year. HMPV can independently cause acute lower respiratory tract infection in young children, while all patients showed mild clinical symptoms. Of all the co-infected patients, HMPV was most commonly detected with enterovirus(EV) or rhinovirus(RhV)(38.0%),followed by respiratory syncytial virus(RSV)(32.0%). The highest detection rate occurred from March to May in both northern and southern China. Out of 145 HMPV positive samples, 48 were successfully typed, of which 36strains were subgrouped into subtypes A2c(75%), eight strains were included in subtype B1(16.7%), and four strains were included in subtype B2(8.3%). Moreover, 16 A2c strains contained 111-nucleotide duplications in the G gene. Twenty-seven complete HMPV genomes were successfully obtained, and 25(92.6%) strains belonged to subtype A2c, whereas one strain was included in subgroup B1 and another was included in subgroup B2. A total of 277 mutations were observed in the complete genomes of 25 A2c strains. All results presented here improve our understanding of clinical characteristics and molecular epidemiology of HMPV infection in children.

A multi-center study on Molecular Epidemiology of Human Respiratory Syncytial Virus from Children with Acute Lower Respiratory Tract Infections in the Mainland of China between 2015 and 2019

Human respiratory syncytial virus(RSV) is a major pathogen of acute lower respiratory tract infection among young children. To investigate the prevalence and genetic characteristics of RSV in China, we performed a molecular epidemiological study during 2015–2019. A total of 964 RSV-positive specimens were identified from 5529 enrolled patients during a multi-center study. RSV subgroup A(RSV-A) was the predominant subgroup during this research period except in2016. Totally, 535 sequences of the second hypervariable region(HVR-2) of the G gene were obtained. Combined with182 Chinese sequences from GenBank, phylogenetic trees showed that 521 RSV-A sequences fell in genotypes ON1(512),NA1(6) and GA5(3), respectively;while 196 RSV-B sequences fell in BA9(193) and SAB4(3). ON1 and BA9 were the only genotypes after December 2015. Genotypes ON1 and BA9 can be separated into 10 and 7 lineages, respectively. The HVR-2 of genotype ON1 had six amino acid changes with a frequency more than 10%, while two substitutions H258 Q and H266 L were co-occurrences. The HVR-2 of genotype BA9 had nine amino acid substitutions with a frequency more than10%, while the sequences with T290 I and T312 I were all from 2018 to 2019. One N-glycosylation site at 237 was identified among ON1 sequences, while two N-glycosylation sites(296 and 310) were identified in the 60-nucleotide duplication region of BA9. To conclusion, ON1 and BA9 were the predominant genotypes in China during 2015–2019. For the genotypes ON1 and BA9, the G gene exhibited relatively high diversity and evolved continuously.

Acute lobar nephritis in children: Not so easy to recognize and manage

Acute lobar nephritis(ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children.

Acute Massive Gastric Dialation—A Case Report

Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anorexia, spinal abnormalities, diabetes mellitus and electrolyte imbalance. Without proper and timely diagnosis and treatment, gastric perforation and hemorrhage can occur. In this report, we present a case of acute massive gastric dilation in a settling of type II diabetes mellitus and urosepsis. We will also present a review of literature and management options for such condition. Our report highlights the need for high index of suspicion and early intervention to avoid life threatening complications.

外周血炎症指标联合检测在儿童下呼吸道早期感染中的诊断价值

目的探讨血清白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、全血中性粒细胞与淋巴细胞比值(NLR)联合检测在儿童下呼吸道细菌和病毒早期感染中的鉴别诊断价值。方法收集自贡市第一人民医院2023年1—10月初诊入院的急性下呼吸道感染儿童215例为研究对象,根据感染病原体的类型将其分为细菌感染组(117例)和病毒感染组(98例)。对两组患儿血清IL-6、hs-CRP和全血NLR检测结果进行回顾性分析。采用受试者工作特征曲线(ROC)评估血清IL-6、hs-CRP和NLR及三者联合检测的诊断价值。结果细菌感染组IL-6、hs-CRP和NLR指标均高于病毒感染组,差异有统计学意义(P<0.05);IL-6、hs-CRP和NLR的ROC曲线下面积(AUC)分别为0.839(95%CI:0.765~0.913)、0.783(95%CI:0.693~0.873)和0.840(95%CI:0.769~0.912)。IL-6、hs-CRP和NLR联合检测的AUC为0.875(95%CI:0.810~0.940)。IL-6、hs-CRP和NLR的最佳截断值分别为33.54 ng/L、32.15mg/L、9.62;IL-6单独诊断的灵敏度为67.1%、特异度为91.6%、约登指数为0.587;hs-CRP单独诊断的灵敏度为80.6%、特异度为72.9%、约登指数为0.600;NLR单独诊断的灵敏度为67.2%、特异度为91.7%、约登指数为0.589。三者联合诊断的灵敏度为79.2%、特异度为82.1%、约登指数为0.613。结论血清IL-6、hs-CRP和全血NLR测定均可用于儿童急性下呼吸道细菌感染和病毒感染的早期鉴别诊断,但三者联合检测诊断效能更高。

快速Pitt菌血症评分联合乳酸预测急性下呼吸道感染患者的死亡风险

目的分析快速皮特菌血症(qPitt)评分联合急诊常用指标是否可作为急性下呼吸道感染患者28 d死亡风险的预测因素。方法以2018年7月1日至2023年12月31日收治于首都医科大学附属北京朝阳医院急诊科的急性下呼吸道感染患者为研究对象,以入院后28 d死亡为终点,将研究对象分为存活组和死亡组。使用单因素分析比较两组qPitt评分和临床指标的差异,并通过Logistic回归筛选影响急性下呼吸道感染患者28 d死亡的独立相关因素,建立联合预测模型,使用受试者工作特征(ROC)曲线评价独立相关因素及联合变量预测模型对急性下呼吸道感染患者28 d死亡的预测价值。结果共纳入患者696例,其中28 d存活组445例(63.9%)和28 d死亡组251例(36.1%)。死亡组年龄、降钙素原、D-二聚体、血乳酸(lactate,LAC)、血肌酐(SCr)及qPitt评分均高于存活组(均P<0.05),淋巴细胞计数和血小板计数均低于存活组(均P<0.05)。Logistic回归分析得出LAC(OR=1.258,95%CI 1.143~1.384,P<0.001)、年龄(OR=1.021,95%CI 1.008~1.034,P=0.001)及qPitt评分(OR=1.923,95%CI 1.597~2.317,P<0.001)是预测急性下呼吸道感染患者28 d死亡风险的独立因素。年龄、LAC与qPitt评分联合变量预测模型的ROC曲线下面积(area under curve,AUC)为0.746(95%CI 0.708~0.784),高于LAC(AUC=0.692,95%CI 0.650~0.733)和qPitt评分(AUC=0.702,95%CI 0.660~0.743),且其预测效能优于单独应用LAC(Z=2.888,P=0.004)和qPitt评分(Z=3.850,P<0.001)。结论qPitt评分和LAC是急性下呼吸道感染患者死亡的独立危险因素,二者与年龄构建的联合变量预测模型可有效预测28 d死亡风险。

改良尿道口成形术治疗复发性下尿路感染伴尿道外口处女膜融合

目的探讨改良尿道口成形术治疗复发性下尿路感染(LUTI)伴尿道外口处女膜融合的安全性和有效性。方法回顾性分析2016年7月—2023年1月于北京和睦家医院泌尿外科接受改良尿道口成形术治疗的15例复发性LUTI伴尿道外口处女膜融合的女性患者的临床资料。手术改良之处:在尿道外口下缘与阴道处女膜上缘之间横行切开皮肤,分离尿道与阴道间隙,然后纵行缝合切口,从而使尿道外口与阴道处女膜上缘距离保持在1.5 cm以上。采用随访问卷评估临床治疗结果。结果15例患者均顺利完成手术,围手术期无切口感染,无继发性出血等Clavien-DindoⅠ级以上并发症发生。平均随访48(18~96)个月,治愈11例,好转4例,治愈率+好转率为100%。所有接受手术的患者均表示会推荐有类似病症的患者接受此项手术治疗。结论改良尿道口成形术是治疗复发性LUTI伴尿道外口处女膜融合的一种安全、有效的方法。

通淋解毒化热方结合敏感抗生素治疗急性泌尿系感染临床疗效及对炎症因子的影响

目的观察通淋解毒化热方结合敏感抗生素治疗急性泌尿系感染的临床疗效及对炎症因子影响。方法选取2020年5月—2022年4月医院收治的91例急性泌尿系感染患者,以随机数字表法分为对照组(45例)和观察组(46例),对照组根据药敏试验予敏感抗生素治疗,观察组在对照组的基础上给予通淋解毒化热方治疗,观察比较两组患者细菌清除率、临床疗效、中医症状积分(小便频急不畅、血尿、小腹拘急、腰部酸痛等)变化、平均尿菌转阴时间、尿路刺激征消失时间及体温恢复正常时间、降钙素原(PCT)和C反应蛋白(CRP)及白细胞计数(WBC)水平等炎症因子指标变化、不良反应、治疗3个月与6个月疾病复发次数。结果观察组患者细菌清除率及总有效率均比对照组患者更高,P<0.05;治疗前两组患者中医症状积分,PCT、CRP、WBC等炎症因子指标比较,P>0.05,治疗后两组患者中医症状积分,PCT、CRP、WBC等炎症因子指标均较治疗前降低,P<0.05,且观察组明显低于对照组,P<0.05;观察组平均尿菌转阴时间、尿路刺激征消失时间及体温恢复正常时间均短于对照组,P<0.05;观察组治疗后3个月与治疗后6个月疾病复发次数均少于对照组,P<0.05;两组均未见明显不良反应发生。结论通淋解毒化热方结合敏感抗生素治疗急性泌尿系感染的临床疗效显著,患者细菌清除率高,症状改善,炎症因子水平降低,无不良反应,值得应用。

Effects of Appropriate Prolonged Sacral Neuromodulation Testing in Improving Implantation Rate of a Permanent Implantable Pulse Generator in Patients with Refractory Lower Urinary Tract Dysfunctions in China's Mainland

Background： Sacral neuromodulation （SNM） has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator （IPG） implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms （LUTS） in China's Mainland. Methods： From January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy, in this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications （such as pain, infection, and electrode displacement） and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness. Results： Among 51 patients receiving SNM therapy, 19 patients （mean age 45.0 ±16.9 years） had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients （mean age 46.7 ± 15.3 years） received Stage If permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage Ⅰ-Ⅱ conversion was 62.7% （32/51） in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% （8/51 ）, which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% （27/32） of the patients received Stage 11 implantation within 4 weeks. None of the patients had incision infections. In one patient, the entire system was removed 1 month after Stage II implantation due to pain in the implantation site. Conclusions： Appropriate extension of the Stage I testing time of an SNM-barbed electrode could significantly improve the Stage II permanent implantation rate in Chinese refractory LUTS patients; there were no wound infections, and the postoperative complication rate was low. This study recommended that Stage I period of SNM therapy should be 4 weeks according to safety and successful conversion rate.

赵文景教授运用栝楼瞿麦丸类方治疗糖尿病合并再发性下尿路感染经验

糖尿病合并再发性下尿路感染迁延难愈,常对多种抗生素耐药,治疗困难,极大影响了患者的身体健康及生活质量。赵文景教授认为糖尿病合并再发性下尿路感染的病机主要为肾阳亏虚,肾-命门-三焦气化失司,从阳虚为本、阳不化气出发,基于“肾—命门—三焦气化”理论,探讨运用栝楼瞿麦丸类方培补命门、调理肾、膀胱与三焦的功能以复气化,随证选用泻心栝楼瞿麦丸、补中栝楼瞿麦丸、化瘀栝楼瞿麦丸、解郁栝楼瞿麦丸、温下栝楼瞿麦丸等进行治疗,以期为中医药诊治糖尿病合并再发性下尿路感染提供新思路。

热毒宁对慢阻肺伴急性下呼吸道感染患者炎性因子水平及肺功能的影响

目的探讨热毒宁对慢阻肺伴急性下呼吸道感染(ALRI)患者炎性因子水平及肺功能的影响。方法选取我院2022年1月到2023年10月收治的慢阻肺伴ALRI患者100例,以抽签法分为对照组(50例)、治疗组(50例);对照组予常规治疗,治疗组基于常规治疗予热毒宁治疗;对比两组治疗效果、炎性因子指标、凝血指标、肺功能指标及不良反应。结果治疗组总治疗有效率较对照组高,差异有统计学意义(P<0.05);治疗7d,治疗组白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)、D-二聚体(D-D)水平较对照组低,用力肺活量(FVC)、第一秒用力呼气容积(FEV1)占预计值较对照组高,差异有统计学意义(P<0.05);组间不良反应对比差异无统计学意义(P>0.05)。结论热毒宁治疗慢阻肺伴ALRI患者效果较好,可降低炎性因子水平,改善凝血指标,提高肺功能,且安全性好。

LPS、PCT与PDGF联合检测对COPD急性期合并下呼吸道感染的诊断价值

目的探讨血清内毒素(LPS)、降钙素原(PCT)与血小板衍生生长因子(PDGF)联合检测对慢性阻塞性肺疾病急性期(AECOPD)合并下呼吸道感染的诊断价值。方法选取2021年1月—2022年12月期间联勤保障部队第九〇四医院收治的147例AECOPD患者为观察对象。统计AECOPD患者合并下呼吸道感染情况,并依据是否合并下呼吸道感染分为发生组和未发生组。对比发生组和未发生组患者的临床资料。Logistic多因素回归分析影响AECOPD患者合并下呼吸道感染的危险因素。制作受试者工作特征曲(ROC),以曲线下面积(AUC)分析血清LPS、PCT及PDGF三者联合对AECOPD患者合并下呼吸道感染的诊断价值。结果AECOPD患者合并下呼吸道感染发生率为21.09%。发生组肿瘤坏死因子-α、白细胞介素-6、干扰素-γ、C反应蛋白(CRP)、血清LPS、PCT及PDGF水平均高于未发生组(P<0.05),IgG则低于未发生组(P<0.05)。Logistic多因素分析显示,白细胞介素-6(CI:2.898,95%CI:1.076~4.185)、LPS(CI:3.725,95%CI:2.729~10.354)、PCT(OR:3.089,95%CI:1.762~6.435)、PDGF(CI:3.330,95%CI:2.187~8.496)水平均是影响AECOPD患者合并下呼吸道感染发生的危险因素(P<0.05)。ROC曲线分析结果显示,血清LPS、PCT及PDGF三者联合对AECOPD患者合并下呼吸道感染诊断的灵敏度分别为77.42%(95%CI:58.46~89.72)、67.74%(95%CI:48.53~82.68)、70.97%(95%CI:51.76~85.11)、67.74%(95%CI:48.53~82.68),特异度分别为77.59%(95%CI:68.72~84.59)、75.00%(95%CI:65.95~82.37)、75.86%(95%CI:66.87~83.11)、98.28%(95%CI:93.30~99.71),AUC分别为0.715(95%CI:0.635~0.787)、0.820(95%CI:0.748~0.878)、0.723(95%CI:0.643~0.793)、0.902(95%CI:0.842~0.945)。结论血清LPS、PCT及PDGF三者联合检测对AECOPD合并下呼吸道感染的诊断效能较高。

AECOPD机械通气病人下呼吸道感染风险预测Nomogram模型的构建

目的:构建慢性阻塞性肺疾病急性加重(AECOPD)机械通气病人下呼吸道感染的风险预测Nomogram模型。方法:回顾性选取2019年1月—2022年12月在本院行机械通气的417例AECOPD病人,将所有病人按照2∶1比例随机分为训练集(278例)和验证集(139例)。收集病人资料,统计AECOPD机械通气病人下呼吸道感染发生率,采用单因素分析和多因素Logistic回归分析AECOPD机械通气病人下呼吸道感染的影响因素,应用R软件构建下呼吸道感染风险预测Nomogram模型并进行验证。结果:下呼吸道感染发生率为51.80%(216/417);多因素Logistic回归分析结果显示,年龄、合并糖尿病、机械通气持续时间、气管插管、合并低蛋白血症、抗菌药物使用时间、抗菌药物使用种类≥2种均是AECOPD机械通气病人下呼吸道感染的独立影响因素(P<0.05);基于多因素Logistic回归分析筛选出的7个影响因素构建风险预测Nomogram模型,该模型在训练集和验证集中预测的曲线下面积分别为0.873[95%CI(0.831,0.915)]、0.858[95%CI(0.791,0.914)];训练集和验证集校准曲线和Hosmer-Lemeshow检验(P>0.05)均显示预测值和实际值具有良好一致性;决策曲线显示,当训练集阈概率在4%~90%、验证集阈概率在9%~78%时该模型的净收益高。结论:基于7项影响因素[年龄、合并糖尿病、机械通气持续时间、气管插管、合并低蛋白血症、抗菌药物使用时间、抗菌药物使用种类(≥2种)]构建的AECOPD机械通气病人下呼吸道感染的风险预测Nomogram模型具有良好区分度和一致性,且具有临床应用价值。

乳杆菌活菌联合常规方案治疗绝经后复发性尿路感染的效果及安全性

目的:分析乳杆菌活菌联合常规方案治疗绝经后复发性尿路感染(rUTI)的效果和安全性。方法:采用随机数字表法将2022年1—12月重庆市巴南区第二人民医院收治的98例绝经后rUTI患者分为对照组(n=49,左氧氟沙星治疗)与观察组(n=49,左氧氟沙星联合乳酸杆菌活菌治疗)。比较两组治疗总有效率、女性改良下尿路症状得分、阴道pH值、复发间隔时间及复发率、不良反应发生情况。结果:与对照组相比,观察组治疗总有效率更高(P=0.021);治疗后,两组女性改良下尿路症状得分及阴道pH值均低于治疗前,观察组低于对照组(P<0.001);与对照组相比,观察组复发间隔时间更长,复发率更低(P<0.05);观察组不良反应发生率为6.12%,对照组为4.08%,无统计学差异(P>0.05)。结论:乳杆菌活菌联合左氧氟沙星片治疗绝经后rUTI的效果理想,能够改善下尿路症状,降低阴道pH值,减少疾病复发,安全性较高。