Value of urine culture combined with urine β2-microglobulin in diagnosis of location of simple urinary tract infection
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摘要:目的 探讨尿培养和尿β2-微球蛋白(β2-MG)对单纯性尿路感染定位的诊断价值。方法 选择江苏省苏北人民医院143例泌尿科确诊为单纯性尿路感染的患者，将上尿路感染的52例患者设为上尿路组, 91例下尿路感染患者设为下尿路组，同期体检人群22例为对照组。治疗前行中段尿培养和尿β2-MG检测。结果 上尿路组尿培养阳性率为78.8%, β2-MG升高患者比例84.6%, 主要致病菌为金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌; 下尿路组尿培养阳性率为90.1%, β2-MG升高患者比例5.5%, 主要致病菌为大肠埃希菌、粪肠球菌和白色假丝酵母菌; 对照组尿培养阳性率为4.5%, β2-MG升高患者比例4.5%。上、下尿路组尿培养结果差异无统计学意义(P>0.05), 但β2-MG差异有统计学意义(P < 0.01)。结论 尿培养联合β2-MG对单纯性上下尿路感染的定位、菌群分布和经验用药有很好的诊断价值。Abstract:Objective To explore the value of urine culture and urine β2-microglobulin (β2-MG) in the diagnosis of location of simple urinary tract infection.Methods A total of 143 patients with simple urinary tract infections diagnosed as simple urinary tract infection in the Department of Urology in Subei People′s Hospital, among whom 52 patients with upper urinary tract infections were as upper urinary tract group, 91 patients with lower urinary tract infections were as lower urinary tract group, and 22 patients with physical examination at the same time were as control group. Midstream urine culture and urine β2-MG were detected before treatment.Results The positive rate of urine culture in upper urinary tract group was 78.8%, the proportion of increase of β2-MG level was 84.6%, and the main pathogens were Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa, and the positive rate of urine culture in lower urinary tract group was 90.1%, and the proportion of increase of β2-MG level was 5.5%. The main pathogenic bacteria were Escherichia coli, Enterococcus faecalis and Candida albicans. The positive rate of urine culture in the control group was 4.5% and the proportion of increase of β2-MG level was 4.5%. There was no significant difference in urine culture results between upper and lower urinary tract groups (P>0.05), but there was significant difference in β2-MG (P < 0.01).Conclusion Urinary culture combined with β2-MG has good diagnostic value in the localizationof simple upper and lower urinary tract infections, as well as the flora distribution and empirical medication.
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表 1 上、下尿路感染组尿培养菌群分布株
排序 上尿路组(n=52) 下尿路组(n=91) 菌名 数量/株 菌名 数量/株 1 金黄色葡萄球菌 16 大肠埃希菌 33 2 肺炎克雷伯菌 13 粪肠球菌 26 3 铜绿假单胞菌 7 白色假丝酵母菌 9 4 鲍曼不动杆菌 5 无乳链球菌 8 5 流感嗜血杆菌 2 屎肠球菌 4 6 其他 9 其他 12 
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表 2 上、下尿路感染组尿培养与β2-MG结果比较[n(%)]
组别 尿培养结果 β2-MG 阳性 阴性 升高 下降 上尿路组(n=52) 41(78.8) 11(21.2) 144(84.6) 8(15.4) 下尿路组(n=91) 82(90.1) 9(9.9) 15(5.5)* 86 (94.5)* 与上尿路感染组比较, *P < 0.05。
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表 3 主要致病菌对临床常用抗生素敏感实验结果
菌名 青霉素 头孢曲松 亚胺培南 左旋氧氟沙星 氟康唑 S I/R S I/R S I/R S I/R S I/R 革兰阳性球菌 金黄色葡萄球菌 17.8 82.2 - - - - 55.1 44.9 - - 粪肠球菌 73.2 26.8 - - - - 65.7 34.3 - - 屎肠球菌 15.4 84.6 - - - - 37.5 62.5 - - 无乳链球菌 88.9 11.1 94.4 5.6 - - 90.3 9.7 - - 革兰阴性杆菌 肺炎克雷伯菌 - - 58.5 41.5 68.1 31.9 54.3 45.7 - - 铜绿假单胞菌 - - 69.8 30.2 77.3 22.7 70.9 29.1 - - 鲍曼不动杆菌 - - 42.8 57.2 46.1 53.9 22.1 77.9 - - 大肠埃希菌 - - 63.4 36.6 81.7 18.3 33.9 66.1 - - 流感嗜血杆菌 - - 93.4 6.6 92.7 7.3 - - - - 真菌 白色假丝酵母菌 - - - - - - - - 98.7 1.3 S: 敏感; I/R: 中介/耐药。
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