| 摘要: |
| 目的 调查并比较尿路感染（UTI）和无症状菌尿（ABU）在神经源性膀胱（NB）患者分布情况及实验室数据。方法：收集2015年3月-2023年10月，在青岛市胶州中心医院和潍坊市妇幼保健院就诊的142例NB患者就诊资料，比较两组患者年龄、性别、膀胱受累时间、间歇导尿情况、复发尿路感染、镜检白细胞数目、肾积水程度、预后等分布特征。结果：在142例患者中，25例诊断UTI，117例诊断ABU，两组患者的年龄、性别、膀胱受累时间差异无统计学意义。UTI组有8例患者行间歇性导尿，ABU组有13例；UTI组有9例患者复发尿路感染，ABU组则有11例；UTI组尿常规镜检白细胞中位数为67.00/ul，ABU组则为15.00/ul；差异均有统计学意义。ABU组中无肾积水、轻度肾积水、中度肾积水、重度肾积水的患者分别为92、17、6、2例；在UTI组中，分别为14、5、4、2例，差异有统计学意义（z=-2.560，P=0.010）。所有UTI组患者均接受了抗感染治疗，其预后情况分别为治愈14例、好转9例、未愈2例；部分ABU组患者（50例）接受了治疗，预后情况为治愈41例、好转6例、未愈3例，差异有统计学意义（z=-2.254，P=0.024）。应用ROC曲线探讨镜检白细胞对NB患者感染类型的诊断效能，提示当镜检白细胞为21.5/ul时，可作为区分UTI和ABU临界点（AUG=0.743，95%CI=0.657~0.829）。结论：在NB患者中，UTI患者较ABU患者更易复发尿路感染，间歇导尿率更高；尿常规镜检白细胞也多于后者，肾积水程度更重，感染经治疗预后转归情况也相对较差。镜检白细胞≥21.5/ul时，对鉴别UTI和ABU有一定的诊断价值。通过了解两类感染的特征分布，可为NB患者泌尿系感染的预防和治疗提供一定的指导。 |
| 关键词: 神经源性膀胱 无症状菌尿 尿路感染 临床特征 |
| DOI： |
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| 基金项目:山东省医药卫生科技项目 |
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| Analysis of characteristics of urinary tract infection and asymptomatic bacteriuria in patients with neurogenic bladder |
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Chen Shi Kai1, Guo Tingting1, Li Monong2, Song Zhao Lu3, Peng Chuanzhen3, Zhang Yuhai1
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1.Weifang Maternal and Child Health Hospital;2.Qingdao Municipal Hospital;3.Qingdao Jiaozhou Central Hospital
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| Abstract: |
| Objective To investigate and compare the distribution and laboratory data of urinary tract infection (UTI) and asymptomatic bacteriuria (ABU) in patients with neurogenic bladder. Methods: The clinical data of 142 patients with neurogenic bladder who were treated in Qingdao Jiaozhou Central Hospital and Weifang Maternal and Child Health Hospital from March 2015 to October 2023 were collected, and the distribution characteristics of age, gender, bladder involvement time, intermittent catheterization, recurrent urinary tract infection, number of white blood cells under microscope, degree of hydronephrosis, and prognosis were compared between the two groups. Results Among 142 patients, 25 were diagnosed with UTI and 117 with ABU, and there was no significant difference in age, sex, and duration of bladder involvement between the two groups. Intermittent catheterization was performed in 8 patients in UTI group and 13 patients in ABU group. There were 9 cases of recurrent urinary tract infection in UTI group and 11 cases in ABU group. The median white blood cell count was 67.00/ul in UTI group and 15.00/ul in ABU group. The differences were statistically significant. In ABU group, there were 92, 17, 6 and 2 cases without, mild, moderate and severe hydronephrosis, respectively. In the UTI group, there were 14, 5, 4 and 2 cases, respectively, and the difference was statistically significant (z=-2.560, P=0.010). All patients in UTI group received anti-infection therapy, and the prognosis was cured in 14 cases, improved in 9 cases, and not cured in 2 cases, respectively. Part of the ABU group (50 cases) received treatment, and the prognosis was cured in 41 cases, improved in 6 cases, and not cured in 3 cases, with statistical significance (z=-2.254, P=0.024). ROC curve was used to explore the diagnostic efficiency of microscopic leucocyte in NB patients with infection types, suggesting that when the microscopic leucocyte was 21.5/ul, it could be used as the critical point to distinguish UTI and ABU (AUG=0.743, 95%CI=0.657~0.829). Conclusion: In NB patients, UTI patients are more prone to recurrent urinary tract infection than ABU patients, more intermittent catheterization is required, more white blood cells are detected by routine microscopy in urine than the latter, the degree of hydronephrosis is more serious, and the treatment is relatively poor. Microscopic examination of white blood cells ≥21.5/ul has a better diagnostic value for differentiating UTI and ABU. By understanding the characteristic distribution of the two types of infection, it can provide certain guidance for the prevention and treatment of NB patients. Conclusions In NB patients, UTI patients are more likely to have recurrent UTI than ABU patients, and the intermittent catheterization rate is higher. The number of white blood cells in urine routine microscopy was also more than that in the latter, and the degree of hydronephrosis was more serious. The prognosis of infection after treatment was relatively poor.Microscopic examination of white blood cell more than 21.5/ul has certain diagnostic value for the differential diagnosis of UTI and ABU. By understanding the characteristics of the two types of infections, it can provide some guidance for the prevention and treatment of urinary tract infections in NB patients. |
| Key words: Neurogenic bladder Asymptomatic bacteriuria Urinary tract infection Clinical Features |