摘要
目的探讨糖尿病患者泌尿系统结石合并感染的病原菌分布特点及感染的影响因素,为临床防治提供参考依据。方法选取2022年2月至2024年12月本院泌尿外科收治的212例糖尿病泌尿系统结石患者为研究对象,根据是否合并感染分为感染组(112例)和非感染组(100例)。采集感染组患者中段尿标本进行病原菌分离鉴定,收集两组患者临床资料(一般资料、实验室指标、结石相关指标等),采用单因素分析及多因素Logistic回归模型分析糖尿病患者泌尿系统结石感染的影响因素。结果112例感染患者共检出病原菌121株,其中革兰阴性菌占75.21%(91/121),以大肠埃希菌为主(52.07%,63/121);革兰阳性菌占20.66%(25/121),以粪肠球菌为主(14.88%,18/121);真菌占4.13%(5/121),均为白色假丝酵母菌。感染组与非感染组在性别、年龄、BMI方面差异有统计学意义(P<0.05),男性、年龄≥60岁、BMI≥25 kg/m2患者感染率更高。感染组白细胞计数、C反应蛋白(CRP)、降钙素原(PCT)、空腹血糖、血肌酐及尿素氮水平均显著高于非感染组(P<0.05)。单因素分析显示,糖尿病患者泌尿系统结石感染与糖尿病病程、糖化血红蛋白(HbA1c)水平、结石直径、结石成分及是否合并神经源性膀胱相关(P<0.05);多因素Logistic回归分析显示,糖尿病病程≥10年(OR=0.082,95%CI:0.009~0.738)、HbA1c≥7.0%(OR=20.503,95%CI:2.594~162.059)、草酸钙结石(OR=2.747,95%CI:1.456~5.183)及合并神经源性膀胱(OR=3.116,95%CI:1.140~8.519)是感染的独立危险因素(P<0.05)。结论糖尿病患者泌尿系统结石感染以革兰阴性菌为主,且受多种因素影响,临床应针对糖尿病病程较长、血糖控制不佳、草酸钙结石及合并神经源性膀胱的患者加强干预,以降低感染风险。
Objective To explore the distribution characteristics of pathogenic bacteria and influencing factors of urinary calculi complicated with infection in diabetic patients,so as to provide reference for clinical prevention and treatment.Methods A total of 212 diabetic patients with urinary calculi admitted to the Department of Urology in our hospital from February 2022 to December 2024 were selected as the research objects.They were divided into the infection group(112 cases)and the non-infection group(100 cases)according to whether they were complicated with infection.Midstream urine samples from the infection group were collected for pathogenic bacteria isolation and identification.Clinical data(general data,laboratory indicators,calculus-related indicators,etc.)of patients in both groups were collected.Univariate analysis and multivariate Logistic regression model were used to analyze the influencing factors of urinary calculi infection in diabetic patients.Results A total of 121 strains of pathogenic bacteria were detected in 112 infected patients,among which gram-negative bacteria accounted for 75.21%(91/121),mainly Escherichia coli(52.07%,63/121);gram-positive bacteria accounted for 20.66%(25/121),mainly Enterococcus faecalis(14.88%,18/121);fungi accounted for 4.13%(5/121),all ofwhich were Candida albicans.There were statistically significant differences in gender,age and BMI between the infection group and the non-infection group(P<0.O5).The infection rates were higher in male patients,patients aged≥60 years and patients with BMI≥25 kg/m^(2).The levels of white blood cell count,C-reactive protein(CRP),procalcitonin(PCT),fasting blood glucose,serum creatinine and urea nitrogen in the infection group were significantly higher than those in the non-infection group(P<0.05).Univariate analysis showed that urinary calculi infection in diabetic patients was related to the course of diabetes,glycosylated hemoglobin(HbAlc)level,calculus diameter,calculus composition and whether complicated with neurogenic bladder(P<0.O5).Multivariate Logistic regression analysis showed that diabetes course≥10 years(OR=0.082,95% CI:0.009-0.738),HbA1c≥7.0%(OR=20.503,95% CI:2.594-162.059),calcium oxalate calculi(OR=2.747,95% CI:1.456-5.183)and complicated with neurogenic bladder(OR=3.116,95% CI:1.140-8.519)were independent risk factors for infection(P<0.05).Conclusion Urinary calculi infection in diabetic patients was mainly caused by gram-negative bacteria,and was affected by many factors.Clinically,intervention should be strengthened for patients with long course of diabetes,poor blood glucose control,calcium oxalate calculi and complicated with neurogenic bladder to reduce the risk of infection.
作者
陈军君
王琼
张文龙
李若蕾
齐珊
CHEN Junjun;WANG Qiong;ZHANG Wenlong;LI Ruolei;QI Shan(Xuzhou Medical University Affiliated Hospital,Xuzhou 221000,Jiangsu,China)
出处
《中国病原生物学杂志》
北大核心
2026年第1期77-81,共5页
Journal of Pathogen Biology
关键词
糖尿病
泌尿系统结石
病原菌
影响因素
diabetes mellitus
urinary calculi
pathogenic bacteria
influencing factors
