Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS)
Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS)
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DOI：
10.1007/s00345-019-02764-0
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发表时间：
2020-02-01
影响因子：
3.4
通讯作者：
Ehrlich, Garth D.
中科院分区：
文献类型：
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作者：
Nickel, J. Curtis;Stephens, Alisa;Ehrlich, Garth D.
目的在一项纳入MAPP研究网络的IC/BPS女性患者的前瞻性、纵向研究中，探讨真菌的存在与症状发作、疼痛和泌尿系统严重程度的相关性。方法在基线、6个月和12个月收集至少有一次耀斑的女性IC/BPS参与者和年龄匹配的无耀斑报告的参与者的耀斑状态、盆腔疼痛、尿严重程度和中游尿。采用多位点PCR与电喷雾电离/质谱联用技术对真菌种类和属进行鉴定。利用广义线性混合模型、多变量方差分析、Wilcoxon秩和检验评估“真菌群落”（种/属存在、相对丰度、Shannon’s/Chao1多样性指数）与当前病情、疼痛、泌尿严重程度之间的关系。结果202例女性尿样共504份，检出8属13种真菌。更灵敏的分析检测到43个属。在真菌种类/属组成或多样性方面，没有观察到耀斑状态或疼痛严重程度的总体差异。纵向分析表明，在高和低尿严重程度的参与者中，真菌多样性更大（Chao1平均比3.8,95% CI 1.3-11.2, p = 0.02），检测到任何真菌种类的可能性更大（OR = 5.26, 95% CI 1.1-25.8, p = 0.04）。个体分类分析显示，在高尿症状和低尿症状中，念珠菌（OR = 6.63, 95% CI 0.8-58.5, p = 0.088）和马拉色菌（仅在“高”尿严重表型中发现）的存在和相对丰度呈增加趋势。结论本分析提示，在一些IC/BPS女性患者中，更严重的泌尿症状可能与尿真菌组尿有关。
Purpose To correlate the presence of fungi with symptom flares, pain and urinary severity in a prospective, longitudinal study of women with IC/BPS enrolled in the MAPP Research Network. Methods Flare status, pelvic pain, urinary severity, and midstream urine were collected at baseline, 6 and 12 months from female IC/BPS participants with at least one flare and age-matched participants with no reported flares. Multilocus PCR coupled with electrospray ionization/mass spectrometry was used for identification of fungal species and genus. Associations between "mycobiome" (species/genus presence, relative abundance, Shannon's/Chao1 diversity indices) and current flare status, pain, urinary severity were evaluated using generalized linear mixed models, permutational multivariate analysis of variance, Wilcoxon's rank-sum test. Results The most specific analysis detected 13 fungal species from 8 genera in 504 urine samples from 202 females. A more sensitive analysis detected 43 genera. No overall differences were observed in fungal species/genus composition or diversity by flare status or pain severity. Longitudinal analyses suggested greater fungal diversity (Chao1 Mean Ratio 3.8, 95% CI 1.3-11.2, p = 0.02) and a significantly greater likelihood of detecting any fungal species (OR = 5.26, 95% CI 1.1-25.8, p = 0.04) in high vs low urinary severity participants. Individual taxa analysis showed a trend toward increased presence and relative abundance of Candida (OR = 6.63, 95% CI 0.8-58.5, p = 0.088) and Malassezia (only identified in 'high' urinary severity phenotype) for high vs low urinary symptoms. Conclusion This analysis suggests the possibility that greater urinary symptom severity is associated with the urinary mycobiome urine in some females with IC/BPS.