腸管を利用した尿路変向術後の尿路感染症に関する研究

肠道尿路改道术后尿路感染的研究

• 批准号: 05771181
• 负责人: 寺井 章人
• 金额: $ 0.58万
• 依托单位: Kyoto University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Encouragement of Young Scientists (A)
• 财政年份: 1993
• 资助国家: 日本
• 起止时间: 1993 至 无数据
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-05771181/
• 关键词: 尿路変向術; Kock pouch; Indiana pouch; 回腸導管; 尿路感染症; 尿路結石危険因子; 分泌型IgA

(1)当教室で施行した腸管利用尿路変向術(Kock pouch,Indiana pouch,回腸導管)後患者の尿中分離細菌を調査した.尿定量培養(患者1人当たり複数回を含む)の結果,回腸導管からは99%細菌が検出され,複数菌感染の比率が高かった(29%)のに対し,Indiana pouchでは26%, Kock pouchでは8%が無菌尿であった.またKock pouch,Indiana pouch では単独菌感染が多く,尿中細菌数にも大きな違いはなかった.尿中分離菌種の分布は3群間で大きな差は認めなかった.(2)Kock pouch,Indiana pouch患者でのパウチ内結石の発生状況を調査した.パウチ内結石はKock pouch患者の42%,Indiana pouch患者の13%に発生し,Indiana pouch患者での発生頻度が有意に低かった.この差はKock pouch内に存在する異物(金属ステープル等)によると考えられた.結石分析の結果,struvite±carbonate apatiteを主成分とする感染結石の頻度が高かったが,calcium oxalate/calcium phosphateのいわゆる代謝結石も認められた.(3)腸管を利用した尿路変向術に伴う代謝異常の結果として代謝結石が発生した可能性を検討するため,24時間蓄尿し,尿路結石危険因子(カルシウム,燐酸,尿酸,蓚酸,クエン酸,マグネシウム)の尿中排泄量を測定した.その結果,Kock pouch,Indiana pouchでは回腸導管に比べ有意に尿中のCa,P,Mgの排泄量が多く,腸管からの尿中諸物質再吸収による代謝異常の可能性が考えられた.尿中蓚酸は異常なし.尿中クエン酸は個体差が大きく,細菌によるクエン酸分解の影響が考えられた.これらの尿中諸物質排泄量に明かな経時的変化は認められなかったことから,代謝異常はパウチ粘膜の萎縮にもかかわらず術後長期間継続すると考えられた.(4)尿路感染症防御機構として,腸管からの免疫グロブリン分泌が重要と考えられる.上記の24時間蓄尿を用いて尿中slgA排泄量を測定した.その結果,Kock pouch,Indiana pouchでは回腸導管に比べ有意に尿中sIgA排泄量が多く,感染防御に重要な役割を果たしていると考えられた.また主に結腸を利用するIndiana pouchのほうが,回腸を利用するKock pouchよりも尿中sIgA排泄量が多い傾向が認められた.尿中sIgA排泄量は個体差が大きく,尿中細菌の種類・濃度にも相関せず,また(3)の尿中諸物質排泄量と同様,経時的変化は認められなかった.以上の研究結果は,現在3篇の論文(うち2篇は投稿中)にまとめている段階である.

(1)Bacterial isolation from urine of patients after Kock pouch,Indiana pouch, ileal catheter was investigated. The results of quantitative urine culture (1 patient with multiple cycles) showed that 99% of bacteria were detected in ileal duct, and the rate of multiple bacterial infection was high (29%). In contrast,Indiana pouch was 26%, Kock pouch was 8% and sterile urine was detected. Kock pouch,Indiana pouch. The distribution of isolated species in urine is among 3 groups. (2)Kock pouch,Indiana pouch patients were investigated for the development of intramural stones. The incidence of intramural stones in Kock pouch patients was 42%, Indiana pouch patients was 13%, and Indiana pouch patients was significantly lower. The difference is that foreign matter exists in the Kock pouch. Results of stone analysis,struvite±carbonate apatite principal component and high frequency of infection stone,calcium oxalate/calcium phosphate and metabolic stone identification. (3)The results of intestinal tract utilization and urinary tract surgery accompanied by metabolic abnormalities and the possibility of occurrence of metabolic stones were discussed. The urinary excretion of urinary calculi risk factors (phosphoric acid, uric acid, citric acid, citric acid) was determined after 24 hours of urinary storage. As a result, the Kock pouch,Indiana pouch was found to have higher urinary Ca,P,Mg excretion than the ileal duct, and the possibility of metabolic abnormalities due to reabsorption of urinary substances by the ileal duct was examined. Urine acid abnormal. The individual difference of urine acid is large, and the influence of bacteria on acid decomposition is examined. The amount of substances excreted in the urine is different from that in the urine. (4)Urinary tract infection defense mechanism, intestinal tract immune secretion is important. The above mentioned 24-hour urine storage was used to determine the amount of slgA excreted in urine. As a result, the Kock pouch,Indiana pouch was found to have a higher urinary sIgA excretion rate than the intended one, which was important for infection defense. The amount of sIgA excreted in urine tends to increase with the use of Indiana pouch and ileum. The excretion of sIgA in urine varied greatly from individual to individual, and the species and concentration of bacteria in urine were correlated with each other. The results of the above research are now 3 papers (2 papers are submitted).