Reinhart H H, Spencer J R, Zaki N F, Sobel J D
Division of Infectious Diseases, Wayne State University, Detroit, Mich.
Eur Urol. 1992;22(3):194-9. doi: 10.1159/000474754.
It has been suggested that urinary Tamm-Horsfall protein (THP) prevents colonization of the urinary tract by binding uropathogens. We tested the hypothesis that low urinary THP levels may predispose to urinary tract infection (UTI) by measuring THP levels in children. We studied a cohort of 35 girls with uncomplicated recurrent UTI (group 1) that was compared with 27 patients with myelomeningoceles undergoing clean intermittent catheterization (group 2) and 16 female controls (group 3). We measured urinary THP in both aggregated (aTHP) and disaggregated form (dTHP), leukocyte esterase activity, urine chemistries and culture. No significant differences in dTHP or aTHP levels were seen between groups 1 and 3, but group-1 patients had higher dTHP levels than group-2 patients (p < 0.008). History of reflux or the presence of bacteriuria or pyuria at the time of urine collection did not affect dTHP levels; in contrast, pyuria or bacteriuria at the time of sampling was associated with markedly lower aTHP levels when compared with sterile samples (p < 0.0001). For all groups, measured quantities of dTHP did not correlate with aTHP levels. We conclude that excretion of dTHP in children with history of recurrent UTI is not reduced. In contrast, concentrations of aTHP are profoundly depressed in children during times of UTI, suggesting a role for THP in the pathogenesis of UTI. Assaying THP in its aggregated form may prove valuable when studying its physiologic function and merits further investigation.
有人提出，尿中的Tamm-Horsfall蛋白（THP）通过结合尿路致病菌来预防尿路定植。我们通过测量儿童的THP水平来检验低尿THP水平可能易患尿路感染（UTI）这一假说。我们研究了一组35名患有单纯复发性UTI的女孩（第1组），并与27名接受清洁间歇性导尿的脊髓脊膜膨出患者（第2组）和16名女性对照者（第3组）进行比较。我们测量了聚集形式（aTHP）和解聚形式（dTHP）的尿THP、白细胞酯酶活性、尿液化学成分和培养情况。第1组和第3组之间的dTHP或aTHP水平没有显著差异，但第1组患者的dTHP水平高于第2组患者（p < 0.008）。反流病史或尿液采集时存在菌尿或脓尿并不影响dTHP水平；相反，与无菌样本相比，采样时的脓尿或菌尿与明显较低的aTHP水平相关（p < 0.0001）。对于所有组，测量的dTHP量与aTHP水平无关。我们得出结论，有复发性UTI病史的儿童中dTHP的排泄并未减少。相反，在UTI期间儿童的aTHP浓度显著降低，提示THP在UTI发病机制中起作用。在研究THP的生理功能时，检测其聚集形式的THP可能证明是有价值的，值得进一步研究。
