Wullt Björn, Bergsten Göran, Carstensen Jens, Gustafsson Elisabeth, Gebratsedik Negash, Holst Elisabet, Månsson Wiking
Department of Urology, Lund University Hospital, Lund, Sweden.
Eur Urol. 2006 Nov;50(5):1065-71; discussion 1071-2. doi: 10.1016/j.eururo.2006.02.012. Epub 2006 Feb 24.
To study the local host response in patients with colonic and ileal neobladders, with or without bacteriuria.
Twenty-three patients with colonic neobladders and 19 with ileal neobladders were included. Eleven radical prostatectomy patients and seven healthy male volunteers were used as controls. Six urine samples were obtained from all patients and controls over a six-month period. The samples were cultured semiquantitatively, and the number of neutrophils and concentrations of the inflammatory mediators interleukin 6 and 8 (IL-6, IL-8) in the urine were determined.
The prostatectomy patients and healthy volunteers had sterile urine, and concentrations of IL-6 and IL-8 were below the detection limit. Most (>70%) of the urine samples from patients with colonic and ileal neobladders showed anaerobic or aerobic bacterial growth, and uropathogens were identified in about 45% of the samples. The local host response was minimal or undetectable in the sterile urine samples. However, the host response was markedly induced by uropathogenic strains in the urine, but not by urinary carriage of nonpathogenic or anaerobic strains. IL-8, but not IL-6, was increased in colonic neobladders, which corresponds to the mucosal host responses in patients with intact lower urinary tracts and asymptomatic bacteriuria. In ileal neobladders, the IL-8 responses were higher, and levels of IL-6 were significantly increased.
Neobladders exhibit a significant local host response to colonization with bacterial uropathogens. This reaction is more pronounced and includes IL-6 activation in ileal neobladders than in colonic neobladders.
研究有或无菌尿的结肠新膀胱和回肠新膀胱患者的局部宿主反应。
纳入23例结肠新膀胱患者和19例回肠新膀胱患者。11例根治性前列腺切除术患者和7名健康男性志愿者作为对照。在6个月期间从所有患者和对照中获取6份尿液样本。对样本进行半定量培养，并测定尿液中中性粒细胞数量以及炎症介质白细胞介素6和8（IL-6、IL-8）的浓度。
前列腺切除术患者和健康志愿者的尿液无菌，IL-6和IL-8浓度低于检测限。结肠新膀胱和回肠新膀胱患者的大多数（>70%）尿液样本显示有厌氧菌或需氧菌生长，约45%的样本中鉴定出尿路病原体。在无菌尿液样本中，局部宿主反应最小或无法检测到。然而，尿路致病菌株可显著诱导宿主反应，而非致病或厌氧菌株的尿路携带则不会。结肠新膀胱中IL-8升高，而IL-6未升高，这与下尿路完整且无症状菌尿患者的黏膜宿主反应一致。在回肠新膀胱中，IL-8反应更高，IL-6水平显著升高。
新膀胱对尿路细菌病原体定植表现出显著的局部宿主反应。这种反应在回肠新膀胱中比在结肠新膀胱中更明显，且包括IL-6激活。
