Ye Yuanxin, Hu Xuejiao, Shi Yunying, Zhou Juan, Zhou Yi, Song Xingbo, Xie Yi, Lu Xiaojun, Wang Lanlan, Ying Binwu, Chen Xuerong
From the Department of Laboratory Medicine (YY, XH, JZ, YZ, XS, YX, XL, LW, BY), West China Hospital, Sichuan University, Sichuan Province; Department of Nephrology (YS); and Department of Tuberculosis (XC), West China Hospital, Sichuan University, Chengdu, The People's Republic of China.
Medicine (Baltimore). 2016 May;95(19):e3537. doi: 10.1097/MD.0000000000003537.
To investigate the epidemiology, clinical features, and drug-resistance profile of urinary tuberculosis (UTB) in south-western China to improve UTB diagnostics.After the screening of 1036 cases of suspected UTB, 193 patients with UTB were enrolled during 2009 to 2014. Urine samples were collected for routine urinalysis, smear, tuberculosis DNA (TB-DNA) detection, and drug-resistant analysis, whereas blood samples were collected for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and renal function evaluation. Clinical features (such as symptoms and outcome) and imageology results (such as B ultrasonic, computerized tomography, intravenous pyelography, and renography) were also collected and analyzed to investigate the epidemiology, clinical features, and drug-resistance profile.The most common presenting symptoms were urinary irritation (61.1%) and lumbago (49.2%). High proportions of microscopic hematuria (63.2%) and microscopic proteinuria (45.6%) were also observed. The positive rate for TB-DNA was 66.3%. The positive rate for culture was 13.1% and for smear it was 9.8%. The abnormal outcome rates of the computerized tomography, ultrasonography, intravenous pyelography, and the nephrogram were 76.9%, 70.1%, 29.8%, and 37.0%, respectively. The total rate of drug-resistant TB (resistant to at least 1 drug) was 39.7%, of which 20.7% was multidrug-resistance TB. The most prevalent mutation sites were katG S315T1, rpoB S531L, and gyrA D94G.We observed a serious epidemic of drug-resistant UTB and a substantial number of new UTB cases with multidrug resistance TB. Molecular diagnostics is crucial in the definite diagnosis of UTB, and our finding is a supplement and further confirmation of polymerase chain reaction usage for TB diagnosis. We recommend real-time polymerase chain reaction for TB-DNA identification instead of culture, and GenoType tests (MTBDRplus and MTBDRsl assay) for drug resistance as routine assays for patients with suspected UTB.
为研究中国西南部地区泌尿生殖系结核（UTB）的流行病学、临床特征及耐药情况，以改善UTB的诊断。在筛查1036例疑似UTB病例后，于2009年至2014年纳入193例UTB患者。收集尿液样本进行尿常规、涂片、结核分枝杆菌DNA（TB-DNA）检测及耐药分析，同时收集血液样本进行红细胞沉降率（ESR）、C反应蛋白（CRP）及肾功能评估。还收集并分析临床特征（如症状和转归）及影像学结果（如B超、计算机断层扫描、静脉肾盂造影及肾图），以研究其流行病学、临床特征及耐药情况。最常见的症状为尿路刺激征（61.1%）和腰痛（49.2%）。镜下血尿（63.2%）和镜下蛋白尿（45.6%）的比例也较高。TB-DNA阳性率为66.3%。培养阳性率为13.1%，涂片阳性率为9.8%。计算机断层扫描、超声、静脉肾盂造影及肾图的异常率分别为76.9%、70.1%、29.8%和37.0%。耐多药结核病（至少对1种药物耐药）的总发生率为39.7%，其中耐多药结核病为20.7%。最常见的突变位点为katG S315T1、rpoB S531L和gyrA D94G。我们观察到耐多药UTB疫情严重，有大量新的耐多药结核病UTB病例。分子诊断在UTB的明确诊断中至关重要，我们的发现是对聚合酶链反应用于结核病诊断的补充和进一步证实。我们建议采用实时聚合酶链反应进行TB-DNA鉴定而非培养，采用基因分型检测（MTBDRplus和MTBDRsl检测）进行耐药检测，作为疑似UTB患者的常规检测方法。
