Lomberg H, Hanson L A, Jacobsson B, Jodal U, Leffler H, Edén C S
N Engl J Med. 1983 May 19;308(20):1189-92. doi: 10.1056/NEJM198305193082003.
Bacterial attachment to urinary-tract epithelium is important in the pathogenesis of urinary-tract infection. Most pyelonephritogenic Escherichia coli bind specifically to epithelial-cell receptors, which are glycolipids of the globoseries and also antigens in the P blood-group system. Among 36 girls with recurrent pyelonephritis who did not have vesicoureteral reflux, we found that attaching bacteria were common and the P1 blood-group phenotype was present in 97 per cent, as compared with 75 per cent of 84 age-matched children without urinary-tract infection (P less than 0.01). In 32 girls with recurrent pyelonephritis who had reflux, attaching bacteria were rare, and the frequency of the P1 phenotype was not significantly higher than in controls (82 per cent, P greater than 0.05). In the group of patients with the P1 phenotype, 68 per cent of the urinary bacterial isolates from those without reflux, but only 25 per cent of isolates from those with reflux, bound to globotetraosylceramide, as determined by a receptor-coating technique (P less than 0.001). Our data suggest that, in the absence of reflux, the P1 blood group contributes to susceptibility to recurrent pyelonephritis due to bacteria that bind to the glycolipid receptors of the globoseries. In the presence of reflux, uroepithelial attachment does not seem to confer an advantage to bacteria that infect the kidney.
细菌附着于尿道上皮在尿路感染的发病机制中起重要作用。大多数致肾盂肾炎的大肠杆菌能特异性地结合上皮细胞受体，这些受体是球系列糖脂，也是P血型系统中的抗原。在36例无膀胱输尿管反流的复发性肾盂肾炎女孩中，我们发现附着细菌很常见，P1血型表型在97%的患者中出现，而在84名无尿路感染的年龄匹配儿童中这一比例为75%（P<0.01）。在32例有反流的复发性肾盂肾炎女孩中，附着细菌很少见，P1表型的频率并不显著高于对照组（82%，P>0.05）。在P1表型的患者组中，通过受体包被技术测定，无反流患者的尿细菌分离株中有68%能结合球四糖神经酰胺，而有反流患者的分离株中只有25%能结合（P<0.001）。我们的数据表明，在无反流的情况下，P1血型会导致因细菌结合球系列糖脂受体而发生复发性肾盂肾炎的易感性增加。在有反流的情况下，尿道上皮附着似乎并不会给感染肾脏的细菌带来优势。
