Gargan R A, Hamilton-Miller J M
Department of Medical Microbiology, Royal Free Hospital and School of Medicine, London, United Kingdom.
J Urol. 1994 Nov;152(5 Pt 1):1615-8. doi: 10.1016/s0022-5347(17)32489-8.
Polymorphonuclear neutrophils (PMN) in freshly voided urines from 20 symptomatic bacteriuric patients were examined. Although the PMN were viable (median 85%), in only 2 cases could phagocytosis of the infecting organisms be demonstrated, even after the addition of serum opsonins. Polymorphonuclear neutrophils from urines of 12 patients were also unable to phagocytose added opsonized Staphylococcus aureus. These urines were found to be of pH < 6.0 and/or osmolality > 700, or < 180 mOsm. However, the phagocytic function of these PMN was restored when transferred to Hanks balanced salt solution (HBSS). By contrast, most PMN in urines of suitable pH (> or = 6.0) and osmolality (between 200 to 700 mOsm.) phagocytosed the opsonized S. aureus. When bacteria cultured from the infected urine were incubated in the same urine and then transferred to HBSS, in 17 of 19 cases opsonization occurred and the organisms were phagocytosed when PMN, isolated from blood, were added. IgG appeared to be the prime opsonin in the urines, and heat-stable opsonins for S. aureus were also present. It is concluded that lack of opsonization is not a major cause of the absence of phagocytosis by urinary PMN. Low pH and adverse osmolality are largely responsible, correction of which may restore PMN function in vivo.
对20例有症状菌尿症患者新鲜晨尿中的多形核中性粒细胞（PMN）进行了检查。尽管PMN具有活性（中位数为85%），但即使添加血清调理素后，也仅在2例中证实了对感染菌的吞噬作用。12例患者尿液中的多形核中性粒细胞也无法吞噬添加了调理素的金黄色葡萄球菌。发现这些尿液的pH值<6.0和/或渗透压>700，或<180 mOsm。然而，当转移到汉克斯平衡盐溶液（HBSS）中时，这些PMN的吞噬功能得以恢复。相比之下，大多数pH值合适（≥6.0）且渗透压（200至700 mOsm之间）的尿液中的PMN吞噬了调理过的金黄色葡萄球菌。当将从感染尿液中培养的细菌在同一尿液中孵育，然后转移到HBSS中时，在19例中的17例中发生了调理作用，并且当加入从血液中分离的PMN时，这些细菌被吞噬。IgG似乎是尿液中的主要调理素，并且也存在对金黄色葡萄球菌的热稳定调理素。结论是调理作用缺乏不是尿液中PMN缺乏吞噬作用的主要原因。低pH值和不利的渗透压在很大程度上起作用，纠正这些因素可能在体内恢复PMN功能。
