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NEJM：气肿性前列腺炎-案例报道

2016-09-01 MedSci MedSci原创

前列腺尿道感染
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一名42岁的男子因严重排尿困难和尿失禁糖尿病几天而到急诊科就诊。

患者男性，42岁，既往患有糖尿病，近日因出现严重排尿困难和尿失禁几天余而到急诊科就诊。

 

实验室检查结果显示脓尿，白细胞增多（白细胞计数为10820/mm3）、C-反应蛋白水平升高（134.1mg/L），高血糖（血糖水平900mg/dL）以及糖化血红蛋白水平升高（11.4%）。

肾、输尿管造影检查显示耻骨联合右侧膀胱内部可见非典型的焦点（图A，箭头）。

随后行腹部计算机断层扫描（CT）显示气肿性前列腺炎（图B，箭头）。

随即，会诊医师根据该患者的情况，对其进行留置导尿管，并在CT引导下经皮穿刺引流前列腺分泌液。

同时，应用广谱抗生素和静脉补液治疗，并实施了严格的血糖控制与胰岛素滴注。

此外，尿液和血液培养中都发现了肺炎克雷伯菌的存在。

最后，该患者因感染、败血症和高血糖以及急性肾损伤住院治疗1个月。随后，病情逐渐好转，顺利康复出院。

气肿性前列腺炎是一种罕见的尿路感染并发症，最常见于免疫抑制、糖尿病血糖控制不良、肝硬化、酒精中毒，或最近行尿道手术的患者。

在本案例中，患者是一名糖尿病患者，在这种情况下，最常见的发病病原体是肺炎克雷伯菌。 

原始出处： 

Hsun-Shuan Wang, M.D.Ming-Chen Shih, M.D. Emphysematous Prostatitis. N Engl J Med 2016; 375:879 2016 September 1.

本文系梅斯医学（MedSci）原创编译整理，转载需授权！

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    2016-09-05 李东泽

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    2016-09-05 李东泽

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    2016-09-03 doctorJiangchao

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  5. [GetPortalCommentsPageByObjectIdResponse(id=112558, encodeId=2c091125583a, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 20:45:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111562, encodeId=160c111562aa, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 16:42:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111300, encodeId=a0c5111300f9, content=很好，不错，以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 10:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=110477, encodeId=78991104e7d6, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Sep 03 20:56:00 CST 2016, time=2016-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=110478, encodeId=65081104e895, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Sep 03 20:56:00 CST 2016, time=2016-09-03, status=1, ipAttribution=)]
    2016-09-03 doctorJiangchao

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JCO：中年人的PSA水平能预测将来前列腺癌的死亡率

根据一个嵌套的病例对照研究结果显示，中年男性PSA水平的升高，可能意味着患前列腺癌的风险增加了。布莱根妇女医院的Mark A. Preston博士说：“我们发现中年时测定的PSA水平，能很好的预测之后30年致命性前列腺癌的后续发展。”虽然PSA筛查能降低前列腺癌的死亡率，但也与过度诊断和过度治疗有关，并且好处和风险之间谁大谁小仍存在争议。研究人员使用了医师健康研究的数据，该数据中纳入了安慰剂对照试

cience：单一基因或可驱动前列腺分化

最近，一项发表在国际杂志Science上的研究论文中，来自哥伦比亚大学医学中心的研究人员通过研究发现，单一基因的表达就可以将骨盆精囊中的内衬细胞转化成为前列腺细胞，这项研究或可帮助深入理解控制前列腺组织和精囊发育背后的分子机制，同时还可以帮助科学家们揭示为何癌症通常多发于前列腺而很少在精囊组织中发生。此前研究中，研究者Aditya·Dutta等人通过研究发现，Nkx3.1基因的缺失会损伤小鼠前列腺

Sleep：前列腺癌风险与男性睡眠不足

先前有研究表明，睡眠不足（包括睡眠时间短与睡眠中断）可能会增加癌症风险。关系男性睡眠情况与前列腺癌风险之间的研究目前还很少，因此有研究者对瑞典14,041名男性进行了一项前瞻性队列研究，探究男性睡眠不足与前列腺癌风险的关系。研究对象在1997年向研究者提供了平时的睡眠时间以及睡眠中断情况等基本睡眠信息，研究者根据2010年瑞典癌症统计数据获得研究对象中前列腺癌发生情况，包括致死性前列腺癌（诊断时已

血清肿瘤标志物PSA检测助力前列腺癌有效管理

日前，在北京举办的肿瘤标志物大师班交流会上，西班牙巴塞罗那临床医院生化实验室癌症研究中心主任Rafael Molina教授就PSA的研究发展、医学价值及其对前列腺癌管理的应用进行了深入探讨。

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