常规尿检整合分类作为肾病理损伤的标志物  

Urine sediment combined with urine protein as a biomarker for renal injury

作　　者：李惊子[1] 陈育青[1] 王素霞[1] 鄂洁[1] 庞维[1] 秦小琪[1] 

机构地区：[1]北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,北京100034

出　　处：《北京大学学报（医学版）》2010年第2期169-172,共4页Journal of Peking University:Health Sciences

摘　　要：目的:探讨常规尿检整合分类是否能预测肾病理损伤。方法:采集北京大学第一医院肾内科住院患者肾活检当日晨尿标本146份,行位相差显微镜检查尿沉渣,查尿蛋白定量(g/24 h),进行尿检整合分类。尿沉渣谱整合蛋白定量后分3类,Ⅰ类:蛋白尿,多细胞及管型;Ⅱ类:蛋白尿,少细胞,透明/细颗粒管型;Ⅲ类:少量蛋白,肾小管上皮细胞和/或有核细胞管型。对肾活检标本常规处理,行光镜(HE、PASM、Masson染色)、免疫荧光和电镜检查做出病理诊断。将常规尿检资料整合与分类的关系及分类与肾病理诊断的符合率进行统计学处理,采用kappa检验,配对χ2检验,P<0.05为差异有统计学意义。结果:(1)肾活检组织病理诊断:肾小球增殖性病变95例、非增殖性病变46例、小管间质病5例。(2)常规尿检资料整合对分类的影响:单凭尿沉渣镜检,146例中有67例(46%)归于Ⅰ类,79例(54%)不能确定;再整合尿蛋白定量可从79例中再确认75例,4例仍不能确定。(3)尿检分类与肾组织病理诊断符合率:肾小球疾病符合率为77.7%。结论:常规尿液检查整合分类可在一定程度上判断肾病理损伤。Objective：To investigate whether combination of urine sediment and urine protein can predict the renal pathological changes.Methods： We prepared 146 specimens of routine fresh fasting morning urine.Sediment analysis was performed with phase-contrast microscopy and 24-hour urine protein was measured.Both urine protein and sediment data were integrated to form three urine analysis groups.Urine group Ⅰ： proteinuria,hematuira,urine white blood cells,red/white cell casts.Urine group Ⅱ： proteinuria,few cell hyaline/fine granular casts.Urine group Ⅲ： minor proteinuira,epithelial cells of tubule,granular/cell casts.The renal pathological lesions were predicted before and then confirmed by renal biopsy.Statistical analyses were performed using kappa test,χ^2 test,and significance was accepted at P〈0.05.Results： After renal biopsy,we identified 95 cases of glomerular lesion with proliferation,46 cases of glomerular disease without obvious proliferation and 5 cases of tubular interstitial lesion.According to the sediment analysis,only 67 cases（46%） could be attributed to urine group Ⅰ.When combined with urine protein,we could pick out another 75 cases from urine groups Ⅰand Ⅱ,and 8 cases from urine group Ⅲ.The combined urine analysis could predict glomerular disease（77.7%）.Conculsion： Clinically we can take advantage of the combined urine analysis to predict the pathological lesion of kidney disease,which is especially suitable for primary care doctor,who can not perform renal biopsy.

关 键 词：肾疾病 尿分析 活组织检查 针吸 诊断 

分 类 号：R692[医药卫生—泌尿科学]