相差显微镜下晨尿与随机尿对血尿来源鉴别的影响  

Difference between Urina Sanguinis and Random Urine under Phase Contrast Microscope in Determining the Source of Hematauria

作　　者：徐鹏杰[1] 裘晓蕙[1] 孟艳[1] 徐炜峰[2] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院肾脏内科,315040 [2]浙江省宁波市医疗中心李惠利医院检验科,315040

出　　处：《中国全科医学》2011年第32期3749-3750,共2页Chinese General Practice

摘　　要：目的探讨应用相差显微镜观察晨尿与新鲜随机尿红细胞形态之间的差异,以发现不同尿液标本留取对鉴别血尿来源的影响。方法以肾活检作为肾小球性血尿诊断的金标准,应用相差显微镜观察血尿红细胞形态,计算晨尿与不同放置时间随机尿对诊断肾小球性血尿的灵敏度、特异度、总符合率、误诊率、漏诊率、阳性预测值和阴性预测值。结果与晨尿相比,放置时间越短的随机尿对诊断肾小球性血尿的特异性及阳性预测值越高,误诊率越低,但其灵敏度及阴性预测值降低,漏诊率升高,而随着随机尿放置时间延长,其结果越接近晨尿结果。结论在临床工作中,应纠正留取晨尿作为尿液红细胞形态检查的方法,这会增加肾小球性血尿的误诊率,选择及时的随机尿行尿液红细胞形态的检查更为准确。Objective To explore the difference of red blood cell morphology in determining the source of hematauria under phase contrast microscope between urina sanguinis and random urine.Methods Urina sanguinis and random urine samples at different time points from 78 patients with glomerular hematuria and 86 patients with non-glomerular hematuria were collected.Renal biopsy was employed as the gold standard for glomerularhematuria diagnosis.Sensitivity,specificity,total consistent rate,mistaken diagnosis rate,omission diagnosis rate,and predictive values in determining the source of hematuria under phase contrast microscope were analyzed.Results Compared with urina sanguinis,red blood cell morphology of instant random urines had higher specificity,higher positive predictive values,lower mistaken diagnosis rates,but lower sensitivity,lower negative predictive values and higher omission diagnosis rates in determining glomerularhematuria under phase contrast microscope.Conclusion This study reveals that urina sanguinis increased the mistaken diagnosis rate for glomerularhematuria and instant random urines are more accurate for the diagnosis via morphology examination of urinary red blood cells under phase contrast microscope.

关 键 词：尿红细胞形态 血尿 晨尿 随机尿 相差显微镜 

分 类 号：R696.8[医药卫生—泌尿科学]