血尿的病因分析及荧光原位杂交技术用于诊断尿路上皮癌的价值  

Etiological analysis on the causes of hematuria and applicative value of fluorescence in situ hybridization in the diagnosis of urothelial carcinoma

作　　者：王鑫[1] 杨荣[1] 李笑弓[1] 甘卫东[1] 张古田[1] 燕翔[1] 张士伟[1] 章宜芬[2] 郭宏骞[1] 

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,江苏南京210008 [2]南京大学医学院附属鼓楼医院病理科,江苏南京210008

出　　处：《现代泌尿外科杂志》2016年第1期16-19,共4页Journal of Modern Urology

基　　金：江苏省六大人才高峰(No.WSN-005);南京市卫生局杰出青年基金(No.JQX12004)

摘　　要：目的总结并分析初发血尿的病因,同时比较荧光原位杂交技术(FISH)与尿脱落细胞学检查技术在诊断尿路上皮癌(UC)中的敏感性和特异性,从而进一步评估FISH用于筛查尿路上皮癌的临床价值。方法回顾性分析500例入院诊断为"血尿待查"患者的最终出院诊断结果,同时记录其中每例患者的检查诊治经过。计算比较FISH与尿脱落细胞学检查的敏感性与特异性。结果 500例初次诊断血尿待查患者中最终诊断为尿路上皮癌130例、泌尿系结石30例、泌尿系感染135例、前列腺癌12例、前列腺增生(BPH)相关出血66例、乳糜血尿23例、特发性血尿60例、其他44例。有218例诊疗过程中同时采用了FISH检测和尿脱落细胞学检查;FISH敏感性明显优于脱落细胞学(75.4%vs.33.9%,P<0.001),两者特异性无明显差异(96%vs.99%,P=0.837)。对于上尿路尿路上皮癌(UTUC)的诊断,FISH和尿脱落细胞学检查敏感性分别为80.4%和34.8%(P<0.001)。结论血尿待查病因复杂多样,需要临床医生扎实的基础和临床理论知识及正确的临床思维能力。FISH对于尿路上皮癌尤其是上尿路尿路上皮癌的诊断具有重要价值。Objective To explore the etiological causes of incipient hematuria, and to evaluate the application of fluorescence in situ hybridization （FISH） in the diagnosis of urothelial carcinoma （UC）. Methods The diagnostic results of 500 patients with hematuria of unknown origin were retrospectively analyzed, and the sensitivity and specificity of FISH and urine cytology were compared. Results There were 130 cases of urothelial carcinoma, 30 cases of urinary tract calculi, 135 cases of urinary tract infection, 12 cases of prostate cancer, 66 cases of benign prostate hyperplasia, 23 cases of chyle blood in the urine, 60 cases of idiopathic hematuria, and 44 cases of other diseases. For the 218 patients who simultaneously had FISH and urine cytology, the FISH test was superior to cytology for sensitivity （P〈0. 001）, but specificity was equivalent （P= 0. 837）. For upper tract urothelial carcinoma （UTUC）, sensitivity of FISH and urine cytology was 80.4% and 34.8%, respectively （P 〈0.001）. Conclusions The diagnosis and treatment of hematuria is very complicated. Many effective modalites are underscored to identify the diagnosis. FISH has a comparatively high sensitivity and specificity in the early diagnosis of both UC and UTUC.

关 键 词：血尿 病因分析 荧光原位杂交 尿脱落细胞检查 尿路上皮癌 

分 类 号：R696.8[医药卫生—泌尿科学]