血尿在糖尿病肾病与非糖尿病肾病鉴别诊断中的价值  

Value of Hematuria in Differential Diagnosis of Diabetic Nephropathy and Non-diabetic Renal Disease

作　　者：董哲毅[1] 王远大[1] 邱强[1] 张雪光[1] 侯凯[1] 朱晗玉[1] 张利[1] 魏日胞[1] 蔡广研[1] 陈香美[1] 

机构地区：[1]中国人民解放军总医院肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心、北京市重点实验室,北京100853

出　　处：《中国中西医结合肾病杂志》2016年第6期491-494,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：973项目(No.2015CB553605);国家自然科学基金资助项目(No.61471399;61001218)

摘　　要：目的:明确不同标准血尿对2型糖尿病肾病与非糖尿病肾病鉴别诊断的作用,分析糖尿病肾病患者出现血尿的影响因素。方法:分别以尿红细胞>3/Hp、>10/Hp为镜下血尿的标准,尿异形红细胞>80%为肾源性血尿,分析它们对糖尿病肾病和非糖尿病肾病的鉴别诊断效能。用多元回归的统计学方法筛选与血尿相关的影响因素。结果:糖尿病肾病组100例,非糖尿病肾病组200例,三种不同标准血尿的发生率在两组间差异均有统计学意义。肾小球源性血尿预测非糖尿病肾病的特异度(94%)和阳性预测值(90.16%)最高,ROC曲线下面积最大(0.608)。肾病综合征是糖尿病肾病患者出现血尿的独立危险响因素(OR=2.411,P=0.04)。结论:肾源性血尿对2型糖尿病肾病和非糖尿病肾病的鉴别诊断效能优于镜下血尿,表现为肾病综合征的糖尿病肾病患者更易出现血尿。Objective： Clarify the value of different standards hematuria in differential diagnosis of diabetic nephropathy and non- diabetic renal disease in type 2 diabetics. Analysis related factors of hematuria in diabetic nephropathy patients. Methods： Microscopic hematuria was defined as 3, 10 red blood cells per high- power field（ RBCs / hpf）. Glomerular hematuria was diagnosed as dysmorphic erythrocytes 80%. Analysis their respective value of differential diagnosis. Use multiple logistic regression analyses to screen the related factors of hematuria. Results： There were 100 patients in diabetic nephropathy group,200 patients in non- diabetic renal disease group. There were differences between both groups in three kinds of hematuria. Glomerular hematuria had the maximum value of specificity（ 94%）,positive predictive value（ 90. 16%） and AUC. Nephrotic syndrome was an independent risk factor for hematuria（ OR = 2. 411,P = 0. 04）. Conclusion： Glomerular hematuria were superior to microscopic hematuria for predicting non- diabetic renal disease in type 2 diabetics. Patients with nephrotic syndrome were more likely to appear hematuria.

关 键 词：血尿 糖尿病肾病 非糖尿病肾病 鉴别诊断 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]