尿红细胞位相、血尿红细胞MCV差值及肾功能4项在肾小球肾炎中的诊断价值  

Clinical value of urinary red blood cell phase,difference of hematuria erythrocyte MCV and four items of renal function in the diagnosis of glomerulonephritis

作　　者：沈小琴 代超 邸师红 焦婷婷 张成磊 杨秀莲 王利新 SHEN Xiaoqin;DAI Chao;DI Shihong;JIAO Tingting;ZHANG Chenglei;YANG Xiulian;WANG Lixin(Department of Medical Laboratory,Cardiovascular Diseases Hospital of Ningxia Medical University General Hospital,Yinchuan,Ningxia 750002,China)

机构地区：[1]宁夏医科大学总医院心脑血管病医院医学检验科

出　　处：《检验医学与临床》2019年第20期2924-2927,2932,共5页Laboratory Medicine and Clinic

基　　金：宁夏医科大学校级重点项目（XZ2016016）

摘　　要：目的探讨尿红细胞位相,血、尿平均红细胞体积(MCV)差值及肾功能4项指标在肾小球肾炎诊断中的临床价值。方法收集2017年1月至2018年1月在该院肾内科确诊为肾小球肾炎的患者142例,非肾小球肾炎患者80例,以及健康体检者100例作为研究对象;采用相差显微镜检测肾小球肾炎患者血、尿中红细胞的形态,采用流式细胞技术检测患者血、尿红细胞MCV,采用全自动生化分析仪检测患者血清中补体C1q、胱抑素C(CysC)、肌酐(Cr)、尿素(UREA)水平;绘制ROC曲线评价上述指标的诊断效能。结果肾小球肾炎患者血、尿中可见变形红细胞,原发性肾小球肾炎患者血、尿中变形红细胞检出率(61.63%)明显高于继发性肾小球肾炎患者(30.36%)和非肾小球性肾炎患者(5.00%),差异均有统计学意义(P<0.05)。肾小球肾炎患者血清中补体C1q、Cr、UREA、CysC检测结果明显高于非肾小球性肾炎患者和健康体检者,差异均有统计学意义(P<0.05)。用各指标单项及联合检测的ROC曲线来评价诊断肾小球肾炎的效能,MCV差值法与尿红细胞位相法联合检测诊断肾小球肾炎的ROC曲线下面积(AUC)为0.920,灵敏度和阳性预测值高于两种方法单独检测,但特异度仅为79.2%,而3种方法联合检测诊断肾小球肾炎的AUC为0.940,灵敏度(92.0%)、特异度(91.5%)、阳性预测值(89.0%)、阴性预测值(92.5%)明显高于两种方法联合检测和某一方法单独检测结果。结论采用尿红细胞位相,血、尿红细胞MCV差值及肾功能4项指标联合检测,既可排除检测人员的主观判断误差,又可提高诊断肾小球肾炎的灵敏度和特异度,降低漏诊率。Objective To investigate the clinical value of urinary red blood cell phase,difference of hematuria erythrocyte mean corpuscular volume(MCV)and four items of renal function in the diagnosis of glomerular nephritis.Methods A total of 142 patients with glomerular nephritis,80 patients with non-glomerular nephritis and 100 healthy subjects from Jun.2017 to Jun.2018 were selected.The morphology of red blood cells in hematuria was detected by phase contrast microscopy.The difference of hematuria erythrocyte MCV was detected by flow cytometry.The levels of blood C1q,cystatin C(CysC),creatinine(CREA)and urea(UREA)were detected with automatic biochemical analyzer.ROC curve was drawn to evaluate the diagnostic efficacy of the above indicators.Results The morphological changes of red blood cells in hematuria were observed in patients with glomerular nephritis.The detection rate of red blood cells in hematuria of primary glomerular nephritis(61.63%)was significantly higher than that of secondary glomerular nephritis(30.36%)and non-glomerular nephritis(5.00%),and the differences were statistically significant(P<0.05).The serum levels of complement C1q,CREA,UREA and CysC in patients with glomerular nephritis were significantly higher than those in non-glomerular nephritis group and control group(P<0.05).The AUC of combined detection of difference of hematuria erythrocyte MCV method and urinary red blood cell phase method was 0.920.The sensitivity and positive predictive value were higher than the two methods detected alone.The specificity was only 79.2%,and the combined method of three methods for the diagnosis of glomerular nephritis had an AUC of 0.940,the sensitivity,specificity,positive predictive value and negative predictive value were 92.0%,91.5%,89.0%and 92.5%,which were significantly higher than the two methods combined detection and method detected alone.Conclusion The combination of urinary red blood cell phase,urinary red blood cell MCV and four indicators of renal function could not only exclude the subjective ju

关 键 词：尿红细胞位相 血尿平均红细胞体积差值 血清补体C1q 胱抑素C 肾小球肾炎 

分 类 号：R446.1[医药卫生—诊断学]