尿流式细胞术在快速筛查及鉴别尿路感染病原菌中的应用  

Application of urinary flow cytometry in rapid screening and identification of pathogenic bacteria of urinary tract infection

作　　者：钱景荣 张艳丽[1] 郭爱萍 庄学伟[1] QIAN Jingrong;ZHANG Yanli;GUO Aiping;ZHUANG Xuewei(Department of Clinical Laboratory,Shandong Province Third Hospital,Shandong University,Jinan,Shandong 250031,China)

机构地区：[1]山东大学附属山东省立第三医院检验科,山东济南250031

出　　处：《国际检验医学杂志》2023年第10期1188-1194,共7页International Journal of Laboratory Medicine

基　　金：山东大学附属山东省立第三医院院级重点专科项目(JGZK004)。

摘　　要：目的 探讨尿流式细胞术在尿培养前对于疑似菌尿进行快速筛查的价值,以规范抗菌药物使用和减少不必要的尿培养。方法 收集2022年1-8月在该院就诊或住院的1 221例疑似尿路感染患者的UF-5000尿有形成分分析仪检测相关参数,并与尿培养结果比较。以尿培养为金标准,绘制受者工作特征(ROC)曲线,计算曲线下面积(AUC)及最佳cut-off值以评估筛查性能,采用Kappa值评估革兰阳性/阴性菌鉴定的一致性。结果 1 221例患者中,尿培养阳性率为31.6%,最常见革兰阴性菌感染占64.5%,真菌感染占12.4%。与大肠埃希菌尿路感染患者比较,肺炎克雷伯菌尿路感染患者的白细胞计数(WBC)和红细胞计数(RBC)升高(P=0.008、0.026),而肠球菌属尿路感染患者的WBC降低(P=0.003)。在明确尿路感染诊断方面,细菌计数(BACT)优于WBC,对于BACT,老年女性优于老年男性,但老年男性最佳cut-off值略高于老年女性。在筛查尿培养阴性方面,老年男性人群中采用BACT<156.4/μL或WBC<15/μL时,灵敏度为88.6%,阴性预测值为93.4%,与尿培养一致率为73.0%,可减少47.1%不必要的尿培养;老年女性人群中,BACT<134.7/μL或WBC<15/μL时,灵敏度为90.8%,阴性预测值为91.3%,与尿培养一致率为71.3%。在革兰阳性/阴性菌鉴定方面,UF-5000尿沉渣分析仪正确识别率为76.1%,与尿培养结果的Cohen′s Kappa值为0.764(P<0.001)。结论 尿流式细胞术是一种快速、简便、有效的疑似尿路感染筛查方法,特别是针对老年人群,有利于建立尿路感染筛查最佳cut-off值,为临床诊疗提供参考依据。Objective To evaluate the value of urine flow cytometry for rapid screening of suspected bacteriuria before urine culture in order to regulate the use of antibiotics and reduce unnecessary urine culture.Methods Totally 1221 patients with suspected urinary tract infection admitted to the hospital from January to August 2022 were selected as research objects.The relevant parameters of UF-5000 urine visible component analyzer were collected and compared with the results of urine culture.With urine culture as the gold standard,receiver operating characteristic(ROC)curve was drawn,area under the curve(AUC)and optimal cut-off value were calculated to evaluate the screening performance,and Kappa value was used to evaluate the consistency of Gram positive/negative bacteria identification.Results In 1221 patients,the positive rate of urine culture was 31.6%,the most common Gram negative bacterial infection was 64.5%,and fungal infection was 12.4%.Compared with patients with E.coli urinary tract infection,white blood cell count(WBC)and red blood cell count(RBC)were increased in patients with Klebsiella pneumoniae urinary tract infection(P=0.008,0.026),while WBC was decreased in patients with enterococcus urinary tract infection(P=0.003).Bacterial count(BACT)was better than WBC in clarifying the diagnosis of urinary tract infection.For BACT,older women were better than older men,but the optimal cut-off value in older men was slightly higher than that in older women.In terms of screening negative urine culture,when BACT<156.4/μL or WBC<15/μL was used in the elderly male population,the sensitivity was 88.6%,the negative predictive value was 93.4%,the consistency rate was 73.0%,and the unnecessary urine culture was reduced by 47.1%.In the elderly female population,when BACT<134.7/μL or WBC<15/μL,the sensitivity was 90.8%,the negative predictive value was 91.3%,and the consistency rate with urine culture was 71.3%.In the identification of Gram positive/negative bacteria,the correct identification rate of UF-5000 urine sedim

关 键 词：尿路感染 尿流式细胞术 老年人群 CUT-OFF值 革兰阴性菌 革兰阳性菌 

分 类 号：R446.5[医药卫生—诊断学] R691.3[医药卫生—临床医学]