尿胆红素阳性作为尿液分析复检规则的临床应用  

Clinical application of positive urobilirubin as a rule of microscopic review of urinalysis

作　　者：刘善凤 张科 王利民 高云 王平[1] Liu Shanfeng;Zhang Ke;Wang Limin;Gao Yun;Wang Ping(Department of Clinical Laboratory,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院检验科,武汉430022

出　　处：《中华检验医学杂志》2023年第9期919-924,共6页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨尿胆红素与管型之间的相关性,评估尿胆红素阳性作为尿液分析复检规则的准确性。方法回顾性分析。收集505例2021年10月至2022年4月间华中科技大学附属协和医院住院患者的尿样本,包括男339例,女166例,年龄(53.74±13.35)岁。其中研究组202例,其尿胆红素为阳性,用于评估尿胆红素阳性作为尿液分析复检规则的准确性,根据尿蛋白干化学结果将研究组分为两组:尿蛋白干化学阳性组70例,尿蛋白干化学阴性组132例。对照组40例,为研究组患者同时期相应科室的尿胆红素为阴性的尿样本。验证组263例,综合假阴性率(漏检率)和复检率以验证各复检规则的有效性,验证实验一选用200例,选取时不考虑科室来源和尿常规结果分布;验证实验二选用63例为尿胆红素阳性且尿蛋白干化学阴性的尿样本。各仪器室内质控合格后,分别进行肝肾功能检测、尿干化学分析、沉渣计数、离心尿沉渣显微镜镜检和尿β2-微球蛋白(β2-MG)、尿视黄醇结合蛋白(RBP)定量检测。显微镜复检规则一:干化学检测的隐血(BLD)、白细胞酯酶(LEU)和蛋白与对应的尿流式检出的红细胞(RBC)、白细胞(WBC)、管型结果不符以及尿蛋白干化学阳性;复检规则二:规则一基础上增加尿胆红素阳性。采用Mann-Whitney U检验和χ^(2)检验进行数据统计分析,评估各复检规则的准确性。结果①研究组和尿蛋白干化学阴性组的管型阳性率依次为58.42%(118/202)和55.30%(73/132),均高于对照组(20.00%,8/40),差异有统计学意义(χ^(2)=19.74、15.36,P<0.01)。单变量分析显示,尿蛋白干化学阴性时,尿胆红素阳性[OR(95%CI):5.619(2.466~12.806),P<0.01]可用于预测尿管型阳性。②分别以尿蛋白干化学阳性、UF-5000i计数管型阳性、规则一以及规则二为复检规则,4个方案对研究组的复检率依次为34.65%(70/202)、30.69%(62/202)、60.89%(123/202)和100%(202/202),管型漏检率依次为3Objective To study the correlation between urobilirubin and urine cast,and further assess the accuracy of positive urobilirubin as a new microscopic review rule for urinalysis.Methods 505 inpatients′urine samples were selected from Wuhan Union Hospital during October 2021 and April 2022,including 339 males and 166 females with an age range of 51.45±16.64 years.202 samples with positive urobilirubin were selected as study objects and were divided into two groups,one group includes 70 samples with positive urine protein and another group includes 132 samples with negative urine protein.According to the clinical departments′distribution of the study objects,40 samples from the corresponding clinical departments with negative urobilirubin were selected as a control group.200 samples were selected for verification test one without consideration of the clinical department distribution and the urinalysis results and another 63 samples with positive urobilirubin and negative positive urine protein were selected for verification test two.After the IQC of each instrument was passed,the liver and renal functions were detected and the urine samples were detected by dry chemical analysis,automated sediment analyzer,microscope exam after centrifugation,and urineβ2-MG and RBP quantitative detections.Two microscope review rules were defined,rule one:if any of WBC,RBC,PR0/CAST were different between the dry chemical system and urine sediments analyzer and the urine protein was positive by dry chemical analysis.Rule two:positive urobilirubin plus rule one.We estimated the accuracies of the two rules by Mann-Whitney U test andχ^(2)test.Results①The positive rates of the cast of study objects and patients with negative urine protein were 58.42%(118/202)and 55.30%(73/132)respectively,both higher than that of the control group(20%,8/40)(χ^(2)=19.74,15.36,P<0.01),and on univariate analysis,positive urobilirubin was found to be a significant predictor of urine cast when the urine protein was negative by dry chemical system[OR(9

关 键 词：胆红素 尿液分析 化学 分析 显微镜检 自动分析 

分 类 号：R446.12[医药卫生—诊断学]