兰州市重工业区初中在校学生尿液筛查结果报告及分析

目的通过对兰州市重工业区在校七年级学生进行尿液筛查,了解其肾脏相关疾病的患病情况、分布特点及风险因素。方法采用尿试纸法对兰州市西固区1 969例在校七年级学生的晨起中段尿进行检测,对初次尿液异常者进行复查。对2次结果异常者的尿中红细胞、血尿+蛋白尿、白蛋白尿及尿中白细胞进行分析及随访。结果2次尿检异常率达15.4%,其中尿潜血阳性301例,尿蛋白阳性200例,白细胞尿39例。当地常驻学生的总体尿异常率高于农村外来学生(P0.05);女生尿中白细胞的异常率高于男生(P0.05)。本地城镇男生的总尿异常率、尿潜血及蛋白尿阳性率均高于农村外来学生(P0.05)。女生尿潜血伴蛋白尿的阳性率显著高于农村外来学生(P0.05)。结论兰州市西固区七年级学生尿异常情况高,且当地常驻人口尿异常情况高于外来农村学生。     

扬州地区1973名学生尿常规筛查结果分析

目的调查分析扬州市在校学生尿液筛查结果特点,为扬州地区儿童尿检异常提供基础数据,对异常尿常规者进行规范管理随访。方法选取2021年扬州地区部分幼儿园及中小学儿童1973名,年龄6~14岁在校学生,采用尿液分析仪法进行尿常规检测,并对异常结果进行尿液分析仪及尿沉渣复测,分析尿液常规筛查及复检结果。结果此次尿常规筛查结果:尿隐血初筛阳性率9.22%,复检血尿阳性率0.61%,尿蛋白初筛6.08%,复检0.76%,尿白细胞酯酶阳性初筛5.58%,复测白细胞增多者1.93%,还有少部分其他异常。结论在校中小学生尿常规异常以儿童尿隐血最为常见,尿蛋白以少量蛋白尿为主,泌尿道感染以女性儿童为多;尿液筛查可以早期发现无症状尿检异常患儿,提供早期干预的时机。     

泰安市3924例小学生尿液筛查及随访结果分析

目的了解小学生尿异常情况,探讨儿童尿液筛查的意义。方法对泰安市泰山区、高新区3 924例6~13岁在校小学生晨尿样本红细胞、白细胞、尿蛋白等指标进行检测,初筛阳性者2周后进行复查,复筛阳性者进一步明确诊断并随访、统计、分析。结果参与筛查的3 924例小学生中,初筛尿液异常者522例(13.30%),男214例(5.45%),女308(7.85%)。初筛白细胞尿223例(5.68%),潜血尿211例(5.38%),蛋白尿72例(1.83%),血尿并蛋白尿16例(0.41%)。初筛阳性者2周后复查,阳性者118例(3.01%),其中男42例(1.07%),女76例(1.94%)。复查白细胞尿30例(0.77%),血尿59例(1.50%),蛋白尿17例(0.43%),血尿合并蛋白尿12例(0.31%)。女生尿液初筛、复筛阳性率和白细胞尿的发生率均高于男生,差异有统计学意义(P0.05)。复查阳性118例中有94例得到进一步诊治、随访,其中尿路感染16例,急性肾炎6例,左肾静脉压迫综合征17例,紫癜性肾病8例,特发性高钙尿症5例,Ig A肾病3例,膀胱输尿管反流5例,肾积水2例,多囊肾2例,30例暂时病因不明。结论尿液筛查是早期发现儿童无症状性肾脏疾病和泌尿系統感染的有效方法,可为患儿提供早期干预时机,减少远期慢性肾病的发生。     

1390例儿童尿液分析

目的 分析临沧市0～4岁健康儿童尿液中蛋白质、白细胞、红细胞的存在情况与早期发现儿童不典型泌尿系感染的关系.方法 采取随机抽样法留取1 390例0～4岁儿童随机尿液进行尿液分析(尿蛋白质、白细胞、红细胞检出阳性率),并按性别分年龄段进行统计.结果 1 390例0～4岁儿童随机尿液中蛋白质、白细胞 、红细胞的阳性检出率有随年龄增长而增高的趋势,其中3～4岁年龄组尿白细胞、红细胞检出率与同性别儿童的尿白细胞、红细胞总检出率相比有明显差异.女童尿液中白细胞检出率与男童相比有明显差异.结论 0～4岁儿童不典型泌尿系感染情况不容怱视,尿液检查是发现不典型泌尿系感染简便、安全、准确的方法 之一.     

成人无症状尿检异常59例分析

尿检异常是肾小球疾病的常见临床征之一,肾组织活检是最直接的诊断手段,对无症状尿检异常患者做肾组织活检的临床价也日渐明确[1].本文成人无症状尿检异常多在健康体检或其他疾病(尤其是高血压、糖尿病等导致肾损害的早期指标)尿检时被发现,无肾脏疾病的阳性体征.通过对本组病例尿红细胞形态分析和肾穿分析无症状尿检异常的可能原因,进一步探讨无症状血尿和(或)蛋白尿(微量)的临床意义,为基层医疗尤其健康体检的进一步筛查提供参考.1临床资料1.1 一般资料2008-01-2010-07在我院健康体检、门诊及住院的无症状尿检异常患者59例,男24例,女35例,年龄16～59(平均32.5)岁.尿检提示单纯持续性镜下或(和)血尿22例;持续性镜下血尿伴蛋白尿(微量)8例;单纯持续性蛋白尿(微量)19例.经尿红细胞形态分析均为肾性血尿且肾功能正常.     

长春市1329名男童外生殖器疾患的调查研究

目的 了解长春市小学男童外生殖器主要疾患的流行现状,为进一步做好儿童生殖卫生宣教及筛查工作提供依据.方法 采用整群抽样的方法对长春市某小学1329名男童进行外生殖器检查.结果 有28.46％的男童存在异常,其中包茎、包皮粘连、隐匿阴茎、回缩睾丸和隐睾的检出率分别为20.71％、0.98％、3.54％、2.18％和0.98％,检出蹼状阴茎2例、尿道下裂1例、精索静脉曲张2例、鞘膜积液4例和腹股沟斜疝2例.结论 小学男童外生殖器健康现状不容乐观,应加强生殖系统卫生宣教,积极开展生殖系统健康筛查.     

视力筛查仪应用于儿童眼保健中的价值研究

目的探究视力筛查仪应用于儿童眼保健中的价值。方法选取2016年8月~2017年8月收治的150例于我院行健康体检儿童作为研究对象,均行Suresight视力筛查仪与阿托品散瞳检影验光检查,以阿托品散瞳检影验光检查视作"金标准",比较两种检查结果及不同年龄段检出情况、Suresight视力筛查仪检查效能。结果 150例共300眼儿童中,阿托品散瞳检影验光屈光异常总检出率为23.33%,Suresight视力筛查仪检出21.00%,差异无统计学意义(P0.05);两种检查方式不同年龄段总屈光异常检出率比较,无显著差异(P0.05),且Suresight视力筛查仪与阿托品散瞳检影验光检查均以4~6岁年龄段屈光异常检出率31.00%、33.00%高于0.5~2岁、2~4岁年龄段,差异有统计学意义(P0.05);Suresight视力筛查仪检查灵敏度为71.42%、特异度为94.34%、准确度为89.00%。结论视力筛查仪检查可有效检出儿童屈光异常情况,且检查灵敏度、特异度较高,可用于指导临床儿童眼保健及屈光异常儿童治疗。     

基层医院产前超声在消化道先天异常诊断中的应用35例分析

目的探讨超声检查在先天性消化道异常中的诊断价值。方法将2005-01-2010-12在产前超声筛查中发现消化道异常征象的出生儿22例;产前超声未发现异常但出生后检出先天性消化道畸形的患儿13例,作为研究对象。结果 (1)产前发现异常征象的22例中有13例出生后证实合并先天性消化道畸形,阳性预测值72.7%;(2)检出率55.2%;(3)先天性消化道畸形儿在胎儿期合并羊水过多的占75.9%。结论超声筛查对胎儿先天性消化道的检出率有限,但通过细心检查能检出大部分的先天畸形。     

中晚孕期超声筛查胎儿染色体异常的有效性及应用价值研究

目的 研究中晚孕期超声筛查胎儿染色体异常的有效性及应用价值.方法 经超声筛查为结构异常的中晚孕期胎儿和经孕母血清筛查为高风险的中期妊娠胎儿,行羊膜腔或脐静脉穿刺取羊水或脐血,作染色体核型诊断.结果 ①超声筛查接受检查的结构异常胎儿31例,检出异常染色体8例,检出率为25.8%.31例中颈部淋巴囊肿伴水肿3例,全部染色体异常;单纯颈项皮肤增厚3例,其中2例染色体异常;多发畸形、Dandy-Walker畸形及前脑无裂畸形各1例,染色体均异常.②血清筛查接受检查的唐氏综合征和18-三体高风险孕妇516例,检出异常染色体14例,检出率为2.71%.14例中唐氏综合征7例,其他染色体异常7例.③单纯超声筛查和血清筛查共筛查为高危又接受诊断者544(516+28)例,检出异常染色体21(14+7)例,两种方法互补染色体异常检出率为3.86%.互补筛查检出率是血清筛查的1.42倍,比血清筛查提高42.43%.结论 ①中晚孕期超声显示的某些胎儿结构异常是提示胎儿染色体异常的有效指征.②超声和血清两种筛查方法互补,可以提高染色体异常的检出率,对于血清失筛查或筛查低危漏诊孕妇是有效的弥补措施.     

健康体检女性阴道分泌物对尿检干化学结果的干扰及对策分析

目的探讨健康体检女性阴道分泌物对尿检干化学结果的干扰影响。方法随机收集健康体检女性阴道分泌物250例,采用干化学法测定其中的潜血、白细胞酯酶、蛋白质和亚硝酸盐;收集洗涤分离正常阴道分泌物的鳞状上皮细胞,加入健康体检正常女性尿液后,配制成含上皮细胞50个/μl和200个/μl两个浓度的尿液各50例,进行干化学潜血、白细胞酯酶、蛋白质和亚硝酸盐测定比较;再随机选取100例健康体检女性留取外阴清洗前后的尿液进行干化学项目测定比较,另收集妇检前后各100例尿液,对比分析健康体检女性妇检前后尿干化学结果。结果 250例健康体检女性阴道分泌物的潜血和白细胞酯酶阳性率分别是62.8%和71.2%;正常尿液A组、上皮细胞低浓度(50个/μl)尿液B组及上皮细胞高浓度(200个/μl)尿液C组的潜血、白细胞酯酶、蛋白质和亚硝酸盐阳性率比较,差异无统计学意义(P0.05);健康体检女性外阴清洗前尿液的潜血、白细胞酯酶和蛋白质阳性率均大于外阴清洗后,妇检前尿液潜血、白细胞酯酶和蛋白质阳性率均少于妇检后,差异均有统计学意义(P0.05)。结论单纯的阴道鳞状上皮细胞对尿液干化学检测不构成干扰。绝大多数阴道分泌物含潜血物质、白细胞酯酶,且浓度较高,混入尿液严重干扰尿液干化学结果,健康体检女性尿检时应注意避免阴道分泌物的污染,采取妇检前、外阴清洗后进行留取中段尿液检测,可有效保证尿检分析前质量控制。     

Screening for proteinuria in Japanese schoolchildren: a new approach.

By governmental mandate, Japanese school children are screened annually for proteinuria, hematuria, and glucosuria to identify children with possible renal disorders. We added urine dipstick tests for albumin and creatinine to the Japanese screening protocol, and used their dipstick results for blood, glucose and protein. The sulfosalicylic acid precipitation test was used to confirm "trace" positive protein dipsticks. The Japanese and our screening protocol have in common the same data for glucosuria and proteinuria. Their scheme has an algorithm for repeat testing of children with abnormal results, and further testing and medical evaluation for those showing persistently abnormal values. Out of the 23,121 students, we found seven with likely nephritis, one with confirmed nephritis, one with nephrotic syndrome, 170 with persistent unexplained hematuria, 19 with persistent unexplained proteinuria, 14 cases of urinary tract infection, and 20 cases of likely diabetes mellitus. We conclude that dipstick testing for albumin, protein, creatinine, glucose and occult blood has significant value in a multilevel testing scheme for identifying children with urinary tract abnormalities or diabetes. The assay of albumin increases the sensitivity of the screening, and dividing the albumin by the creatinine concentration reduces the potential errors arising from concentrated or dilute urines.     

Screening for hematuria, glucosuria and proteinuria in people aged 55-64. Technical, clinical and cost-benefit experience from a pilot study

A total of 754 persons randomly selected from the age group 55-64 years were invited by letter to take part in a screening for hematuria, proteinuria and glucosuria. Each person was asked to provide one sample of morning urine and immediately mail it to the laboratory. A total of 413 persons (55%) responded. Two dipsticks: BM-Test-5L and a new single strip for hematuria determination preliminary named BM 33075 were used, both manufactured by Boehringer Mannheim GmbH. The test strips gave positive reaction for hematuria in 21 persons (5.1%), for proteinuria in 14 persons (3.4%), and for glucosuria in six persons (1.5%). All persons with positive tests were invited to follow-up investigations. In the hematuria group we found one person with a malignant disease, 13 with benign conditions and in seven persons we found no reason for the hematuria. Among those with proteinuria one person had a nephritis. Four persons with glucosuria knew about their diabetes mellitus. The cost of the screening was NOK 99 per participant.     

Urine Dipstick as a Screening Test for Serum Creatinine Elevation in Emergency Department Patients with Severe Hypertension

OBJECTIVE: Patients presenting to the emergency department (ED) with severe hypertension require assessment for acute end-organ damage. Serum creatinine (SCr) measurement is routinely recommended to detect renal dysfunction. The authors assessed the utility of the urine dipstick test in screening for acute SCr elevation in this population. METHODS: The authors performed a prospective study of adult ED patients with diastolic blood pressures > or = 115 mm Hg that persisted for > or = 30 minutes or necessitated emergent treatment. Excluded were menstruating and pregnant women and patients with urinary infection, trauma, or dialysis dependence. Patients reporting a history of renal disease were excluded if the SCr was abnormal and no baseline value was available. Each subject had an SCr and urine dipstick test. The authors examined the performance of the dipstick in identifying an elevated SCr, defined as SCr > 1.2 mg/dL or > 25% above baseline. RESULTS: Of 143 patients, 42 had SCr > 1.2 mg/dL. Eighteen reported prior renal disease but had an SCr that was normal or < or = 25% above baseline. The remaining 24 subjects comprised the elevated SCr group. The presence of either proteinuria or hematuria on dipstick identified these patients with 100% sensitivity and 29.7% specificity. Specificity rose to 42.4% without loss of sensitivity when an abnormal dipstick was defined as hematuria or > or = 1+ proteinuria. CONCLUSIONS: The urine dipstick may be an effective screening test for SCr elevation in patients with severe hypertension. A restrictive definition of an abnormal dipstick would identify all patients with elevated SCr and substantially reduce the number of SCr assays necessary.     

过敏性紫癜肾脏损害的临床因素分析

目的探讨过敏性紫癜肾脏损害的临床因素。方法回顾性分析72例过敏性紫癜患儿的临床资料，根据尿常规检查，分为尿检正常组和紫癜肾损害组；紫癜肾损害组分为一过性尿异常组及持续性尿异常组。观察相应的临床因素，并行统计学分析。结果紫癜肾损害组年龄，皮疹反复、皮疹持续时间，消化道出血的发生率及严重程度均高于尿检正常组，差异有显著性（P〈0．05）。持续性尿异常组皮疹持续时间、血尿并蛋白尿发生率均高于一过性尿异常组，差异有显著性（P〈0．05）。单纯皮肤紫癜者、紫癜加关节症状者、紫癜加消化道症状者以及同时有紫癜、关节症状和消化道症状者肾损害发生率分别是33．3％、41．7％、54．5％和75．0％，混合型和单纯紫癜者肾损害发生率的差异有显著性（P〈0．01）。结论发病年龄较大，皮疹反复及持续时间长，消化道出血者易发生肾损害；除皮肤紫癜外，合并关节症状和消化道症状者易发生肾损害；皮疹持续时间长、血尿合并蛋白尿与肾脏持续受累有关。     

Can urine dipstick predict an elevated serum creatinine?

Objective

Chart review studies have suggested that point-of-care urine dipstick testing may accurately predict an elevation in serum creatinine (Cr). We aimed to prospectively evaluate the test characteristics of proteinuria/hematuria in predicting elevated serum Cr.

Methods

A prospective, observational study was conducted between March 2007 and June 2008 at 2 affiliated, urban hospitals with an annual emergency department census of 150?000. Patients undergoing laboratory urinalysis, point-of-care urine dipstick, and a serum chemistry panel were enrolled. Trained research assistants collected data on consecutive patients 18 hours per day using preformatted data forms and entry into an anonymized Access (Microsoft, Seattle, Wash) database. Demographic baseline variables including age, sex, chief complaint, vital signs, and source of sample (catheter vs “clean catch”) were also collected. An elevated Cr level was defined as greater than 1.3 based on the laboratory reference range. Standard statistical methods were used to calculate diagnostic test operating characteristics of proteinuria or hematuria as a predictor of elevated serum Cr.

Results

Five thousand four hundred sixteen subjects were enrolled with 28.3% male and a mean age of 50.2 years. Elevated serum Cr greater than 1.3 mg/dL was found in 13.9% (755/5416) of subjects. The sensitivity of either proteinuria or hematuria for elevated Cr was 82.5% (95% confidence interval [CI], 80%-85%) and specificity was 34.4% (95% CI, 33%-36%). Positive predictive value was 16.9% (95% CI, 16%-18%) and negative predictive value was 92.4% (95% CI, 91-94%). The likelihood ratio for a positive test was 1.3 (95% CI, 1.1-1.5), and the likelihood ratio for a negative test was 0.5 (95% CI, 0.3-0.8).

Conclusions

Although negative predictive value was high, the presence of proteinuria/hematuria was only moderately predictive of elevated serum Cr level.     

Routine urinalysis (dipstick) findings in mass screening of healthy adults

We present results of simple urinalysis examinations (dipstick) in a large (approximately 21,000 people) working population. In about 10% of the screened individuals at least one abnormality was found. In men the most common finding was proteinuria (4.9%). Hematuria was found in 2.6% and glycosuria in 0.6%. The most prevalent finding in women was hematuria (8.1%), followed by proteinuria (3.9%) and glycosuria (0.6%). Only about 1% of the examinees had two or more abnormalities in their urine examinations. These findings attest to the utility and practicability of incorporating urine testing into various screening and clinical examinations.     

Increased sensitivity in detecting renal impairments by quantitative measurement of marker protein excretion compared to detection of pathological particles in urine sediment analysis.

BACKGROUND: Positive test strip results, pathological particles in urine and the presence of proteinuria are common findings in nephropathies. A comparison between these methods and renal biopsies became available with the introduction of quantitative measurement of marker proteins (albumin, transferrin, IgG, alpha(1)-microglobulin, retinol binding protein, alpha(2)-macroglobulin, Bence Jones proteins) and standardised urine sediment analysis by flow cytometry or microscopy. METHODS: A total of 400 urine samples were examined using marker protein patterns, test strips and quantitative sediment analyses. RESULTS: Results from standardised urine sediment analyses were compared with the excretion of renal marker proteins. Increased erythrocyte and leukocyte counts in urine were observed in only 29% and 39% of the samples for which pathological protein excretion was found. The sensitivity in detecting pathological particles in urine sediment, such as casts and/or dysmorphic erythrocytes, was only 19%. Renal biopsies from 65 patients who were classified as pathological were compared with proteinuria and sediment analyses. Increased excretion of marker proteins was found in all cases, whereas only 41% of the cellular urine sediments showed pathological results. CONCLUSIONS: Quantitative measurement of marker proteins from both the glomerular and tubular sides should be used upfront as screening parameters for the early detection of renal disorders.     

尿红细胞Tamm-Horsfall蛋白检测在儿童血尿诊断中的意义探讨

目的 :探讨尿红细胞Tamm Horsfall蛋白 (THP)检测在确定血尿来源上的诊断意义。方法 :对诊断明确的 86例肾小球性血尿和 2 6例非肾小球性血尿患儿尿样本同时进行尿红细胞THP间接免疫荧光法检测和尿红细胞的形态检测 ,比较这两种确定血尿来源方法的差异。结果 :在 86例肾小球性血尿中 ,红细胞THP检测法确定肾小球性血尿 79例 ,7例与诊断不符 ,在 2 6例非肾小球性血尿中 ,红细胞THP检测法确定为非肾小球性血尿 2 4例 ,2例与诊断不符 ,灵敏度为 91 9% ,特异性为 92 3 % ,准确性为 92 0 % ,漏诊率为 8 1% ,误诊率为 7 7% ,尿红细胞的形态检测法敏感性为 77 9% ,特异性为 69 2 % ,准确性为 76 7% ,漏诊率为 2 2 1% ,误诊率为 2 2 1% ,两者在灵敏性、准确性和漏诊率上的差异有极显著意义 (P <0 0 1) ,在特异性及误诊率上的差异有显著意义 (P <0 0 5 )。结论 :尿红细胞THP检测法确定血尿来源优于红细胞形态检查法 ,值得临床上推广应用。     

Urinalysis in chronic kidney disease

Chronic kidney disease (CKD) is defined by glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 and/or renal abnormalities including proteinuria and/or hematuria beyond 3 months. Urinalysis is an important screening test to find out CKD subjects earlier. In health check examination, proteinuria was detected in 2.3% of male population over 18 years old. The prevalence of lower estimated GFR below 50 mL/min/1.73 m2 increased to 8.9% of subjects with 1+ proteinuria and 31.8% of subjects with 2+ or more proteinuria as compared with 2.0% of subjects with negative proteinuria (p < 0.0001). To detect CKD stage IV or V, the sensitivity and the specificity of proteinuria were 0.68 and 0.978, respectively, and the positive likelihood was 30.9 (95% CI, 8.3-114.9, p < 0.0001).     

TCT，HR—HPV检测在宫颈病变筛查中的应用

【目的】评价新柏士液基薄层细胞学检查（TCT）,人乳头状瘤病毒（HPV）高危型检测（HR—HPV）对宫颈病的筛查价值。【方法】对门诊858例TCT异常（TBS系统诊断≥ASC—US）的患者,同时行HPV高危型检测,配合阴道镜检查并取活检,以病理学为标准对结果进行分析。[结果]858例液基细胞细胞学异常中与病理组织学检查的符合率为：LSIL76．2％（112／147）,HSIL90．1％（136／151）,宫颈癌100％（9／9）。细胞学异常858中,HPV阳性率分别为ASC34．7％（191／551）,LSIL78．2％（115／147）,HSIL91．4％（149／163）,宫颈浸润癌88．9％（8／9）。858例患者阴道镜组织活检病理学诊断结果的HR—HPV阳性率分别为：慢性宫颈炎17．2％（67／390）、CIN ⅠHPV77．3％（225／291）、CINⅡCINⅢ92．7％（140／151）宫颈癌92．9％（13／14）。【结论】TCT检查,HPV检测是宫颈病变筛查的有效方法,二者结合提高宫颈病变及宫颈癌的检出率。