Sysmex UF-100尿沉渣分析仪检测尿中红细胞的准确性的探讨

目的探讨UF-100尿沉渣分析仪检测尿中红细胞的准确性及其影响因素. 方法随机收集住院及门诊患者的晨尿标本,先用UF-100尿沉渣分析仪自动进样模式检测,后再将标本离心取沉渣于显微镜下镜检.将两种方法检测的结果作比较.结果UF-100尿沉渣分析仪检测1102例,阳性率占40.8%.显微镜下镜检红细胞阳性率占23.8%,其中假阳性率20.67为%,假阴性率占7.42%.结论UF-100尿沉渣分析仪对尿中红细胞的检测存在较高的假阳性率.对UF-100尿沉渣分析仪检测红细胞阳性的标本仍需用显微镜进行复检,两种方法必须结合在一起才能正确的判断一个标本是否为红细胞阳性的根据.     

UF-1000i尿沉渣分析仪与显微镜检测尿液红细胞、白细胞结果比较

目的 对UF-1000i尿沉渣分析仪与显微镜检测尿中红细胞、白细胞的结果进行比较,探讨UF-1000i尿沉渣分析仪临床应用价值.方法 收集1085例尿液样本,分别进行UF-1000i尿沉渣分析仪与显微镜检测.结果 UF-1000i尿沉渣分析仪与显微镜检测结果比较,红细胞的阳性符合率91.87%,假阳性率15.58%,阴性符合率84.41%,假阴性率8.12%;白细胞的阳性符合率92.70%,假阳性率12.46%,阴性符合率87.53%,假阴性率7.30%.两组检测结果分别做配对资料χ2检验,均无显著差异.结论 UF-1000i尿沉渣分析仪自动化程度高,与显微镜检测结果符合率良好,但受干扰因素较多,对结果异常者仍需用显微镜复检,以提高报告结果的准确性,为临床诊断、治疗提供有价值的信息.     

基于不同方法对尿液红细胞检测的比对与疾病符合程度分析

目的采用尿干化学分析仪、尿沉渣分析仪检测尿液红细胞,人工显微镜复检,对结果进行比对分析,同时进行疾病的符合程度分析。方法随机收集1233例临床患者新鲜中段尿液标本,采用尿干化学分析仪、尿沉渣分析仪,分别对尿液中的红细胞进行检测,用显微镜进行人工复检,并对结果进行比对分析,同时进行疾病的符合程度分析。结果尿干化学法检测红细胞阳性符合率为89.13%,阴性符合率为98.11%,假阴性率为10.87%,假阳性率为1.89%。尿沉渣自动分析仪法检测红细胞阳性符合率为79.79%,阴性符合率为98.47%,假阴性率为20.21%,假阳性率为1.53%。各年龄组三种方法检测结果显示,60岁以上年龄段组干化学法阳性率为40.63%、尿沉渣仪法阳性率为42.77%、显微镜复检法阳性率为40.21%,显著高于其他年龄段组别。性别分组不同的三种方法检测结果显示,男性组干化学法阳性率为41.07%、尿沉渣仪法阳性率为37.95%、显微镜复检阳性率为38.62%,而女性组干化学法阳性率为58.93%、尿沉渣仪法阳性率为62.05%、女性组显微镜复检阳性率为61.38%。由此可见女性组阳性率均显著高于男性组阳性率。差异有统计学意义(P<0.05)。结论使用尿干化学分析仪、尿沉渣分析仪法检测尿液中的红细胞存在假阳性和假阴性的结果,需要结合显微镜进行人工复检,才能提高检验的准确率,更好地服务于临床。     

多种检测方法对尿液中红细胞测定结果的对比分析

目的 强调在使用尿干化学分析仪和全自动沉渣仪常规检测红细胞时显微镜检查的重要性.方法 随机收集患者新鲜晨尿800例,分别使用显微镜检查、干化学分析仪和全自动尿沉渣分析仪检测,比较三种方法红细胞的检测结果.结果 干化学分析仪法红细胞阳性率31.3％,尿沉渣仪法红细胞阳性率27.0％,尿沉渣镜检红细胞阳性率为21.0％,结论 干化学法和沉渣分析仪法在检测尿液红细胞时均出现一定的假阳性分别为10.6％和9.0％和假阴性分别为2.7％和2.5％,因此,当红细胞结果出现异常,就必须对异常标本依据显微镜检查的标准化程序进行显微镜检查以确诊,力争为临床提供更准确的检验结果,避免造成误诊误治.     

探讨尿干化学法检查尿潜血和离心尿液显微镜法检查尿红细胞在临床中的应用

目的：通过对尿干化学法检测尿潜血和离心尿液显微镜法检查尿红细胞这两种检验方法进行比较和分析，探讨这两种检验方法在临床中的应用价值。方法随机选取2013年4月~2014年4月1年间400例门诊患者的尿标本，按照尿液分析仪(尿干化学法)和离心尿液显微镜法检查的标准操作规程对尿标本进行红细胞检测。结果400例尿液标本中尿液分析仪检测阳性结果123例，其中镜检红细胞为阳性结果的有108例，镜检红细胞为阴性结果的有15例，假阳性率为12.2%，尿液分析仪检测阴性结果277例，镜检红细胞为阴性结果的有269例，镜检红细胞为阳性结果的有8例，假阴性率为2.9%，两种检测方法的结果有差异。结论在临床工作中尿液红细胞(尿潜血)检查最好用尿干化学法检测和离心尿液显微镜法检查相结合的方法，能有效避免假阴性和假阳性，提高准确性，避免误诊和漏诊。     

野战卫生检验装备PU4210与实验室常规尿液分析仪的对比分析

目的 将野战检验装备PU4210和实验室常规使用的尿液分析手段进行比对分析,评价其性能.方法 对123例尿液标本在PU4210、SIMENS干化学尿液分析仪、Sysmex UF-1000i尿流式细胞仪进行平行检测,并均进行沉渣镜检.计算出PU4210和SIMENS干化学分析仪间各项目的符合率,进行kappa检验评价两者的一致性;并分析PU4210及尿沉渣分析仪与沉渣镜检在检测红细胞和白细胞时的一致性.结果 两台干化学尿液分析仪多数项目一致性较高,KET、PRO、NIT、LEU、URO、BIL、GLU、BLD的kappa值分别为1.0、0.929、0.895、0.877、0.805、0.723、0.656、0.573,但SG、PH的完全符合率仅为48.8％,结果间的差异具有统计学意义(P＜0.01);PU4210检测红细胞的灵敏度为90.0％,特异性为85.7％,检测白细胞的灵敏度为82.6％、特异性为88.9％.结论 野战检验装备PU4210与实验室常规干化学分析仪一致性较好,基本能够满足平时和战时临床对疾病诊断的需要.     

不同尿沉渣检测方法在检测尿红细胞形态及参数中的价值分析

目的 探究全自动尿沉渣分析仪联合尿干化学分析法在尿沉渣检测中的价值.方法 随机选取118份从住院患者处收集的血尿样本,根据临床诊断结果将其分为肾小球疾病组(肾小球性血尿组,n =72)及非肾小球疾病组(非肾小球性血尿组,n=46).比较两组血尿样本尿平均红细胞体积(MCV)、尿平均红细胞血红蛋白(MCH)水平差异.每份尿样均分为2管(15mL/管),分别予以显微镜人工镜检法及全自动尿沉渣分析仪+尿干化学检测法检测(尿液收集后2h内完成).记录两种检测方法的尿红细胞(RBC)阳性检出率;以临床诊断结果为依据评估其尿RBC形态参数测定结果差异.结果 肾小球性血尿组患者尿MCV、尿MCH水平均明显低于非肾小球性血尿组患者,差异有统计学意义(P＜0.05).118份血尿样本经全自动尿沉渣分析仪+尿干化学检测法测得尿RBC阳性率为76.3％ (90/118),显微镜人工镜检法测得尿RBC阳性率75.4％ (89/118);两组尿RBC阳性检出率比较,差异无统计学意义(P＞0.05).显微镜人工镜检法鉴别灵敏度为97.2％(70/72)、特异性为84.8％ (39/46);全自动尿沉渣分析仪+尿干化学检测法鉴别灵敏度为94.4％ (68/72)、特异性为80.4％(37/46),两种方法灵敏度及特异性比较,差异无统计学意义(P均＞0.05).结论 全自动尿沉渣分析仪+尿干化学检测法对血尿来源的定位诊断准确性较高且操作性强,临床可将其作为一种可行性途径,为后续治疗工作的顺利开展提供依据.     

三种不同方法检测尿液有形成分定量分析的比较

目的 探讨并比较用不同原理的尿液有形成分全自动分析仪进行尿液定量检测与非离心镜检计数的关系.方法 采用UF-500i全自动尿液有形成分分析仪、AVE-764全自动尿有形成分镜检分析仪和人工显微镜检查分别测定我院522份住院患者的尿液中的有形成分,比较尿液有形成分定量分析方法之间的差异.结果 以标准显微镜检查法为标准,UF-500i全自动尿液有形成分分析仪和AVE-764全自动尿有形成分镜检分析仪对尿液中有形成分的测定结果与显微镜法的测定结果间差异无统计学意义（P＞0.05）.以红细胞超过25个/μl、白细胞超过30个/μl,管型超过1个/μl和上皮细胞超过15个/μl为阳性界值,3种方法检测红细胞的完全符合率为68.8％,白细胞为80.4％,管型为75.3％,上皮细胞为56.1％.AVE-764测红细胞的特异性和敏感性为92.9％、84.1％,白细胞为88.2％、83.1％,管型为91.6％、75.4％,上皮细胞为48.4％、76.8％.UF-500i测红细胞的特异性和敏感性为74.1％、75.3％,白细胞为89.9％、82.5％,管型为85.4％、61％,上皮细胞为90％、87.6％.结论 UF-500i和AVE-764全自动尿有形成分分析仪对尿液中有形成分的定量计数与标准的人工显微镜检查的符合率高,比较能够满足临床的需求.     

ISO15189认证中Sysmex UF-1000i尿沉渣分析仪的性能验证

目的 按IS015189要求,评价Sysmex UF-1000i尿沉渣分析仪的性能.方法 分别检测UF-1000i尿沉渣分析仪的精密度、准确度、携带污染率、线性范围并对生物参考区间进行验证.结果 UF-1000i的精密度、准确度、携带污染率、可报告范围均在厂家要求的范围内,并且生物参考区间验证结果符合要求.结论 Sysmex UF-1000i尿液沉渣分析仪各项性能均符合仪器要求范围,可用于临床尿液沉渣分析检测.     

尿液分析仪检测尿隐血与镜检尿红细胞的评价

随着尿液分析仪的普及使用，尿液分析既简便又快速，为临床诊断提供了方便，但在实际应用中可能会出现许多新问题。尿液分析仪与显微镜检测的符合程度受到普遍关注，特别是红细胞的符合率一直是检验人员和临床医生关心的问题。本文对尿液分析仪检测隐血和镜检尿液中红细胞数作一简单的分析对比。     

尿沉渣检验在泌尿系统疾病诊断中的临床意义分析

目的 分析尿沉渣检验在泌尿系统疾病诊断中的临床意义。方法 选取我院2016年5月~2017年9月100例疑似泌尿系统疾病患者,采用全自动尿沉渣分析仪行尿沉渣检验,同时采用显微镜观察,以显微镜观察结果作为金标准,对比两种检查诊断方式的效果。结果 本组100例患者中,肉眼血尿阳性率为4.00%,尿糖阳性率为15.00%,尿液脱落细胞异常阳性率为11.00%;与显微镜检查结果相比,尿沉渣检验红细胞阳性47例,准确率为88.33%,假阳性率为11.67%;白细胞阳性标本65例,检验准确率为83.33%,假阳性率为16.67%;管型阳性标本39例,准确率为83.56%,假阳性率为16.43%。结论 尿沉渣检验泌尿系统疾病,准确度较高,诊断价值明显,但是存在一定假阳性现象,应对尿沉渣检验进行规范,必要时配合镜检结果,对患者病情做出更为准确的判断。     

Development of a new method for diagnosing the origin of urinary bleeding by doghnut-shape urinary red blood cells

Although the presence of acanthocytes (AC) is a reliable indicator of glomerular bleeding, acanthocytes could be observed in only 60% of patients with glomerulonephritis. Therefore, we attempted to develop a new method for diagnosing the origin of urinary bleeding by the morphological characteristics of doughnut-shaped of urinary red blood cells (RBC). In the present study, urine samples from 7 patients with glomerular bleeding and 4 patients with non-glomerular bleeding, and from 35 urine samples of the glomerular bleeding and non-glomerular bleeding-model were examined. The various type of RBC were observed by a phase contrast microscopic examination. The doughnut-shaped RBC were divided into three shapes (namely, smooth, uneven, target-shaped RBC) by individual characteristics. The appearance rate of each shape was calculated, and both outer and inner diameters of doughnut-shaped RBC in the photographs were also measured. Although there was no change in the value of outer diameter of doughnut-shaped RBC between glomerular bleeding and non-glomerular bleeding, the values of inner diameter of doughnut-shaped RBC in non-glomerular bleeding was significantly smaller than those in glomerular bleeding in all shapes. These results strongly suggested that the measurement of inner diameters of doughnut-shaped RBC is one of the useful diagnostic methods to distinguish the origin of urinary bleeding when AC could not be observed.     

Pseudo-outbreak of extremely drug-resistant pseudomonas aeruginosa urinary tract infections due to contamination of an automated urine analyzer

By the end of May 2010, an increase in the number of urine specimens that were culture positive for extremely drug-resistant (XDR) Pseudomonas aeruginosa was observed in our 800-bed university hospital. This led to an infection control alert. No epidemiological link between the patients and no increase in the frequency of XDR P. aeruginosa in non-urine samples were observed. Therefore, a pseudo-outbreak due to analytical contamination in the laboratory was rapidly suspected. A prospective and retrospective search of cases was initiated, and the sampling of the automated urine analyzers used in the laboratory was performed. Antibiotypes were determined by disc diffusion, and genotypes were determined by pulsed-field gel electrophoresis (PFGE). From February to July 2010, 17 patients admitted to 12 different departments and 6 outpatients were included. The mixing device of the cytometric analyzer used for the numeration of urinary particles (Sysmex UF1000i) proved to be heavily contaminated. Isolates recovered from 12 patients belonged to the same antibiotype and PFGE type as the isolate recovered from the analyzer. Extensive disinfection with a broad-spectrum disinfectant and the replacement of the entire tubing was necessary to achieve the complete negativity of culture samples taken from the analyzer. A pseudo-outbreak caused by an XDR P. aeruginosa clone was proven to be due to the contamination of the cytometric analyzer for urinary sediment. Users of such analyzers should be aware that contamination can occur and should always perform culture either before the processing of the urine sample on the analyzer or on a distinct sample tube.     

Detection of neutrophilocytes and NO2-producing bacteria in urine by dipstick BM-test-9

A prospective study compared the detection of leucocytes and bacteria in urine with the dipstick test (presence of esterases in granulocytes and nitrite) to chamber counting of urine, microscopic examination of the urinary sediment, and urine culture. Examined were 174 urine specimens. The dipstick esterase test and the sediment count were almost equally sensitive in detecting leucocyturia. Using chamber count and a cut-off point of 10 or more leucocytes per cubic millimeter as denoting significant leucocyturia, the esterase test gave a predictive value for negative test (PV neg) of 75% and a predictive value for positive test (PV pos) of 96%. PV neg of the dipstick nitrite test was 78% and PV pos 100% in detecting bacteriuria (10(5) bacteria per milliliter). Combining the esterase test with the nitrite test did not increase PV neg. Our result was that the dipstick test seems to be a simple screening procedure for leucocyturia and bacteriuria. The test is suggested to replace the time-consuming microscopic examinations of urine for leucocytes. When the nitrite test is positive, routine urine culture may be omitted.     

Bacteriuria screening by automated whole-field-image-based microscopy reduces the number of necessary urine cultures

We evaluated a new automated urine sediment analyzer that provides whole-field images for the screening of urine samples prior to bacterial culture. Sterile urine samples from 1,011 male and female outpatients and inpatients (mean age 54.7) with a urinary tract infection prevalence of 18.3% were studied. Screening rapidly provides negative results.     

Direct Identification of Urinary Tract Pathogens from Urine Samples,Combining Urine Screening Methods and Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry

Early diagnosis of urinary tract infections (UTIs) is essential to avoid inadequate or unnecessary empirical antibiotic therapy. Microbiological confirmation takes 24 to 48 h. The use of screening methods, such as cytometry and automated microscopic analysis of urine sediment, allows the rapid prediction of negative samples. In addition, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) is a widely established technique in clinical microbiology laboratories used to identify microorganisms. We evaluated the ability of MALDI-TOF MS to identify microorganisms from direct urine samples and the predictive value of automated analyzers for the identification of microorganisms in urine by MALDI-TOF MS. A total of 451 urine samples from patients with suspected UTIs were first analyzed using the Sysmex UF-1000i flow cytometer, an automatic sediment analyzer with microscopy (SediMax), culture, and then processed by MALDI-TOF MS with a simple triple-centrifuged procedure to obtain a pellet that was washed and centrifuged and finally applied directly to the MALDI-TOF MS plate. The organisms in 336 samples were correctly identified, mainly those with Gram-negative bacteria (86.10%). No microorganisms were misidentified, and no Candida spp. were correctly identified. Regarding the data from autoanalyzers, the best bacteriuria cutoffs were 1,000 and 200 U/μl for UF-1000i and SediMax, respectively. It was concluded that the combination of a urine screening method and MALDI-TOF MS provided a reliable identification from urine samples, especially in those containing Gram-negative bacteria.     

Automated analysis on urine formed element by using FCM]

Recent advances in the automated instruments for morphological tests are significant. Although the urine sediment (urine formed element) analyzer was developed 20 years after the automated leukocyte differential analyzer, remarkable advances were made in these several years in Japanese manufacturers with an excellent technology. Now accurate and precise results can be obtainable quickly, especially, in RBCs & WBCs with unspun urine. Moreover, additional clinically useful findings are available such as RBC morphological information and Glitter cells of WBCs. At the moment, detailed examination of epithelial cells and casts is difficult but from now on, the automation of these fundamental tests will be improved increasingly by a development of analytical algorithm & staining technology, supported by the current laboratory needs for higher reliability and labor savings.     

Safely reducing manual urine microscopy analyses by combining urine flow cytometer and strip results.

We aimed to reduce the number of manual urine microscopy examinations safely by cross-interpretation of the Sysmex UF-100 (TOA Medical Electronics, Kobe, Japan) and urine strip results such that microscopy would be performed if there was discordance between the UF-100 and urine strip results. We also evaluated the usefulness of the optional UF-100 expert software. We performed 2 studies: study 1 to establish review rules for eventual microscopic examination; study 2, a validation study. Our review rates were 40% and 48% and those of UF-100 software were 16% and 32% for the 2 studies. Our false-positive and false-negative results, among the samples not flagged for microscopic review, were acceptably low. We did not find a good correlation between the microscopic classification of RBC morphologic features and the classification given by the UF-100. Since incorporation of the automated urine strip reader and the UF-100 in routine use, our manual microscopy has been reduced to less than 40%.