光学显微镜在尿红细胞形态检查中的应用价值

目的探讨应用普通光镜进行尿红细胞形态检查对血尿肾源性诊断的临床价值。方法用光学显微镜对血尿中红细胞形态进行鉴别分型及计数,对照血尿判断标准归类肾小球性和非肾小球性血尿。结果在血尿肾源性诊断上敏感性为87.3%,特异性为82.7%,且肾小球源性血尿红细胞畸形率明显高于非肾小球源性血尿。结论普通光镜下尿红细胞形态检查敏感性和特异性都较高,对血尿来源的定位诊断具有一定指导作用,且成本较低、使用方便,更易于在基层医院检验科普及使用,值得推广。     

Tris缓冲盐水甲基绿染色法尿液红细胞形态观察的临床应用

目的应用尿中异形红细胞诊断血尿来源。方法采用2%Tris缓冲盐水(pH7.4)甲基绿染液法,对128例血尿患者在显微镜下观察变形红细胞形态和百分率,对照肾小球性血尿诊断标准,分别统计敏感性和特异性。结果肾小球性血尿68例,其中63例表现为畸形红细胞性血尿,2例为正形红细胞性血尿,3例为混合性血尿,其敏感性为92.6%,特异性为97.1%。非肾小球性血尿60例,其中58例表现为正形红细胞性血尿,2例为混合性红细胞血尿。其敏感性为96.7%,特异性为92.1%。结论 Tris缓冲盐水甲基绿染色法具有试剂简单、方法简便、不需特殊仪器和设备、红细胞着色明显、红细胞形态保存时间长等特点,对于判断血尿来源具有重要临床意义,为早期诊断肾小球性和非肾小球性疾病提供了有价值的实验依据,适合在基层医院开展。     

相差显微镜下红细胞形态在鉴别血尿来源中的临床价值

目的探讨相差显微镜下血尿中红细胞形态改变在鉴别血尿来源中的临床价值。方法收集肾小球性疾病血尿215例;非肾小球性血尿233例;正常对照组210例,用相差显微镜观察尿红细胞形态与临床肾活检诊断血尿进行比较,评价相差显微镜下尿红细胞形态判定血尿来源的可靠性。结果215例肾小球性血尿患者中非均一红细胞血尿阳性率为96.3%,均一性红细胞血尿阳性率为3.7%,233例非肾小球性血尿患者中均一红细胞血尿阳性率为96.1%,非均一性红细胞血尿阳性率为3.9%。相差显微镜法的灵敏度为96.3%,特异度为96.1%。结论在相差显微镜下检测红细胞形态操作简便,结果与临床符合率较高,敏感性和特异性都较高,对鉴别血尿来源和定位诊断具有一定的临床应用价值。     

光镜下尿红细胞形态检查在血尿诊断中的应用价值

目的 探讨光镜下尿红细胞形态检查对血尿定位诊断的作用及临床意义.方法 用光学显微镜对血尿中红细胞进行计数及形态分型;应用Midtron JuionⅡ尿干化学分析仪对尿酸碱度、蛋白、隐血试验进行分析.对照肾小球性血尿判断标准区分肾性和非肾性血尿.结果 肾小球肾炎组光镜下尿中红细胞数及畸形率比非肾小球疾病组显著升高.尿畸形红细胞对诊断肾小球性血尿的敏感性为87.1%,特异性为91.9%,与文献报道大致相符.结论 光镜下尿红细胞形态检查对血尿来源的定位诊断具有指导作用,敏感性和特异性高,且无需特殊仪器设备,适于基层医院普及,是一种值得推广的方法.     

尿红细胞形态分析在血尿诊断中的意义

目的 :应用尿红细胞形态检测分析肾脏血尿的临床意义。方法 :应用普通光学显微镜观察尿红细胞形态 ,鉴别肾小球血尿或非肾小球血尿。结果 :5 0例肾小球性血尿患者中变形红细胞血尿阳性率为 90 % (45 / 5 0 ) ,混合性红细胞血尿阳性率为 10 % (5 / 5 0 ) ;5 0例非肾小球性血尿患者中均一红细胞血尿阳性率为 96 % (48/ 5 0 ) ,混合性红细胞血尿阳性率为 4 % (2 / 5 0 )。结论 :普通光镜下检测红细胞形态操作简便 ,对鉴别血尿来源和诊断具有一定的临床价值     

尿沉渣检测分析仪联合血细胞分析仪在鉴别血尿来源中的应用

目的探讨尿沉渣检测分析仪和血细胞分析仪联合检测在鉴定肾小球性血尿和非肾小球性血尿中的应用价值。方法利用US-2020尿沉渣检测分析仪和血细胞分析仪对81例不同来源血尿标本进行检测。结果 42例肾小球性血尿中红细胞畸形率为(81.70±9.29)%,39例非肾小球性血尿中红细胞畸形率为(19.0±12.0)%,利用红细胞形态鉴别血尿来源敏感性71.4%,特异性94.8%,诊断符合率82.7%,血细胞分析仪测定肾源性和非肾性血尿中红细胞平均体积和红细胞体积分布宽度分别为(64.00±7.98)fL,(24.90±3.98)%和(89.00±11.89)fL,(14.90±2.45)%,二者差异有统计学意义(P0.05)。结论利用尿沉渣检测分析仪对尿中有形成分的测定和红细胞形态观察,利用血细胞分析仪测定尿红细胞相关参数等对血尿的诊断均有指导意义,二者联合应用提高了诊断符合率,可更加客观准确的鉴别血尿来源,为基层医院提供了很好的鉴别诊断策略。     

普通光镜检查尿红细胞形态在血尿来源诊断中的价值

目的评价在普通光学显微镜下观察尿红细胞形态对鉴别血尿来源的价值。方法回顾102例血尿患者的尿红细胞形态,用接受者工作特征(ROC)曲线评价尿畸形红细胞对肾小球性血尿的诊断价值。结果 ROC曲线下面积(AUC=0.953)表明尿畸形红细胞对肾小球性血尿有很高的诊断价值;尿畸形红细胞大于或等于70%为该实验室诊断肾小球性血尿的最佳诊断点(敏感性为82.5%,特异性为92.3%)。结论在普通光学显微镜下观察尿红细胞形态对鉴别血尿的来源有较高的临床应用价值。     

2种检测方法鉴别尿红细胞来源价值

目的比较普通光学显微镜、自动尿沉渣分析仪在肾小球性和非肾小球性血尿鉴别诊断中价值。方法分别应用以上2种方法检测98例血尿患者尿红细胞形态,并与肾组织穿刺活检病理结果进行对比。结果自动尿沉渣分析仪诊断肾小球源性血尿敏感性92．7％,特异性88．0％;普通光学显微镜诊断肾小球源性血尿敏感性85．4％,特异性84．0％,2种方法诊断敏感性、特异性比较差异无统计学意义（P〉0．05）。结论2种方法对鉴别血尿来源均有诊断价值。     

改进的光镜检查尿红细胞形态在血尿诊断中价值探讨

为确定普通光镜检查尿红细胞形态是否准确，采用双盲法对经肾活检证实的５２例肾小球疾病及４０例非肾小球疾病尿样用在普通光镜下降低其聚光镜强度方法，在暗视野中观察尿畸形红细胞形态。当血尿病人的尿畸形红细胞≥７０％时，诊断为肾小球性血尿，敏感性９２％，特异性１００％。此法操作简便，准确性高，有较强的临床实用价值。     

G1细胞及多项尿检指标在血尿诊断中的相关性研究

目的 探讨血尿患者多项尿检指标联合诊断提高鉴别肾小球性血尿和非肾小球性血尿的准确性。方法 利用普通光镜对血尿样本中红细胞形态观察及G1细胞计数并进行尿干化学分析，研究各项指标及联合指标在肾性血尿（经肾活检证实）和非肾性血尿中的相关性。结果 肾小球性血尿和非肾小球性血尿中尿G1细胞、尿蛋白、尿pH、尿隐血结果比较均有显著性差异（P〈0．05）。结论 尿G1细胞联合尿蛋白、尿PH、尿隐血等尿检指标综合判断血尿来源有望提高血尿鉴别诊断的准确性。     

尿棘形红细胞在肾性和非肾性血尿鉴别中的意义

本文用相差显微镜对结晶紫－沙黄染色的２４例肾性出血和２１例非肾性出血尿沉渣各种形态红细胞进行观察和分类计数。结果,棘形红细胞在肾性出血红细胞总数中所占的比率（５．５％）远高于非肾性出血（０．６％）。表明棘形红细胞是区别肾性出血和非肾性出血有用的特征性标志物。     

异常形态红细胞百分比法和芽孢状等特殊异常形态红细胞百分比法在小儿肾性血尿诊断中临床价值的对比观察

目的对小儿肾性血尿进行红细胞形态学分析,评价异常形态红细胞百分比法和芽孢状等特殊形态红细胞百分比法在小儿肾性血尿鉴别诊断中的临床价值。方法回顾性对来自首都医科大学附属北京友谊医院的117例非重复性小儿肾性血尿标本红细胞形态检查结果进行分析,比较尿红细胞形态检查两种判断标准的敏感性。结果在肾小球疾病组和对照组,异常形态红细胞占红细胞总数80%的标本百分比分别为62. 5%(73/117)和12. 0%(15/125),差异具有明显统计学意义(P <0. 01);芽孢状红细胞等特殊异常形态红细胞百分比≥30%标本百分比分别为83. 8%(98/117)和8. 0%(10/125),差异具有非常显著性统计学意义(P <0. 01)。明确诊断为肾小球疾病患儿,尿液异常形态红细胞占红细胞总数≥80%百分比显著低于芽孢状红细胞等特殊异常形态红细胞百分比≥30%者(62. 4%,73/117 vs.83. 8%,98/117),差异具有非常显著性统计学意义(P <0. 01)。结论以芽孢状红细胞等特殊异常形态红细胞百分比法作为判断标准对小儿肾性血尿的诊断具有较好的敏感性。     

Determination of the Tamm and Horsfall glycoprotein in human urine.

A method for the routine determination of the Tamm and Horsfall glycoprotein in human urine is presented. The method is based on quantitative electroimmunoassay. It was demonstrated that the solubility of the Tamm and Horsfall glycoprotein was dependent on urinary ionic strength and pH. To minimize these variables all urines were buffered to pH 5.5 and then preincubated at 37 degrees C in 0.3% sodium dodecyl sulphate. This procedure solubilized and maintained the Tamm and Horsfall glycoprotein in solution. Excess sodium dodecyl sulphate was removed by gel filtration before the quantities of the Tamm and Horsfall glycoprotein were determined by electroimmunoassay. The method is simple, reproducible, has high precision and compares favourably with earlier published methods for the determinations of the Tamm and Horsfall glycoprotein.     

The characteristics of hematuria in chronic glomerulonephritis and nonglomerular diseases of the kidneys and urinary tract]

Upon the analysis of qualitative and quantitative characteristics of hematuria in renal and urinary tract affections it was established that whatever the red blood cell count in the urine, hematuria is primarily glomerular in contrast to nonglomerular in chronic glomerulonephritis and nonglomerular diseases of the kidneys and urinary tracts, respectively. Morphologic studies of urinary red blood cells using phase-contrast microscopy proved a valuable tool for identification of hematuria origin.     

外周血和尿液红细胞平均体积差值在血尿定位诊断中的应用

目的探讨采用血、尿中红细胞平均体积差值(ΔMCV)鉴别肾性和非肾性血尿的诊断价值。方法采用BAY-120血细胞分析仪检测100例肾小球性疾病和非肾小球性疾病患者外周血和尿中ΔMCV,计算二者之间的差值,利用受试者工作曲线(ROC曲线)确定临界值;同时应用相差显微镜观察尿液异常红细胞情况。结果肾性与非肾性血尿患者自身血和尿中ΔMCV差异有统计学意义(P<0.01),ROC曲线下面积为0.978,以ΔMCV≥10fL鉴别肾性、非肾性血尿约登指数为0.82,敏感度为92%,特异性为90%。相差显微镜法的敏感度为94%,特异性为92%,两种方法诊断血尿来源差异无统计学意义(P>0.05)。结论采用血、尿中ΔMCV鉴别肾性和非肾性血尿具有较高的敏感度和特异性,可以作为筛查血尿来源较好的诊断指标。     

血清PCT检测在小儿急性细菌性脑膜炎及病毒性脑炎鉴别诊断中的应用

目的观察分析血清降钙素原(PCT)在小儿急性细菌性脑膜炎与病毒性脑膜炎鉴别诊断中的应用及其灵敏度与特异度。方法选取164例细菌性脑膜炎患儿与98例病毒性脑膜炎患儿及60例健康体检儿为研究对象,采用电化学发光免疫检测血清PCT、白细胞计数(WBC)、红细胞沉降率(ESR)及C反应蛋白(CRP),分析两组患者实验室检查结果、PCT检测结果分布、灵敏度及特异度。结果细菌性脑膜炎患儿的PCT、CRP、WBC检查结果均高于病毒性脑膜炎患儿。而阳性率比较细菌组PCT、WBC阳性率高于对病毒性脑膜炎组,两组PCT检查分布构成比较有显著差异(χ2=16.151,P0.01)。PCT检查鉴别诊断病毒性脑膜炎的灵敏度为97.6%(160/164),特异度为95.0%(57/60),误诊率为3.1%(7/224)。PCT检查鉴别诊断细菌性脑膜炎的灵敏度为98.0%(96/98),特异度为96.7%(58/60),误诊率为2.5%(4/158)。结论血清PCT作为小儿急性细菌性脑膜炎与病毒性脑膜炎的鉴别诊断指标准确性良好,结合CRP、WBC、ESR等联合鉴别诊断能够在早期快速给予准确的病原体诊断,从而提高临床治疗的针对性,减少抗菌药物滥用情况的发生,值得临床推广应用。     

Erythrocyte morphology in asymptomatic microhematuria: experimental studies and clinical significance

Renal and postrenal origin of hematuria can be differentiated by analysis of the morphology of the erythrocytes in the urinary sediment. In order to investigate the mechanisms which cause the membrane changes in dysmorphic erythrocytes, indicating renal origin of bleeding, normal red blood cells were exposed in vitro to an osmotic environment similar to that of the nephron. Upon exposure of osmotically challenged erythrocytes to a hemolytic environment, 50 to 90% of the cells became dysmorphic in a time- and dose-dependent manner and were indistinguishable on light and electron microscopy from those obtained in vivo from a patient with proven glomerular microhematuria. The reliability of erythrocyte morphology in differentiating between renal and postrenal microhematuria was evaluated by performing microscopic analysis as the initial step in the investigation of 316 consecutive patients. In 123 patients with eumorphic red cells in their urine complete urological investigation revealed a postrenal source of bleeding in 85%. Out of 193 patients with dysmorphic erythrocytes, 132 were followed up for at least 2 years after only minimal diagnostic evaluation. An additional postrenal source of bleeding developed in two patients, which was easily diagnosed by the change in erythrocyte morphology. Our studies, representing experience over 6 years with asymptomatic microhematuria, show that microscopic examination of erythrocyte morphology as initial diagnostic step is a safe, inexpensive and efficient method which renders invasive investigations superfluous in the majority of patients.     

尿红细胞形态在鉴别肾性与非肾性疾病中的临床应用评价

目的通过对尿红细胞各种形态的观察,为肾性与非肾性疾病提供快速鉴别诊断依据。方法对尿红细胞进行活体染色(Sternheimer-Malbin,SM染色),采用相差显微镜进行观察和分类计数,对各种尿红细胞形态分类计数值应用ROC曲线进行评价。了解不同形态红细胞在肾性与非肾性血尿中的检测意义。结果棘形、靶形红细胞及变形小红细胞只出现在肾性疾病组;皱缩、环形、影形红细胞在肾性和非肾性组均可出现;用ROC曲线评价正常、皱缩、影形、环形红细胞其AUC面积分别为96.5％,77.5％,63.3％和50％;临床诊断最佳分界值分别为13％,11％,12％和36％;灵敏度分别为98％,84％,81％和77％;特异度分别为91％,60％,49％和40％;准确度分别为94％,76％,65％和78％。结论尿红细胞活体染色各种形态分类计数最佳分界值对鉴别肾性与非肾性血尿具有较高的诊断价值:同时,棘形,靶形红细胞及变形小红细胞的检出更具有临床诊断价值。     

Differentiation of renal from non-renal hematuria by microscopic examination of erythrocytes in urine

Recent studies indicate that hematuria of renal parenchymal origin can be differentiated from hematuria of other origin by the presence of dysmorphic urinary erythrocytes (cells exhibiting irregular membranes or small surface blebs). We investigated the utility of this simple screening assay in a routine clinical laboratory. Dysmorphic erythrocytes in urine from 69 patients (18 with renal-parenchymal disease) were quantified on unstained slides by medical technologists using phase-contrast microscopes. Samples stored at 4 degrees C or 23 degrees C for up to 5 h had no significant changes in percentages of dysmorphic erythrocytes (PDE). PDE was also not modified by urea nitrogen concentration, osmolality, or pH over the physiological ranges of these variables. Receiver-operating characteristic (ROC) curves indicated an optimal sensitivity of 88% and specifity of 94% at a decision level of 14% dysmorphic erythrocytes per high-power field. Thus, the presence of fewer than 14% dysmorphic cells is suggestive of extra-renal disease; more than 14% is suggestive of intra-renal disease.