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     

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.     

尿红细胞形态及平均体积在在血尿定位应用分析

目的探讨尿红细胞形态及尿红细胞平均体积(MCV)检查在判定血尿来源定位应用价值。方法选取100例血尿的标本作为考察对象,Sysmex XN-1000全自动血球分析仪检测尿红细胞平均体积(MCV),并用相差显微镜检查尿红细胞形态学,观察和分析肾小球性血尿组(glomerular hematuria,GH)和非肾小球血尿组(non glomerular hematuria,NGH)尿红细胞形态及尿红细胞平均体积的差异。结果肾小球性血尿(GH)组尿MCV值(63.71±6.03)fl明显低于非肾小球性血尿(NGH)组MCV值(92.37±12.11)fl(P0.05)且尿MCV不高于72.0fl,变形红细胞80%呈多形型。结论尿中红细胞形态及红细胞平均体积特征分析可作为血尿定位诊断和鉴别诊断的方法之一,有助于判断血尿的来源提供临床参考依据。     

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。     

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。     

124例血尿在光镜下红细胞形态观察的结果分析

目的:探讨光镜下血尿红细胞形态在血尿定位中的诊断作用。方法:采用OLYMPUS光学显微镜对血尿红细胞形态进行观察并计算均一形与非均一形红细胞及G1细胞所占的比例。结果:124例血尿标本,56例肾小球性血尿有50例为非均一形红细胞血尿,G1细胞>3%有51例,5例漏诊;68例非肾小球性血尿有4例尿路感染者为非均一形红细胞血尿,G1细胞<3%。结论:光镜下血尿红细胞的形态观察对诊断肾小球性血尿具有临床意义。该方法简单,无需特殊设备,适宜在基层医院推广和使用。     

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。     

尿红细胞形态判断标准探究

目的寻找一个主观性小而又实用的肾小球性血尿的诊断标准。方法首先采用普通光学显微镜确定特征变形红细胞(主要为环形、靶形和芽胞形3种),然后分析经过肾穿刺病理确诊的150例患者的特征变形红细胞的百分比,分成多个诊断值,分别计算敏感性和特异性,绘制受试者工作特征(ROC)曲线,并计算ROC曲线下面积(AUC)。结果肾小球性血尿患者特征变形红细胞百分比30%,而非肾小球性血尿患者特征变形红细胞百分比10%。以特征变形红细胞百分比30%为标准,诊断为肾小球性血尿,其敏感性为84%、特异性为97%、AUC为0.976,同时显著缩小了混合型血尿的范围。结论以环形、靶形、芽孢形作为肾小球性血尿的特征变形红细胞,对诊断肾小球性血尿简单、易行,具有很好的实用价值。     

血尿标本158例尿红细胞形态分析

目的：通过尿红细胞形态观察来判断肾小球性血尿与非肾小球性血尿,对临床诊断有实际意义。方法：取20 ml尿离心后,留0.2 ml沉淀,用4×40倍镜观察。结果：尿液中红细胞的形态可将血尿分为3种,即均一性红细胞血尿（非肾小球性血尿）、非均一性红细胞血尿和混合性血尿。结论：血尿性质的辨别首先是要判断是肾源性的还是非肾源性的。肾源性红细胞形态为多形性,一般形态可超过两种以上和见到棘形细胞。非肾源性红细胞变化较少形态不超过两种。     

尿中红细胞形态镜检和MCV测定及临床意义

目的　探讨检查尿中红细胞形态和MCV来鉴别肾性和非肾性血尿 ,并研究此方法的最佳条件。方法　用CoulterJT血液分析仪和相差显微镜检测肾性和非肾性两组血尿病人的尿红细胞MCV曲线及红细胞的形态和畸形率。结果　肾性和非肾性血尿中 ,红细胞的MCV值有显著差异 (P <0 0 5 )。肾性血尿时 ,尿红细胞MCV≤ 75fl,约登指数为 0 7;畸形红细胞多于 3种以上 ,红细胞畸形率≥ 75 % ,约登指数 0 73。结论　尿中红细胞形态分析和MCV测定可用于肾性与非肾性血尿鉴别诊断     

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。     

Acanthocytes in the urine: useful tool to differentiate diabetic nephropathy from glomerulonephritis?

OBJECTIVE: The presence of hematuria has been suggested to indicate nondiabetic nephropathy in diabetic patients with proteinuria. However, hematuria is frequently found in patients with biopsy-proven diabetic glomerulosclerosis without nondiabetic nephropathy. Urine microscopy allows discrimination of glomerular hematuria, which is defined as acanthocyturia (urinary excretion of acanthocytes, which are dysmorphic erythrocytes with vesicle-like protrusions), from nonglomerular hematuria. We hypothesized that acanthocyturia is an uncommon finding in diabetic nephropathy, which suggests the presence of a nondiabetic nephropathy in diabetic patients with proteinuria. RESEARCH DESIGN AND METHODS: Urine samples of patients with the clinical diagnosis of diabetic nephropathy (n = 68), of patients with biopsy-proven glomerulonephritis (n = 43), and of age-matched healthy control subjects (n = 20) were examined by phase-contrast microscopy for the presence of hematuria (>/=8 erythrocytes/ micro l) and acanthocyturia. Acanthocyturia of >/=5% (5 acanthocytes among 100 excreted erythrocytes) was classified as glomerular hematuria; acanthocyturia of 2-4% was classified as suspected glomerular hematuria. RESULTS: Hematuria was found in 62% of patients with the clinical diagnosis of diabetic nephropathy, in 84% of patients with glomerulonephritis, and in 20% of the healthy control subjects upon a single urine examination. In contrast, glomerular hematuria occurred in 4% of patients with diabetic nephropathy and in 40% of patients with glomerulonephritis (P < 0.001). CONCLUSIONS: In contrast to hematuria, acanthocyturia is uncommon in patients with the clinical diagnosis of diabetic nephropathy. In diabetic patients with proteinuria, the finding of acanthocyturia points to nondiabetic glomerulopathies, and renal biopsy should be considered.     

UF-100尿液自动分析仪和显微镜检测RBC形态在鉴别肾性血尿中的比较

目的探讨尿液RBC形态检测的临床意义。方法采用UF-100和显微镜法对118例尿液标本进行正形(均一性)和异形(非均一性)RBC的检测,将两者结果进行比较分析。结果62例肾性血尿患者中显微镜检测有56例异形RBC增高,临床诊断符合率为90.3%;UF-100检测有58例为非均一性RBC,临床诊断符合率为93.5%。56例非肾性血尿中显微镜检测有54例正形RBC增高,临床诊断符合率为96.4%;UF-100检测有55例为均一性RBC,临床诊断符合率为98.2%。两法比较,经配对x2检验,P>0.05,结果无显著性差异。而肾性和非肾性血尿组相比,经四格表资料x2检验,P<0.05,结果显示两组有显著性差异。结论UF-100和显微镜对RBC形态的检测都可以用于鉴别诊断肾性和非肾性血尿。尤其是UF-100可为临床诊断疗效观察和判断预后起到非常重要的作用。     

尿变形红细胞新分类法在肾小球轻微病变中的应用

目的研究尿变形(D)红细胞的一种新分类法在肾小球轻微病变血尿中的应用价值。方法对84例确诊为肾小球轻微病变患者和73例非肾小球疾病患者的血尿标本应用相差显微镜观察进行分类,同步检测尿蛋白及管型。结果在84例肾小球轻微病变血尿中,经242次检测红细胞,以D1+D2≥5%为诊断标准的敏感性、特异性、准确性分别为49.6%、100%、67.4%,以新分类法(D1+D2≥5%或D3≥20%)为诊断标准的敏感性、特异性、准确性分别为90.1%、98.5%、93.0%。D1+D2≥5%组与D1+D25%而D3≥20%组间尿蛋白、细胞管型检出率有统计学差异(0.01P0.05),而透明管型、脂肪管型检出率无统计学差异(P0.05)。结论D1+D2≥5%或D3≥20%是诊断肾小球轻微病变血尿的敏感方法。     

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。     

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。     

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.     

Albumin affects erythrocyte aggregation and sedimentation

Abstract. Erythrocyte aggregation and sedimentation is determined by the concentration of high molecular plasma proteins such as fibrinogen and immuno-globulins. The role of albumin, the most abundant plasma protein, is controversial. We analysed the influence of human albumin (0–80 gL^-1) on sedimentation behaviour of erythrocytes suspended (haematocrit 35%) in fibrinogen-enriched normal plasma, plasma from patients with hypoalbuminae-mia, solutions of dextran 70 in buffer, and mixtures of fibrinogen, immunoglobulins and albumin in buffer. Sedimentation was measured by the Westergren method, viscometry was performed at low and high shear rate. The addition of albumin to normal plasma, hypoalbuminaemic plasma, or dextran solutions in buffer decreased the erythrocyte sedimentation rate. In contrast, in a mixture of fibrinogen and immunoglobulins in buffer, albumin increased erythrocyte sedimentation. When either fibrinogen or immunoglobulins were omitted, or fibrinogen was replaced by dextran, albumin did not increase sedimentation, which indicates that increased sedimentation was due to an interaction of all three compounds. The viscosity of erythrocyte suspensions was increased by albumin. It is concluded that the influence of albumin on erythrocyte aggregation is complex and depends on the technique used; low shear viscosity is increased, but erythrocyte sedimentation, i.e. under no flow conditions, is decreased. The inhibitory action of albumin on the erythrocyte sedimentation rate has clinical implications and must be known by physicians. It may help to interpret sedimentation rates more correctly and prevent misinterpreting presumed therapeutic successes or failures.     

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.     

急性心肌梗塞、急性脑梗塞及糖尿病患者红细胞变形能力的研究

目的：探讨急性心肌梗塞（ＡＭＩ）、急性脑梗塞（ＡＣＩ）及糖尿病（ＤＭ）患者的发病与血液流变学中红细胞变形能力（ＲＣＤ）的变化关系。方法：采用德国ＦＭ４红细胞过滤仪，检测ＡＭＩ、ＡＣＩ及ＤＭ患者的ＲＣＤ。结果：ＡＭＩ、ＡＣＩ及ＤＭ３组患者的ＲＣＤ的最小余量明显高于对照组（Ｐ均＜０．０１），斜明显低于对照组。ＡＭＩ发病２４小时内的ＲＣＤ最小余量明显高于治疗２周后的ＲＣＤ的最小余量（Ｐ＜０．０１）。ＡＭＩ组ＲＣＤ最小余量与５．７５ｓ－１切变率的粘度呈正相关（ｒ＝０．３５０，Ｐ＜０．０５），与２３０ｓ－１切变率的粘度呈明显正相关（ｒ＝０．５６２，Ｐ＜０．００１）。结论：直接检测ＲＣＤ的变化，对估测活动期心脑血管病及糖尿病微血管病变的轻重及治疗效果有一定的意义。