用尿红细胞前向散射光(Fsc)综合指标鉴别血尿来源

血 尿是临床常见症状之一 ,血尿的诊断一般用普通光学显微镜检查尿中红细胞 ,1977年Ｂｉｒｃｈ和Ｆａｉｒｌｅｙ等应用相差显微镜观察尿红细胞形态变化 ,籍以鉴别肾小球性及非肾小球性血尿。但此法易受主观因素的影响。 1986年Ｓｈｉｃｈｉｒｉ等报告用自动分析仪测定尿红细胞体积鉴别血尿来源 ,认为较显微镜法更为准确。作者用ＵＦ 10 0尿沉渣流式细胞仪[1] 检测了 76例肾病医院住院病人尿标本 ,并与 2 0例非肾小球性疾病血尿标本进行了比较 ,根据尿红细胞平均前向散射光强度 (ＲＢＣ ＭＦｓｃ)、尿红细胞前向散射光分布宽度(ＲＢＣ Ｆｓｃ…     

测定尿红细胞平均体积鉴别血尿来源

用自动血细胞分析仪检测血尿中红细胞平均体积,评价对血尿来源鉴别的价值.实验分2组,肾小球性血尿组,均经肾活检确诊,共12例,非肾小球性血尿组6例.结果显示 肾小球性血尿红细胞平均体积为40.08±28.00 fl,非肾小球性血尿红细胞平均体积为66.58±16.04 fl,差异显著(P<0.05),表明可通过测定血尿中红细胞平均体积鉴别血尿来源,该方法简便、快速,可靠,可克服检验者的主观判断误差.可作为门诊及基层医院对血尿快速筛选手段之一.     

免疫荧光染色、超高倍相差显微仪鉴别血尿的方法对比

肾性血尿与非肾性血尿的区别对临床诊断和治疗有重要价值.检查尿中红细胞形态已经被作为肾性与非肾性血尿的一个常用诊断指标.尿中异形红细胞达到三种以上,同时变异率70%以上代表肾性血尿(非均一性血尿),而红细胞形态一致则说明标本是非肾性血尿(均一性血尿);但是,这种方法有时受到尿液标本的理化性质影响.一些研究表明,尿的渗透压、pH值、离子比等因素都可影响红细胞的形态和大小.我们认为,尿中红细胞上的Ig染色,是鉴别肾性与非肾性血尿的一个很好的方法;用荧光标记的兔抗人Ig抗体(抗IgA抗体,抗IgG抗体)对尿中红细胞上Ig染色(简称免疫荧光染色)的方法来区别肾性与非肾性血尿,同时和超高倍相差显微仪尿沉渣形态学检查(简称形态学检查)结果相比较.     

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.     

尿RDW在鉴别肾性血尿和非肾性血尿中的临床价值的Meta分析

目的 评价尿RDW在鉴别肾性血尿和非肾性血尿中的临床价值.方法 通过检索中国知网（CNKI）、维普数据、万方数据等数据库,收集肾性血尿和非肾性血尿红细胞分布宽度的病例对照实验,采用Revman5.2软件对数据进行Meta分析.结果 共纳入4个病例对照试验,包括397个病例.Meta分析结果显示：纳入4个试验,差异具有统计学意义[MD=14.88,95％ CI（13.85,15.92）];总体效应检验Z=28.14,P＜0.01,差异具有显著性,说明尿RDW对于鉴别肾性血尿和非肾性血尿具有统计学意义.结论 从现有的临床证据来看,尿RDW对尿液红细胞分析方法简单,结果可靠.尿RDW的水平可作为判定血尿来源参考指标,对患者得到及时的诊断和治疗,有着极大的实际意义.     

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.     

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。     

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。     

以血尿为主要表现患者的临床与病理分析

目的探究以血尿为主要临床表现患者的病理类型分布及临床特点,以为临床治疗提供科学依据。方法选取我院2012年5月~2014年7月收治入院的100例肾活检患者为研究对象,回顾性分析其临床及肾脏病理学资料,按照尿红细胞位相结果将患者分为对照组(非肾小球源性血尿)与研究组(肾小球源性血尿)各50例,比较两组患者临床及病理差异。结果通过回顾性分析两组患者肾脏病理学资料集临床检测报告,肾小球源性血尿患者肾损害情况更为多见,与对照组相比较,差异经统计学处理具有统计学意义(P<0.05)。结论 IgA肾病是以血尿为主要表现患者中常见病理类型,肾脏病理改变情况较为严重,需要临床中予以重点关注,以提高患者临床治疗效果。     

Clinical significance of urinary sediment dysmorphic red blood cells and casts in renal disease]

We investigated the utility of measuring dysmorphic red blood cells (d-RBC) and urinary casts in the diagnosis and assessment of prognosis of renal diseases by evaluating these parameters in a total of 278 urine specimens from 78 patients with various renal diseases at our hospital. Urinary sediments obtained by the conventional method with in 4 hours after voiding were subjected to Sternheimer and Malbin's staining and examined under a conventional light microscope. We used the criteria we previously devised for classification of RBC as d-RBC and for classification of casts hyaline, granular, epithelial, red blood cell, white blood cell, fatty, or waxy. When there were 5 or more urinary sediment red blood cells per high-power field, d-RBC was found in 94% of samples from patients with chronic glomerulonephritis. The finding of d-RBC was not related to glomerulonephritis pathologically diagnosed according to the WHO classification system for biopsy specimens. Even when there were fewer than 5 red blood cells per high-power field, d-RBC was sometimes found. Casts of all types were found in samples from patients with chronic glomerulonephritis or chronic renal failure. In samples from patients with chronic pyelonephritis, however, white blood cell, fatty, and waxy casts were not found, and less than 1 granular or epithelial cast per low-power field was found. The findings for the presence and the extent of both d-RBC and casts were in good accord with and changed with the clinical course, indicating that d-RBC and casts of urinary sediment can be used to predict the prognosis of patients with renal disease.     

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。     

Quantitative analysis of urine sediment using newly designed centrifuge tubes

We quantified the formed elements of urine sediment using newly designed plastic centrifuge tubes with top and bottom openings and a 0.5 ml sized bottom ball (YZ tube). This design minimizes the adherence of formed elements that occurs on the glass surface of conventional tubes. The numbers of white blood cells (WBC) and red blood cells (RBC) using glass tubes did not differ from those observed using YZ tubes. However, the YZ tube method detected renal casts more frequently than the conventional glass tube method; the detection rate for renal casts in normal urine samples was 21.4% vs 2.9%, in samples from hospitalized patients it was 47.5% vs 10.2%, and from patients with kidney disease it was 88.9% vs. 44.4%. Especially, the YZ tube method detected more hyaline casts in all types of samples. The correlation between the glass tube and YZ tube methods was good for WBC (r=0.996), RBC (r=0.964), and epithelial cell count (r=0.939), but the correlation was weak for casts (r=0.511 for hyaline casts; r=0.359 for other casts). In conclusion, the YZ tube method of urine sediment analyses is an easy and accurate quantitative method; it is recommended as the method of choice for detecting and quantifying pathological casts in urine. (received     

Phase contrast microscopic examination of urinary erythrocytes to localise source of bleeding: an overlooked technique?

AIMS--To localise the source of bleeding in the urinary tract in patients presenting with haematuria. METHODS--Urine samples were obtained from 109 patients with symptoms referable to the urinary tract. The sample was examined for the presence of red blood cells by phase contrast microscopy (PCM) and the proportion of dysmorphic and isomorphic red blood cells was determined. If more than 20% of the red blood cells were dysmorphic a glomerular origin for the site of bleeding was suspected; if less than 20% of the red blood cells were isomorphic a non-glomerular origin was suspected. Phase contrast microscopy and clinical findings were correlated. RESULTS--The correct bleeding site was shown in 27 of 30 (90%) patients with glomerulopathy and in all 17 patients with bleeding from the lower urinary tract, indicating that this method of analysis has a sensitivity of 90% and specificity of 100% for detecting the glomerular source of bleeding. CONCLUSIONS--The examination of urine for dysmorphic and isomorphic red blood cells by phase contrast microscopy is strongly recommended in routine clinical practice for the detection of glomerular and non-glomerular lesions. This technique may avoid unnecessary investigations for the diagnosis of the site of bleeding in patients with haematuria.     

肾移植术后BK病毒感染的检测及临床意义

目的 研究肾移植患者BK病毒感染的检测方法,并探讨其临床应用价值.方法 对132例两院同种异体肾移植随访患者,采集其血、尿标本进行BK病毒的检测,包括：尿沉渣decoy细胞、尿液BKV-DNA和血浆BKV-DNA,确定是否存在BK病毒复制.结果 132例肾移植患者中,37例（28.0%）尿decoy细胞阳性,出现decoy细胞阳性的中位时间为术后12个月;BK病毒尿症32例（24.2%）,中位时间为术后11个月;BK病毒血症16例（12.1%）,中位时间为术后15个月.5例BK病毒血症患者经病理学证实为BK病毒相关性肾病.结论 尿沉渣decoy细胞和体液BKV-DNA检测能早期发现BK病毒感染,为预防肾移植术后BK病毒相关性肾病提供重要的依据.     

99Tcm-DTPA肾动态显像与血清胱抑素C对泌尿结石患者肾功能评价的价值

目的 探讨99Tcm-DTPA肾动态显像与血清胱抑素C(Cys C)在泌尿结石患者肾功能评价中的价值,为临床评估泌尿结石患者肾功能提供依据.方法 将62例住院患者根据病史、检验结果分成泌尿结石组和非肾病组,应用99Tcm- DTPA肾动态显像测定其肾小球滤过率(GFR),胶乳增强免疫透射比浊法测定血清胱抑素C值,将两组结果进行统计学对比分析.结果 两组患者GFR和血清Cys C值差异有统计学意义(P＜0.01),结石患者中,总GFR与血清Cys C测定值呈负相关(r=- 0.558,P＜0.001).结论 99Tcm-DTPA肾动态显像测定肾小球滤过率和血清Cys C测定联检能全面客观地分析由肾结石引起的肾功能早期损害,具有重要的临床价值.     

甘肃省甘南地区儿童尿液筛查结果及影响因素分析

目的 分析儿童尿常规筛查各指标阳性率分布及其影响因素,早期防治儿童肾脏病。方法 采用多级抽样方法,于2017年8月~9月选取甘肃省甘南地区托幼机构、小学及各乡镇未入托0~10岁儿童为研究对象,进行尿常规检测结果进行统计分析,了解甘南高原地区儿童尿检异常情况及影响因素的差异。结果 多数父母对于儿童肾脏病的知晓率较低,对于孩子肾脏情况关注度不高;尿常规总阳性检出率为40.60%,各指标检出率从高到低依次为维生素C、尿酮体、尿白细胞、尿潜血,阳性检出率分别为12.00%、11.75%、7.70%、5.27%,血尿+蛋白尿为 0.40% 。尿潜血阳性及阴性儿童在民族、是否憋尿、清洗外阴频次比较,差异有统计学意义（P＜0.05）;尿蛋白阳性及阴性儿童在民族、洗澡及摄入粗粮频次比较,差异有统计学意义（P＜0.05）;尿白细胞阳性及阴性在性别、民族、饮水种类、换洗内裤频次、收入比较,差异有统计学意义（P＜0.05）;Logistic回归显示,油炸食品、每天吃甜食是尿检潜血阳性危险因素,洗澡是其保护因素,男性、汉族、饮用纯净水是尿白细胞的保护因素（P＜0.05）;结论 组织甘南地区的肾脏病宣教活动,加强教育及医疗资源投入;蔬菜、水果、甜食等摄入需适量,减少含铅食品摄入,避免儿童暴露于吸烟及污染环境,注意环境及个人卫生有利于儿童肾脏病防治。     

Prostaglandins,a Link between Renal Hydro- and Hemodynamic in Dogs

An increase of the intrarenal pressure to 40 mmHg induced by ureteral constriction or by kidney compression is shown to be followed by increased renal blood flow in anesthetized dogs. This hyperemia is probably the result of enhanced intrarenal prostaglandin activity since it is followed by increased urinary prostaglandin E excretion and is abolished by indomethacin pretreatment. The increase of renal blood flow seems to be due to dilation of the afferent arteriole in order to maintain the filtration pressure. The glomerular filtration rate is thus severely depressed in indomethacin pretreated dogs. Urine and electrolyte excretion is comparably reduced during elevated intrarenal pressure in non-pretreated and in indomethacin pretreated dogs, which suggests that factors other than glomerular filtration rate are involved. Urine osmolarity is positively correlated with renal blood flow, and urine osmolarity increases during elevated intrarenal pressure in non pretreated dogs, whilst urine osmolarity remains unchanged in dogs pretreated with indomethacin.     

Diseases of the kidney in children and adolescents with insulin-dependent diabetes mellitus

In order to estimate kidney functions in 61 juvenile diabetes patients, the glomerular filtration rate, urinary extraction of albumin during night, and systolic and diastolic artery blood pressures were examined. The ratio of these variables in relation to the duration of the disease, the metabolic control of the disease, age, and the interrelation of these elements were analysed. The control group consisted of twenty healthy children. The glomerular filtration rate was increased in 59% of patients. It shows a positive correlation with the duration of the disease and the increased urinary extraction of albumin. Tolerable values were established in relation to the systolic artery blood pressure. Diabetic incipient nephropathy (microalbuminuria) marks the increased urinary extraction of albumin. The prevalence of microalbuminuria in the group of children with diabetes was 27.86%. It was significantly higher in patients with a longer duration of the disease, in older patients and in those with an increased glomerular filtration rate. Microalbuminuria shows a positive correlation with glycogenic hemoglobin and systolic and diastolic artery blood pressure values. Systolic and diastolic artery blood pressures correlate with the duration of the disease and the increased urinary extraction of albumin. The results suggest that glomerular hyperfiltration is the most precise indication of disturbed renal functions. The high percentage of its occurrence is found when the disease was diagnosed and these adverse manifestations are highly reversible. The increased urinary extraction of albumin indicates structural renal lesions. The results also indicate the tendency of an increase of artery blood pressure, especially the diastolic pressure, ten years after the occurrence of the disease. High blood pressure accelerates the progress of diabetic nephropathy. The authors are of the opinion that the examination of kidney functions both in children and adolescents with insulin-dependent diabetes is necessary for the early detection of renal lesions and for the application of an adequate therapy.