尿液干化学分析与尿沉渣镜检的关系探讨

<正> 近年来,应用干化学分析原理的尿液分析仪在各医院检验科已被广泛应用,干化学法可以快速分析尿液中许多化学成份,方法简便、灵敏,精密度高,减轻了检验人员的工作强度。规范的尿沉渣镜检是保证尿液分析结果准确的基础。原则上,每个尿液标本都应镜检。但目前普遍存在检验科人员少,工作量大的情况,特别是在规模较大的医院,     

尿液分析仪和显微镜对尿液白细胞的检测对比分析

目的对尿液干化学法与显微镜法白细胞结果进行比较,以对白细胞进行最准确的检测。方法通过尿液干化学分析法与显微镜镜检法,对485份尿标本进行检测。结果尿液分析仪法与尿沉渣显微镜检测法在尿检中比较得出：干化学分析法检测为阴性的有416份,占85．8％,显微镜分析组为阴性的有423份,占87．2％,两者结果不符的分别有69（14．2％）、62（12．8％）。两种检查结果之间的差异无统计学意义（P〉0．05）。结论干化学分析法和沉渣镜检法由于使用原理不同,检测结果也可能有差异。在实际工作中可以结合两种方法,可以增加检测结果的准确性,尿液干化学分析法不能完全替代镜检法对尿液白细胞进行检测。     

野战(应急)快速检验系统(A型)与实验室常规尿液干化学分析仪的对比分析

野战(应急)快速检验系统在多次非战争军事行动中得到了全方位应用,但对于其基本性能的评价尚未见报道.本文分析了该系统中的尿液分析模块与实验室常规尿液干化学分析仪检测结果的可比性,以期为其应用提供实验依据. 1材料与方法 1.1标本来源 随机收集2011年10-11月解放军白求恩国际和平医院门诊、住院患者(其中肾脏病科患者占20％)的尿液标本200份.     

尿电导率在常见肾病中的临床意义

尿液分析是各种肾病的常规检查项目，其结果是不同肾病的辅助诊断依据。目前我院联合干化学分析和UF-100全自动尿沉渣分析仪（简称UF-100）用于住院患者尿液常规检查，但在应用中，尿电导率应用较少，易被忽略。通过测定不同肾病患者的尿电导率，并与健康成人对比，探讨尿电导率在常见肾病中的意义，现报道如下。     

全程质量控制对保证检验结果质量意义的分析

检验全程质量控制包括有：分析前质控、分析中质控、分析后质控。现在各大、小医院检验科大都参加全国或各省市临检中心组织的室间质评，也都建立了较完整的室内质量控制，它控制着自吸取样本至获得测定结果并对结果进行分析的整个测定过程，在检验科仪器高度自动化、方法标准化及室内质控的保证下，对样本检测的准确度和精密度都大大提高，就单纯的样本检测的准确问题也越来越少，我们现在发生的问题多与临床不能正确采集样本有关，也就是说没有建立一个全面的质量管理体系，没有做到全面质量控制。在检验工作中除分析过程中的影响因素外，常见的分析前影响主要因素有。     

单病种质量管理模式在高压氧医学质量控制中的应用

目的:探讨单病种质量管理模式在高压氧医学质量控制中的应用。方法:为了合理利用医疗资源,规范各相关病种的高压氧诊疗,上海市医用高压氧临床质控中心提出在高压氧质控管理中实施单病种管理模式。通过开展上海市现状调查,筛选出主要治疗病种,建立单病种质控登记表,多学科交叉合作制定单病种质控诊疗规范。结果:筛选出4类主要病种并构建上...     

放免分析室内质量控制中量化指标的应用

放射免疫分析 (ＲＩＡ)是一种具有高灵敏度、精确度和特异性的体外超微量分析法 ,必须进行质量控制才能保证其结果的可靠性。量化质量控制指标评分表及评分标准 ,能从不同角度评价ＲＩＡ室内质量水平 ,对测定结果作可信性评估。笔者建立了 10项常规放射免疫分析质量控制评分表 ,以期为临床ＲＩＡ提供直观、简便、准确的质控方法。资料与方法笔者对每批测定的质量水平进行监测 ,并从量的概念上给予定量。质控血清监测、Ｙｏｕｄｅｎ图监测及标准曲线参数监测法见文献 [1]。本研究在 3种监测方法的基础上加以概括补充 ,建立质控评分表 ,根据误…     

检验科局域网在室内质量控制中的应用研究

 目的使用患者标本检验结果的均值绘制室内质控图来观察结果准确性的变化.方法应用临床检验信息系统软件对2002年6～9月20项生化检验数据进行统计分析,计算患者标本检验结果的均值并绘制室内质控图.结果患者检验结果均值呈正态分布且稳定变化,质控图可以灵敏的反映结果准确性的变化.结论患者结果均值质控法可以用来检查临床标本检测的准确度水平,控制与质控血清无关的重要误差因素,是室内质控的重要补充手段之一.     

UF-100全自动尿沉渣分析和Uritest-300干化学分析结合用于尿液分析研究

目的：探讨UF-100尿沉渣全自动分析仪与Uritest-300尿干化学分析仪结合应用于尿液常规分析的临床应用价值。方法：随机选择300份住院病人尿标本，同时用UF-100尿沉渣分析仪、尿干化学分析仪及显微镜检测，分析多个参数指标。建立UF-100与Uritest-300结合的显微镜筛选方案。并对680份随机样本进行分析。结果：红、白细胞检测在三种方法中符合率很高，UF-100与镜检比较，红细胞符合率90．3％，Cohen’sκ值0．847，白细胞符合率92．0％，Cohen’s κ值0．876。管型检测一致性较差；采用UF-100与Uritest-300结合的显微镜筛选方案，复检率为17．5％。结论：UF-100全自动尿沉渣分析和Uritest-300干化学分析对照用于尿液分析，可提高检测结果的精确度和准确度，降低劳动强度，提高检验效率。     

接骨Ⅱ号合剂的制备及质量控制

目的：研究接骨Ⅱ号合剂的制备方法及质量控制。方法：建立该制剂的制备工艺，采用TLC法对制剂中的成分进行鉴别。结果：该制备工艺可行，质量可控。结论：该制剂制备工艺简单、方便，质量控制的检出结果可靠，可作为接骨Ⅱ号的质控标准。     

Postmortem distribution of α-pyrrolidinobutiophenone in body fluids and solid tissues of a human cadaver

We experienced an autopsy case of a 21-year-old male Caucasian, in which the direct cause of his death was judged as subarachnoid hemorrhage. There was cerebral arteriovenous malformation, which seemed related to the subarachnoid hemorrhage. The postmortem interval was estimated to be about 2 days. By our drug screening test using gas chromatography–mass spectrometry, we could identify α-pyrrolidinobutiophenone (α-PBP) in his urine specimen, which led us to investigate the postmortem distribution of α-PBP in this deceased. The specimens dealt with were right heart blood, left heart blood, femoral vein blood, cerebrospinal fluid, urine, stomach contents and five solid tissues. The extraction of α-PBP and α-pyrrolidinovalerophenone (α-PVP, internal standard) was performed by a modified QuEChERS (quick, easy, cheap, effective, rugged and safe) method, followed by the analysis by liquid chromatography–tandem mass spectrometry. Because this study included various kinds of human matrices, we used the standard addition method to overcome the matrix effects. The highest concentration was found in urine, followed by stomach contents, the kidney, lung, spleen, pancreas and liver. The blood concentrations were about halves of those of the solid tissues. The high concentrations of α-PBP in urine and the kidney suggest that the drug tends to be rapidly excreted into urine via the kidney after its absorption into the blood stream. The urine specimen is of the best choice for analysis. This is the first report describing the postmortem distribution of α-PBP in a human to our knowledge.     

Urinalysis and hair analysis for illicit drugs of driver applicants and drivers in the trucking industry

The purpose of this article is to compare the differential rate of detection of illicit drugs when using two distinct sample types, hair and urine specimens. The specimens were collected from persons who applied for employment as a truck driver, or were collected from randomly selected currently employed truck drivers. The data is examined for job applicants and employees to determine if any differences in outcomes are associated with employment status or specimen type. The data is also assessed for specific patterns associated with particular drugs and their assay outcomes. Overall, it was determined that drug positive cases are relatively rare. Job applicants are more likely to test positive for an illicit drug than a currently employed driver. Applicants are more frequently positive for a drug by a factor of 3 for both urinalysis and hair analysis when compared to currently employed drivers. Approximately 2% of applicants were urine positive and 9% hair positive for an illegal drug. Considering employed truck drivers 0.6% were drug positive by urinalysis and 3% when using hair analysis. It is concluded that hair assays detect more drug use than urinalysis. It is also concluded that when urine and hair assay outcomes are non-concordant the typical case is a positive hair analysis with a negative urinalysis.     

The effect of an enzymatic bone processing method on short tandem repeat profiling of challenged bone specimens

Forensic analysis of DNA from bone can be important in investigating a variety of cases involving violent crimes and mass fatality cases. To remove the potential presence of co-mingled remains and to eliminate contaminants that interfere with forensic DNA analysis, the outer surface of the bone fragment must be cleaned. This study evaluated two methods for processing bone specimens prior to DNA isolation. Mechanical sanding and enzymatic trypsin methods were compared in this study. The effects of these methods on the yield of DNA isolated and the quality of DNA analysis were studied. It was revealed that comparable values of DNA yields between the two methods were observed. Additionally, to evaluate the capabilities of the cleaning effect of the bone processing methods, the presence of polymerase chain reaction inhibitors in the DNA extracts was monitored using the internal positive control. Similar C_t values of the internal positive control were observed as the DNA extracts of the trypsin method compared with that of the sanding method. The characterization of the effects of the trypsin treatment on the quality of DNA profiling was also carried out. To evaluate the integrity of the nuclear DNA isolated, the percentage of allele calls and the peak-height values of alleles of the short tandem repeat profiles were compared between the two methods. A paired-sample t-test revealed no significant difference between the two methods. Our data suggested that the trypsin method can be used as an alternative cleaning method to mechanical cleaning methods. This method can be used to process multiple samples simultaneously. This can be very important for achieving high-throughput DNA isolation through potential automation, which can be extremely valuable for situations such as the forensic DNA analysis of skeletal remains from mass fatality incidents.     

Oripavine as a new marker of opiate product use

During our extensive surveillance of opiates in urine specimens of opium users, we noticed the appearance of an unknown peak (compound X) in total ion chromatograms obtained by gas chromatography-mass spectrometry (GC–MS) after enzymatic hydrolysis and trimethylsilyl (TMS) derivatization. We identified the compound X as oripavine. Oripavine was found to be a new and useful putative marker of opium/poppy seed use in differentiation from heroin, pharmaceutical codeine, and pharmaceutical morphine use. The presence of oripavine in the urine of opium users is probably the result of O-demethylation of the opium alkaloid thebaine. Analytical method optimization for GC–MS detection of oripavine in urine was also undertaken. Underivatized oripavine could not be detected by GC–MS, and trials for derivatization of oripavine with acetic anhydride and propionic anhydride were unsuccessful. Trials were successful with bis(trimethylsilyl)trifluoroacetamide/trimethylchlorosilane. It was also disclosed that almost all amounts of oripavine in human urine existed in the unconjugated form; it was absolutely necessary to hydrolyze the conjugate before TMS derivatization of oripavine for its GC–MS analysis.     

Introduction of sample tubes with sodium azide as a preservative for ethyl glucuronide in urine

Ethyl glucuronide (EtG) is a direct alcohol marker, which is widely used for clinical and forensic applications, mainly for abstinence control. However, the instability of EtG in urine against bacterial degradation or the post-collectional synthesis of EtG in contaminated samples may cause false interpretation of EtG results in urine samples. This study evaluates the potential of sodium azide in tubes used for urine collection to hinder degradation of ethyl glucuronide by bacterial metabolism taking place during growth of bacterial colonies. The tubes are part of a commercial oral fluid collection device. The sampling system was tested with different gram-positive and gram-negative bacterial species previously observed in urinary tract infections, such as Escherichia coli, Staphylococcus aureus, Enterecoccus faecalis, Staphylococcus epidermidis, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa. Inhibition of bacterial growth by sodium azide, resulting in lower numbers of colony forming units compared to control samples, was observed for all tested bacterial species. To test the prevention of EtG degradation by the predominant pathogen in urinary tract infection, sterile-filtered urine and deficient medium were spiked with EtG, and inoculated with E. coli prior to incubation for 4 days at 37 °C in tubes with and without sodium azide. Samples were collected every 24 hours, during four consecutive days, whereby the colony forming units (CFU) were counted on Columbia blood agar plates, and EtG was analyzed by LC-MS/MS. As expected, EtG degradation was observed when standard polypropylene tubes were used for the storage of contaminated samples. However, urine specimens collected in sodium azide tubes showed no or very limited bacterial growth and no EtG degradation. As a conclusion, sodium azide is useful to reduce bacterial growth of gram-negative and gram-positive bacteria. It inhibits the degradation of EtG by E. coli and can be used for the stabilization of EtG in urine samples.

     

Simple analysis of naphthalene in human whole blood and urine by headspace capillary gas chromatography with large-volume injection

A very simple method for analysis of naphthalene in human whole blood and urine by headspace gas chromatography (GC) is presented. It does not require solid-phase microextraction or cryogenic trapping devices, but needs only a conventional capillary GC instrument with flame ionization detection. The advantage of the method is that as much as 5 ml of headspace vapor can be injected into a GC instrument in splitless mode for sensitive detection. After heating a diluted whole blood or urine sample containing naphthalene and 1-methylnaphthalene (internal standard, IS) in a 7.0-ml vial at 80°C for 30 min, 5 ml of the headspace vapor was drawn with a glass syringe and injected into the gas chromatograph. Before injection, the column temperature was set at 50°C to trap the analytes, and then the oven temperature was programmed up to 300°C. Sharp peaks were obtained for both analyte and IS, and only a few impurity peaks appeared, which did not interfere with the test peaks, mainly for whole blood samples. The detection limit (signal-to-noise ratio. 3) were about 0.05 and 0.01 μg/ml for whole blood and urine, respectively. Precision and linearity were also examined to confirm the reliability. Such a simple headspace GC technique with large-volume injection will be applicable to other low-volatility compounds in biological matrices, and will be useful in forensic toxicological analysis.     

Identification and quantification of diphenhydramine,haloperidol, and its metabolite,reduced haloperidol in a saponified brain specimen that was immersed in the sea water for more than 10 years

In forensic toxicology, blood and urine specimens are commonly used for detecting and quantifying drugs and their metabolites. When the cadaver is so damaged or decomposed such that the specimens mentioned above cannot be collected, it is necessary to perform drug analysis using alternative specimens such as hair, nails, oral fluids and meconium. Adipocere is resistant to further degradation; it is thus possible to be used as an alternative specimen to analyze drugs and their metabolites. Some researchers indeed have reported drug concentrations in saponified samples that were collected years after decedents’ deaths.In this study, we subjected saponified brain, which remained under sea for over 10 years after death, to forensic toxicological analysis using liquid chromatography/tandem mass spectrometry (LC/MS/MS). Using product ion scan analysis, we confirmed the presence of diphenhydramine, haloperidol, and reduced haloperidol, a metabolite of haloperidol. In addition, drugs and metabolite quantification were performed using the standard addition method. Correlation coefficients of the calibration curves were over 0.98. Analyte concentrations in the saponified brain were as follows: diphenhydramine was 1.84 ng/g, haloperidol was 1.30 ng/g, and reduced haloperidol was 3.02 ng/g. Our results suggest that it can be possible to quantify not only parent drugs but also their metabolites in saponified brain. These findings indicate that saponified tissues could be applied as alternative specimens for forensic toxicology, and could be useful as supporting information for victim identification.     

Real-time near-body drug screening during autopsy I: use of the Randox biochip drugs of abuse DOA I and DOA II immunoassays

Screening for drugs of abuse is widely employed as part of forensic toxicology investigations. The nature of specimens collected at autopsy varies depending on local customs, the case circumstances, and the condition of the cadaver. It is generally accepted that wherever possible specimens of peripheral blood, liver, stomach contents, vitreous humor, and muscle can be useful for toxicological analysis. In some countries, legislation or religious custom may mitigate against the removal of postmortem tissue unless shown to be necessary. The availability of a sensitive and broad ranging near-body screening test may provide a useful tool to assist pathologists in making decisions regarding the retention of tissues for toxicology analysis. We describe the performance of the Randox drugs-of-abuse (DOA) arrays, DOA I and DOA II, for near-body screening using whole blood, urine, vitreous humor, liver, and psoas major muscle. Samples were obtained from 106 autopsies and screened for the presence of amphetamine, barbiturates, benzodiazepines, benzoylecgonine, buprenorphine, cannabinoids, fentanyl, ketamine, lysergic acid diethylamide, methadone, methamphetamine, methaqualone, methylenedioxymethylamphetamine (Ecstasy), opiates, oxycodone, phencyclidine, and propoxyphene in the mortuary whilst the postmortem was being performed. Blood from each case underwent confirmatory analysis using either gas chromatography-mass spectrometry, liquid chromatography with tandem mass spectrometry or diode array detection. Excellent agreement between the near-body screening tests on a variety of tissues and confirmatory analyses in blood was obtained.     

The possibilities of hair analysis in the determination of involuntary doping in sports

Although not yet fully recognised by international sporting committees, hair analysis in doping control may be a useful adjunct to drug testing of urine. It may permit access to retrospective information and the identification of banned substances, especially when exogenous abuse has to be distinguished from other forms of involuntary exposure to identical substances. Negative hair results coupled with positive urine samples may be used to draw conclusions of involuntary doping in sports whenever athletes claim not to have ingested any drug, identical substances are present in their environment or are normal constituents of food and beverages served to them immediately before the competition. Two cases are well described in the literature in which hair analyses were fundamental in documenting positive doping after urinalysis. In Brazil, 2 cases of athletes testing positive for banned substances caught our attention because of the possibility of involuntary doping; hair analysis, if performed, may have helped to clarify the results of the urinalysis. Despite the fact that it cannot be used for routine control and overrule positive urinalysis, hair analysis can detect long term exposure as well as those substances which are not excreted in urine. In the current International Olympic Committee (IOC) code, hair analysis is not yet considered useful even in special cases of doping control.