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。

Significance of urine Tamm-Horsfall protein-coated erythrocytes in the diagnosis of hematuria origin in children

Objective To explore the significance of urine Tamm Horsfall protein coated erythrocytes in the diagnosis of hematuria origin in children. Methods Urine Tamm Horsfall protein coated erythrocytes were detected through indirect immunoflurescence staining to determine the origin of hematuria in 86 glomerular and 26 nonglomerular hematuric children and the results were compared with erythrocyte morphology method in differentiation of hematuria origin. Results 79 glomerular hematuria were identified among 86 cases through detection of urine Tamm Horsfall protein coated erythrocytes and 7 were misjudged, meanwhile 24 nonglomerular hematuria were identified among 26 cases and 2 were not confirmed. The method was 91 9% in sensitivity,92 3% in specificity and 92% in accuracy,and the rate of underdiagnosis was 8 1% and the rate of misdiagnosis was 7 7%. The erythrocyte morphology method in differentiation of hematuria origin was 77 9% in sensitivity, 69 2% in specificity and 76 7% in accuracy,and the underdiagnosis rate was 22 1% and the misdiagnosis rate was 22 1%. Their difference was statistically significant in specificity and underdiagnosis rate ( P <0 05), and much significant in sensitivity, accuracy and misdiagnosis rate( P <0 01). Conclusion Detection of urine Tamm Horsfall protein coated erythrocytes was better than erythrocyte morphology method in differentiation of hematuria origin in children and therefore it was worthful in clinical.