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。

The Evaluation of Clinical Application of Urinary Erythrocyte Morphology In Differential Diagnosis Between Nephritic And Non-Nephritic Diseases

Objective To observe the morphology of urinary erythrocytes and provide evidences of differential diagnosis between nephritic and non-nephritic diseases. Methods Urinary erythrocytes were stained intravitally with Sternheimer-Malbin (SM staining) and then observed and differential counted with aberration microscope. Results Acanthocytes,targeted erythrocytes and anamorphic microcytes were observed only in nephritic diseases,and wizened erythrocytes,annular erythrocytes and ghosty erythrocytes were observed in both nephritic and non-nephritic diseases. ROC curve was used to e-valuate normal,wizened,ghosty and annular erythrocytes,and the AUC area was 96. 5% ,77. 5% ,63. 3% and 50% ;the optimal dividing line was 13%,11%,12% and 36%;the sensitivity was 98%,84%,81% and 77%;the specificity was 91%, 60%, 49% and 40%; the accuracy was 94%, 76%, 65% and 78% respectively. Conclusion The optimal dividing line of different urinary erythrocyte morphologies have important value in differential diagnosis between nephritic and non-nephritic hematuria. And acanthocytes, targeted erythrocytes and anamorphic microcytes have more important value in differential diagnosis.