尿液有形成分分析联合血清降钙素原检测在尿路感染诊断中的应用价值

doi:10.3969/j.issn.1673-8640.2018.04.006

摘要/Abstract

摘要：

目的探讨UF-1000i全自动尿有形成分分析仪（简称UF-1000i）联合血清降钙素原（PCT）检测在尿路感染诊断中的应用价值。方法收集以无菌方式留取的尿液标本1 372例,进行尿液细菌培养,并运用UF-1000i进行细菌计数和白细胞计数。以尿液细菌培养结果为金标准,得出UF-1000i细菌计数及白细胞计数的临界值,分析敏感性和特异性,并统计分析细菌散点图信息与尿液细菌培养结果的符合性。比较尿液细菌培养阳性组、尿液细菌培养阴性组、UF-1000i阳性组、UF-1000i阴性组与正常对照组（体检健康者87名）的血清PCT水平。结果白细胞计数的最佳临界值为27.5/μL,细菌计数的最佳临界值为143.5/μL。以细菌计数阳性和白细胞计数阳性作为筛查指标时,特异性为92.7%,但假阴性率较高（30.8%）;以细菌计数阳性或白细胞计数阳性作为筛查指标时,特异性为55.3%,但假阳性率较高（44.7%）。UF-1000i细菌散点图信息与尿液细菌培养结果的符合率为57%。UF-1000i阳性组血清PCT水平高于UF-1000i阴性组和正常对照组（P<0.05）,与尿液细菌培养阳性组比较差异无统计学意义（P>0.05）。UF-1000i阳性组联合血清PCT检测可提高尿路感染诊断的特异性。结论 UF-1000i细菌计数、白细胞计数和血清PCT水平可作为尿路感染的快速筛查指标。

关键词: 尿液细菌培养, 尿液有形成分, 降钙素原, 尿路感染

Abstract:

Objective To investigate the role of urinary sediment analysis by UF-1000i urinalysis analyzer combined with serum procalcitonin（PCT） determination in the diagnosis of urinary tract infection. Methods A total of 1 372 urine specimens were collected in sterile process and determined for urinary bacterial culturing and the cut-off values of bacterium and white blood cell counts by UF-1000i. The result of urinary bacterial culturing was used as golden standard. The sensitivities and specificities were evaluated. The consistency of bacterium scatter diagram information of UF-1000i and urinary bacterial culturing was analyzed. Serum PCT levels of urinary bacterial culturing positive group,urinary bacterial culturing negative group,UF-1000i positive group and UF-1000i negative group were compared. Results The cut-off value of white blood cell count was 27.5/μL,and the cut-off value of bacterium count was 143.5 /μL. Using positive bacterium and white blood cell counts as screening parameters,the specificity was 92.7%,and the false negative rate was 30.8%. Using positive bacterium or white blood cell count as screening parameter,the specificity was 55.3%,and the false positive rate was 44.7%. The consistency of bacterium scatter diagram information of UF-1000i and urinary bacterial culturing was 57%. The level of serum PCT in UF-1000i positive group was higher than those in UF-1000i negative group and normal control group（P<0.05）,but there was no statistical significance for UF-1000i positive group compared with urinary bacterial culturing positive group（P>0.05）. UF-1000i positive group combined with serum PCT determination can improve specificity for urinary tract infection. Conclusions UF-1000i white blood cell and bacterium counts and serum PCT level could be used for screening urinary tract infection.

Key words: Urinary bacterial culturing, Urinary sediment, Procalcitonin, Urinary tract infection

中图分类号:

R446.12

虞培娟, 张杲琳, 严茹红, 冯萍, 孙兰云, 朱雪明, 王敬华. 尿液有形成分分析联合血清降钙素原检测在尿路感染诊断中的应用价值[J]. 检验医学, 2018, 33(4): 299-304.

YU Peijuan, ZHANG Gaolin, YAN Ruhong, FENG Ping, SUN Lanyun, ZHU Xueming, WANG Jinghua. Urinary sediment analysis combined with serum procalcitonin determination in the diagnosis of urinary tract infection[J]. Laboratory Medicine, 2018, 33(4): 299-304.

图/表 8

参考文献 12

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尿液细菌培养	例数	白细胞计数		细菌计数		细菌计数或白细胞计数		细菌计数和白细胞计数
尿液细菌培养	例数	阳性	阴性	阳性	阴性	阳性	阴性	阳性	阴性
阳性	341	273	68	273	68	307	34	236	105
阴性	997	394	603	130	867	446	551	73	924
合计	1 338	667	671	403	935	753	585	309	1 029

尿液细菌培养	例数	白细胞计数		细菌计数		细菌计数或白细胞计数		细菌计数和白细胞计数
尿液细菌培养	例数	阳性	阴性	阳性	阴性	阳性	阴性	阳性	阴性
阳性	341	273	68	273	68	307	34	236	105
阴性	997	394	603	130	867	446	551	73	924
合计	1 338	667	671	403	935	753	585	309	1 029

项目	敏感性	特异性	阳性预测值	阴性预测值	假阳性率	假阴性率
白细胞计数阳性	80.1	60.5	40.9	89.9	39.5	19.9
细菌计数阳性	80.1	87.0	67.7	92.7	13.0	19.9
白细胞计数阳性或细菌计数阳性	90.0	55.3	40.8	94.2	44.7	10.0
白细胞计数阳性和细菌计数阳性	69.2	92.7	76.4	89.8	7.3	30.8

项目	敏感性	特异性	阳性预测值	阴性预测值	假阳性率	假阴性率
白细胞计数阳性	80.1	60.5	40.9	89.9	39.5	19.9
细菌计数阳性	80.1	87.0	67.7	92.7	13.0	19.9
白细胞计数阳性或细菌计数阳性	90.0	55.3	40.8	94.2	44.7	10.0
白细胞计数阳性和细菌计数阳性	69.2	92.7	76.4	89.8	7.3	30.8

病原微生物	例数	白细胞计数（/μL）	细菌计数（/μL）	细菌散点图信息
革兰阴性杆菌	222
大肠埃希菌	126	3~2 218	119~30 321	倾向杆菌（有48例未提示）
肺炎克雷伯菌	24	118~11 836	374~62 079	倾向杆菌（有8例未提示）
阴沟肠杆菌	16	263~2 589	245~21 372	倾向杆菌（有5例未提示）
铜绿假单胞菌	13	131~895	278~5 267	倾向杆菌（有3例未提示）
弗劳地氏枸橼酸杆菌	11	115~2 129	144~2 991	倾向杆菌（有4例未提示）
普通变形杆菌	11	36~1 598	763~1 896	倾向杆菌（有2例未提示）
鲍曼不动杆菌	6	10~489	123~954	倾向杆菌（有2例未提示）
奇异变形杆菌	5	19~878	57~782	未提示
粘质沙雷菌	5	212~1 478	76~2 147	未提示
副流感嗜血杆菌	5	271~1 658	1 215~3 214	球杆菌
革兰阳性球菌	102
屎肠球菌	31	10~683	50~3 947	球杆菌,球菌居多（有9例未提示）
无乳链球菌	23	35~985	129~3 698	倾向球菌（有10例未提示）
粪肠球菌	21	2~2 799	12~2 467	倾向球菌（有8例未提示）
金黄色葡萄球菌	13	6~718	57~839	倾向球菌（有6例未提示）
表皮葡萄球菌	8	97~556	321~4 072	球杆菌,球菌居多（有4例未提示）
马链球菌	3	290~556	920~3 589	球杆菌
杰克棒状杆菌	3	13~389	41~1 234	未提示
真菌	17
白假丝酵母菌	8	173~479	23~59	未提示
热带假丝酵母菌	4	402~433	30~43	未提示
光滑假丝酵母菌	4	62~358	16~158	未提示
葡萄牙假丝酵母菌	1	138	58	未提示