尿沉渣分析仪联合尿液干化学法对尿液白细胞检测的价值分析

2020-08-31 11:39:23 中国当代医药 2020年21期

付莲花 余海根 叶山兰

[摘要]目的 探討尿沉渣分析仪联合尿液干化学法对尿液白细胞检测的价值。方法 收集2019年1~6月江西省宜春市第三人民医院检验科的500例尿液标本,依据随机双盲法分为对照组(n=250)与观察组(n=250)。对照组采用尿液干化学法,观察组采用尿沉渣分析仪联合尿液干化学法。以尿沉渣镜检为金标准,比较两组尿液标本尿液白细胞检出的阳性率、漏诊率、误诊率。结果 尿沉渣镜检结果显示,对照组尿液标本的尿液白细胞阳性率为79.20%(198/250),观察组尿液标本的尿液白细胞阳性率为77.60%(194/250)。两组的尿液白细胞阳性率比较,差异无统计学意义(P>0.05)。观察组检测方法检测尿液白细胞的阳性率为76.00%(190/250),高于对照组的56.00%(140/250),差异有统计学意义(P=0.035)。观察组尿液标本的尿液白细胞检出符合率高于对照组,检测漏诊率、误诊率均低于对照组,差异有统计学意义(P<0.05)。结论 尿沉渣分析仪联合尿液干化学法可降低尿液白细胞检测的漏诊率、误诊率,提高检测价值。

[关键词]尿沉渣分析仪;尿液干化学法;尿液白细胞;漏诊率;误诊率

[中图分类号] R446.12          [文献标识码] A          [文章编号] 1674-4721(2020)7(c)-0139-03

Value analysis of urine sediment analyzer combined with urine dry chemistry method for urine white blood cell detection

FU Lian-hua1   YU Hai-gen1   YE Shan-lan2

1. Department of Clinical Laboratory, the Third People′s Hospital of Yichun City in Jiangxi Province, Yichun   336000, China; 2. Department of Clinical Laboratory, Maternal and Child Health Hospital of Tonggu County in Jiangxi Province, Tonggu   336200, China

[Abstract] Objective To explore the value of urine sediment analyzer combined with urine dry chemistry method for urine white blood cell detection. Methods A total of 500 cases of urine specimens from the Third People′s Hospital of Yichun City in Jiangxi Province from January to June 2019 were collected and divided into the control group (n=250) and the observation group (n=250) according to the randomized double-blind method. Urine dry chemical method was used in the control group, and urine sediment analyzer combined with urine dry chemical method was used in the observation group. Urine sediment microscopic examination was used as gold standard, the positive rate, missed diagnosis rate and misdiagnosis rate of urine leucocytes were compared between the two groups. Results The results of urine sediment microscopy showed that the urine leukocyte positive rate of the control group was 79.20% (198/250),and the urine leukocyte positive rate of the observation group was 77.60% (194/250). There was no significant difference in the positive rate of urine leukocytes between the two groups (P>0.05). The positive rate of urine leucocytes detected by the test method in the observation group was 76.00% (190/250), which was higher than that in the control group (56.00%) (140/250), and the difference was statistically significant (P<0.05). The coincidence rate of urine white blood cells detected in the urine samples of the observation group was higher than that of the control group, and the missed diagnosis rate and misdiagnosis rate in the urine samples of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). Conclusion Urine sediment analyzer combined with urine dry chemistry method can reduce the missed diagnosis rate and misdiagnosis rate of urine leukocyte detection, and improve the detection value.

尿液干化学法检测需要专业试纸进行对比分析,试纸成份以重氮盐、吲哚酚酯为主,与白细胞包浆内粒细胞酯酶发生反应,使吲哚酚游离,与重氮盐形成缩合物,并且粒细胞颜色的变化与其数量呈正比[14]。该方法检测过程中受各方面的影响,所有能影响粒细胞酯酶的因素均可影响尿液白细胞检测结果。UF-1000i尿沉渣分析仪是基于电阻抗、流式细胞计数法的原理,尿液标本稀释、染色后,经激光束照射后,尿液标本所有分化粒子得到不同荧光强度、散射光强度、电阻抗大小,仪器通过对不同荧光、散射光强度以及不同电阻抗进行有效分析,识别不同的粒子[15]。该方法检测中易受尿液成分的影响,只能检测完整细胞的有形成分,故易影响检测结果。尿沉渣镜检则是将尿液标本经过离心、分层、滴定等处理,在显微镜下直接观察细胞,是检测的金标准。

本研究结果显示,观察组尿液标本尿液白细胞检出的阳性率、检出符合率均高于对照组,漏诊率低于对照组(P<0.05),提示尿沉渣分析仪联合尿液干化学法检测尿液白细胞阳性率更高,能够有效避免漏诊。单一的尿液干化学法在检测过程中易受多方面因素的影响,若尿液中含有先锋Ⅳ、庆大霉素、乳糜尿、蛋白等,可造成结果假阴性;此外,机体存在免疫系统疾病、肾移植术后的排斥反应,尿液白细胞以淋巴细胞为主,但淋巴细胞不存在粒细胞酯酶,常导致假阴性,从而提高漏诊率。联合尿沉渣分析仪可有效避免上述影响因素,形成互补,从而提高阳性率,有效避免漏诊。

本研究结果还显示,观察组尿液标本尿白细胞检测的误诊率低于对照组(P<0.05),提示尿沉渣分析仪联合尿液干化学法检测能减少误诊。单一的尿液干化学法检测过程中可能由于药物(呋喃坦啶)、甲醛等影响,造成检测尿白细胞假阳性;另外,女性尿液被污染、尿液标本上皮细胞过多等,亦可导致假阳性,导致误诊。联合尿沉渣分析仪检测能避免药物、尿液白带污染等的影响,可有效避免误诊,从而大大降低误诊率。

综上所述,尿液干化学法结合尿沉渣镜检法可降低白细胞检测的漏诊率、误诊率及错误率,有效提高检测价值。

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(收稿日期:2020-02-26)

[基金项目]江西省宜春市科技计划项目(JXYC2017KSC031)