CAJ | 학술논문

目的:探讨常规尿检整合分类是否能预测肾病理损伤.方法:采集北京大学第一医院肾内科住院患者肾活检当日晨尿标本146份,行位相差显微镜检查尿沉渣,查尿蛋白定量(g/24 h),进行尿检整合分类.尿沉渣谱整合蛋白定量后分3类,Ⅰ类:蛋白尿,多细胞及管型;Ⅱ类:蛋白尿,少细胞,透明/细颗粒管型;Ⅲ类:少量蛋白,肾小管上皮细胞和/或有核细胞管型.对肾活检标本常规处理,行光镜(HE、PASM、Masson染色)、免疫荧光和电镜检查做出病理诊断.将常规尿检资料整合与分类的关系及分类与肾病理诊断的符合率进行统计学处理,采用kappa检验,配对χ~2检验,P<0.05为差异有统计学意义.结果:(1)肾活检组织病理诊断:肾小球增殖性病变95例、非增殖性病变46例、小管间质病5例.(2)常规尿检资料整合对分类的影响:单凭尿沉渣镜检,146例中有67例(46%)归于Ⅰ类,79例(54%)不能确定;再整合尿蛋白定量可从79例中再确认75例,4例仍不能确定.(3)尿检分类与肾组织病理诊断符合率:肾小球疾病符合率为77.7%.结论:常规尿液检查整合分类可在一定程度上判断肾病理损伤.
목적:탐토상규뇨검정합분류시부능예측신병리손상.방법:채집북경대학제일의원신내과주원환자신활검당일신뇨표본146빈,행위상차현미경검사뇨침사,사뇨단백정량(g/24 h),진행뇨검정합분류.뇨침사보정합단백정량후분3류,Ⅰ류:단백뇨,다세포급관형;Ⅱ류:단백뇨,소세포,투명/세과립관형;Ⅲ류:소량단백,신소관상피세포화/혹유핵세포관형.대신활검표본상규처리,행광경(HE、PASM、Masson염색)、면역형광화전경검사주출병리진단.장상규뇨검자료정합여분류적관계급분류여신병리진단적부합솔진행통계학처리,채용kappa검험,배대χ~2검험,P<0.05위차이유통계학의의.결과:(1)신활검조직병리진단:신소구증식성병변95례、비증식성병변46례、소관간질병5례.(2)상규뇨검자료정합대분류적영향:단빙뇨침사경검,146례중유67례(46%)귀우Ⅰ류,79례(54%)불능학정;재정합뇨단백정량가종79례중재학인75례,4례잉불능학정.(3)뇨검분류여신조직병리진단부합솔:신소구질병부합솔위77.7%.결론:상규뇨액검사정합분류가재일정정도상판단신병리손상.
Objective:To investigate whether combination of urine sediment and urine protein can pre-dict the renal pathological changes.Methods:We prepared 146 specimens of routine flesh fasting morning urine.Sediment analysis was performed with phase-contrast microscopy and 24-hour urine pro-tein Was measured.Both urine protein and sediment data were integrated to form three urine analysis groups.Urine group Ⅰ:proteinuria,hematuira,urine white blood cells,red/white cell casts.Urine group Ⅱ:proteinuria,few cell hyaline/fine granular casts.Urine group Ⅲ:minor proteinuira,epithelial cells of tubule,granular/cell casts.The renal pathological lesions were predicted before and then con-firmed by renal biopsy.Statistical analyses were performed using kappa test,χ~2 test,and significance was accepted at P<0.05.Results:After renal biopsy,we identified 95 cases of glomerular lesion with pro-liferation,46 cases of glomerular disease without obvious proliferation and 5 cases of tubular interstitial lesion.According to the sediment analysis,only 67 cases(46%)could be attributed to urine group Ⅰ.When combined with urine protein,we could pick out another 75 cases from urine groups Ⅰ and Ⅱ,and 8 cases from urine group Ⅲ.The combined urine analysis could predict glomerular disease(77.7%).Conculsion:Clinically we can take advantage of the combined urine analysis to predict the pathological lesion of kidney disease,which is especially suitable for primary care doctor,who can not perform renal biopsy.