尿沉渣法和尿干化学法结果在尿路感染诊断中的初筛价值研究

摘要

Objective To evaluate the preliminary screening value of bacterium(BACT),leukocyte count(WBC)detected by the UF-1000i urine sediment analyzer and nitrite(NIT)and leukocyte esterase(LEU)detected by the urine dry chemical dipstick analy-zer in diagnosing urinary tract infection(UTI).Methods A total of 346 inpatients or outpatients with suspected UTI in our hospital from July 2012 to June 2013 were performed the midstream urine culture.Among them,91 positive cases as the experimental group and 255 negative cases as the control group were simultaneously performed the urine dry chemical analysis and the urinary sediment analysis.The performance of the various indexes in screening UTI was evaluated with the bacterial culture results as the golden standard.Results The positive rates of NIT,LEU,WBC,BACT,NIT+LEU and WBC+BACT in the experimental group were significantly higher than those in the control group with the statistical differences between the two groups(P <0.05).The areas un-der the ROC curve for diagnosing UTI in NIT,LEU,WBC,BACT,NIT+LEU and WBC+BACT were 0.602,0.664,0.715, 0.770,0.713 and 0.760 respectively,95%CI was 0.530-0.675,0.603-0.725,0.655 -0.775,0.716 -0.824,0.651 -0.774 and 0.704-0.817 respectively;their sensitivity for diagnosing UTI was 0.26,0.86,0.79,0.74,0.86 and 0.85 respectively;The speci-ficity was 0.94,0.47,0.47,0.51,0.46 and 0.33 respectively;The positive likelihood ratio was 4.48,1.62,1.51,1.49,1.58 and 1.27 respectively;The negative likelihood ratio was 0.78,0.30,0.44,0.52,0.31 and 0.46 respectively;The positive predictive value was 0.62, 0.37,0.35,0.35,0.36 and 0.31 respectively;The negative predictive value was 0.78,0.90,0.86,0.84,0.90 and 0.86 respectively.Conclu-sion In the rapid screening of UTI,the indexes of NIT,LEU,WBC and BACT all have the higher negative predictive values.%目的：探讨 UF-1000i 尿沉渣分析仪细菌（BACT）及白细胞计数（WBC）、尿干化学分析仪亚硝酸盐（NIT）及白细胞酯酶（LEU）在尿路感染诊断中的初筛价值。方法选取该院2012年7月至2013年6月疑似尿路感染的住院或门诊患者346例进行中段尿培养，其阳性者91例为实验组，阴性者255例为对照组，同时进行干化学及尿沉渣分析，以细菌培养的结果作为金标准，评价各检测指标对尿路感染的筛检性能。结果实验组 NIT、LEU、WBC、BACT、NIT＋LEU、WBC＋BACT 阳性率均高于对照组，差异有统计学意义（P ＜0．05）。NIT、LEU、WBC、BACT、NIT＋LEU 和 WBC＋BACT 诊断尿路感染的 ROC 曲线下面积分别为0．602、0．664、0．715、0．770、0．713和0．760，95％CI 分别为0．530～0．675、0．603～0．725、0．655～0．775、0．716～0．824、0．651～0．774和0．704～0．817；NIT、LEU、WBC、BACT、NIT＋LEU 和 WBC＋BACT 诊断尿路感染的敏感性分别为0．26、0．86、0．79、0．74、0．86和0．85，特异性分别为0．94、0．47、0．47、0．51、0．46和0．33，阳性似然比分别为4．48、1．62、1．51、1．49、1．58和1．27，阴性似然比分别为0．78、0．30、0．44、0．52、0．31和0．46，阳性预测值分别为0．62、0．37、0．35、0．35、0．36和0．31，阴性预测值分别为0．78、0．90、0．86、0．84、0．90和0．86。结论在尿路感染快速筛查中，NIT、LEU、WBC、BACT 都具有较高的阴性预测值。