Sysmex UF-1000i尿流式分析仪检测住院患者尿标本类酵母菌的临床评价

Clinical application assessment of urine flow cytometer Sysmex UF-1000i in detecting yeast-like fungi of urine specimen of inpatients

目的评价Sysmex UF-1000i尿流式分析仪检测尿标本类酵母菌的分析性能。方法应用尿流式分析仪检测我院住院患者尿标本,对仪器检测类酵母菌阳性尿标本进行镜检、培养鉴定;同时随机选择同期仪器检测阴性标本作对照。结合临床,判断患者尿路类酵母菌定植或感染。结果 2010年10月-2010年12月间共检测6019份尿标本,尿流式分析仪检测类酵母菌阳性127份,经培养证实82份为真阳性。同期仪器检测阴性标本121份中有12份培养阳性。以培养作为金标准,尿流式分析仪分析尿中类酵母菌试验敏感性为87.23%、特异性为70.78%、准确度为77.02%、阳性预测值为64.57%,阴性预测值为90.08%。菌种前三位的是以光滑念珠菌(43.40%)、白念珠菌(21.69%)、热带念珠菌(14.15%)。阿萨希毛孢子菌也存在一定比例(5.66%)。尿中类酵母菌真阳性患者多数患有多种基础疾病,以2型糖尿病(25.61%)、慢性泌尿系统疾病(18.29%)和颅脑脊髓损伤(17.07%)为主;实施的医疗措施以抗细菌药物(52.44%)、留置导尿管(35.37%)多见(P<0.05)。尿流式分析仪检测阴性而培养阳性12例患者均为尿路念珠菌定植。尿流式分析仪检测阳性并且培养阳性82例患者中,69例(84.15%)为类酵母菌尿路定植;13例(15.85%)为尿路感染,其中1(1.22%)例发展为热带念珠菌血症。结论 Sysmex UF-1000i尿流式分析仪对尿标本类酵母菌有较强的筛查价值。实验室应对仪器类酵母菌检测阳性标本进行镜检后确认。临床医师应对类酵母菌检测阳性患者结合其临床表现,采取不同的治疗措施。

Objective To assess performance of urine flow cytometer Sysmex UF-1000i in detecting yeast-like fungi in urine specimen.Methods Yeast-like fungi in urine of inpatients was detected by urine flow cytometer Sysmex UF-1000i.The yeast-like fungi positive urine specimen was checked by microscopy and cultured by CHROMagar medium,and the yeast-like fungi negative urine specimen was selected randomty in the corresponding periods as control.Yeast-like fungi colonization or infection for the inpatients was diagnosed by combination of clinical manifestation.Results 127 were positive for yeast-like fungi in 6019 urine specimens of inpatients for detecting at October to December,2010.Among them,82 were true positive for yeast-like fungi certificated by culture.And among of the 121 negative controls,12 were positive for yeast-like fungi by culture.The results of yeast-like fungi detection by urine culture as ＂gold standard＂,the susceptibility,specialty,accuracy,positive predictive value,and negative predictive value for the test of yeast-like fungi detection by urine flow cytometer Sysmex UF-1000i were 87.23%,70.78%,77.02%,64.57%,and 90.08%,respectively.The top 3 yeast-like fungi were Candida glabrata（43.40%）,Candida albicans（21.69%） and Candida tropicalis（14.15%）.Trichosporon asahii（5.66%） were also isolated from urine.Most of the inpatients for yeast-like fungi true positive urine had multiple underlying diseases,including type 2 diabetes mellitus（25.61%）,chronic urinary tract disease（18.29%）,and craniocerebral and/or spinal injury（17.07%）.The main predisposing factors were antibiotic therapy（52.44%） and indwelling urinary catheter（35.37%）,P〈0.05.Among of 82 inpatients for true positive for yeast-like fungi in urine,69（84.15%） were defined as yeast-like fungi colonization in urine,13 were as infection by yeast-like fungi,and 1（1.22%） developed candidemia by Candida tropicalis.However,12 negative for yeast-like fungi in urine detected by Sysmex UF-1000i but positive by culture were diagnosed as colonization.Conclusion Urine flow cytometer Sysmex UF-1000i have stronger screening function for yeast-like fungi in urine specimen.The positive urine specimen for yeast-like fungi must be checked by microscope.And clinician should combine the results of laboratory and clinical manifestation to decide to different measure.