UF-1000i伞自动尿液分析仪筛查尿路感染和区分细菌种类的评价

Performance Evaluation of Screening of Urinary Tract Infection and Distinguishing the Bacteria Species

目的 为尿路感染快速诊断和避免临床经验性治疗中抗生素药物的滥用提供参考.方法 自2011年11月～2012年6月收集临床疑似尿路感染、进行尿培养的尿标本1 370份,通过UF-1000i尿细菌通道参数（B-FSC和1DFLH）和尿中有形成分的检测与尿液细菌培养结果作比较分析,得到尿路感染诊断的最佳临界值并对该数值进行诊断性能的评价.结果 ①G的B-FSC明显低于G（t=2.672,P=0.007）,故细菌参数B FSC在区别革兰阳性菌和阴性菌种类方面的诊断性能优于B-FLH.②分别以B FSC＜35 ch,DFSC/DFLH＜ 0.4为临界值,判断革兰阴性菌的灵敏度为73.4％和91.8％,特异度为78.9％和93.1％,阳性预测值为95.7％和97.4％,阴性预测值为74.7％和91.9％.③所有人以细菌计数532.7个/μl,白细胞68.5个/μl为临界值以及联合应用细菌和白细胞诊断尿路感染的灵敏度为77.5％,70.1％和92.2％;特异度为94.4％,83.3％和80.5％;阳性预测值为93.2％,80.7％和82.5％;阴性预测值为85.1％,75.6％和91.2％.④男性当细菌计数和白细胞临界值设为383.8个/μl和49.8个/μl及联合应用细菌和白细胞临界值诊断尿路感染的敏感度为80.7％,72.7％和92.8％,特异度为96.2％,92.6％和83.3％;阳性预测值为88.6％,80％和84.7％;阴性预测值为82.0％,89.9％和92.4％;女性当细菌计数和白细胞临界值设为863.1个/μl和90.1个/μl及联合应用细菌和白细胞临界值诊断尿路感染的灵敏度为83.3％,76.9％和93.3％;特异度为99.6％,84.4％和84.6％;阳性预测值为95.9％,76.3％和85.8％;阴性预测值为74.9％,89.2％和93.6％.结论 ①DFSC区分革兰阳性菌和阴性菌种类优于DFLH.②DFSC/DFLH＜0.4区分革兰阴性菌和阳性菌优于DFSC＜35ch.③诊断尿路感染,应以不同性别设置细菌计数和白细胞数的最佳临界值.④细菌参数相对尿白细胞和细菌计数在尿路感染诊断中效果更优.

Objective To provide reference for the rapid diagnosis of urinary tract infection and avoid the abuse of antibiotics in clinical empiric treatment.Methods 1 370 urine samples of clinically suspected urinary tract infection and performed urineculture were collected from November 2011 to June 2012.The urinary bacterial channel parameters （B FSC and B FLH） and the urine visible components were detected by the UF 1000i urine analyzer,Their detected results and the urine bacterial culture results were performed the comparative analysis for getting the best threshold values of the diagnosis of urinary tract in fection and evaluate their the diagnostic performance.Results ①The bacterial parameters BFSC of G was obviously lower than G,（t=2.672,P=0.007）,so,the DFSC was better than DFLH in the diagnosis performance of differencing Grampositive bacteria and Gram negative bacteria species.②With the B FSC＜35ch and B FSC/B FLH＜0.4 as the critical values to determine Gram negative bacteria,the sensitivity was 73.4 ％ and 91.8 ％ ;the specificity was 78.9 ％ and 93.1 ％,respectively;the positive predictive value of 95.7％ and 97.4％ ; negative predictive value of 74.7％ and 91.9％,respectively.③ With the bacterial count 532.7/μl and leukocyte 68.5/μl as the critical values and their combination detection,the sensitivity for the diagnosis of urinary tract infection was 77.5％,70.1％ and 92.2％ ;the specificity was 94.4％,83.3％ and 80.5％,respectively;the positive predictive value of 93.2％,80.7％ and 82.5％ ; negative predictive value of 85.1％,75.6％ and 91.2％,respectively.④The male when bacteria count and WBC critical value in male were set as 383.8/μl and 49.8/μl and their combination application,the sensitivity for diagnosing urinary tract infection was 80.7 ％,72.7 ％ and 92.8 ％,respec tively.The specificity of 96.2 ％,92.6 ％ and 83.3 ％,respectively; the positive predictive value of 88.6 ％,80 ％ and 84.7 ％,and the negative predictive value of 82％,89.9％ and 92.4％,respectively; when the bacteria count and WBC critical value was set as 863.1/μl and 90.1/μl and the combination application,the sensitivity in the diagnosis of urinary tract infection was 83.3 ％,76.9 ％ and 93.3 ％,respectively.The specificity of 99.6 ％,84.4 ％ and 84.6 ％,the positive predictive value of 95.9％,76.3％ and 85.8％,respectively.The positive predictive value of 95.9％,76.3％,85.8％ and negative predictive value of 74.9％,89.2％ and 93.6％,respectively.Conclusion ①B-FSC was better than B-FLH in differentiating Gram-positive and Gram negative bacteria.②B-FSC/B-FLH＜0.4 for distinguishing Gram positive and Gram negative bacteria was better than B FSC＜35ch.③Using the bacteria count and WBC count in diagnosis of urinary tract infection should set the optimal critical values of them according to different sexes.④The bacterial parameters have better effect than WBC count and bacterial count in the diagnosis of urinary tract infection.