尿沉渣谱与肾病理类型的相关性

Correlation between urinary sediment spectra and pathological patterns of renal biopsies

目的:探讨无创检查的尿沉渣谱在判断肾疾病病理类型中的临床应用价值。方法:采集北京大学第一医院肾内科住院患者肾活检日晨尿标本1 140对份:(1)位相差显微镜检查尿沉渣。(2)尿蛋白定量(g/24 h)。(3)尿沉渣谱分型:尿沉渣结合蛋白定量后分4型,Ⅰ型:血尿为主,多细胞及管型;Ⅱ型:蛋白尿为主,少细胞,透明-细颗粒管型;Ⅲ型:有核细胞为主,少量蛋白和有核细胞管型;Ⅳ型:非特异尿沉渣和少量蛋白。(4)肾病理类型分类:根据肾活检的病理特点和病变部位,将肾疾病分为三大类:肾小球增殖性病变、肾小球非增殖性病变和肾小管间质病变。(5)比较各种肾疾病的尿沉渣谱类型及特点,将尿沉渣谱类型与肾组织病理诊断进行对应性分析。(6)统计学处理:采用秩和检验和χ2一致性检验,P<0.05差异有统计学意义。结果:(1)840例行肾活检组织病理诊断显示:肾小球增殖性病变419例,肾小球非增殖性病变375例,肾小管间质病46例。(2)肾病理类型与尿沉渣谱相关,肾小球增殖性病变84%呈Ⅰ型尿沉渣谱,肾小球非增殖性病变93.1%呈Ⅱ型尿沉渣谱,肾小管间质病变67.4%呈Ⅲ型尿沉渣谱。(3)将300对份尿沉渣谱与肾组织病理类型进行对应性分析显示:Ⅰ型尿沉渣谱与肾小球增殖性疾病符合率84.8%,Ⅱ型尿沉渣谱与肾小球非增殖性疾病符合率86.0%,Ⅲ型尿沉渣谱与肾小管间质病符合率73.7%。结论:尿沉渣谱对于判断肾疾病的病理类型具有临床应用价值。

Objective：To investigate the clinical value of urinary sediment analysis,a non-invasive diagnostic means,in the evaluation of pathological patterns of renal diseases.Methods：A total of 1 140 pairs of matched renal biopsies and fresh fasting morning urine specimens were collected from hospitalized patients in Peking University First Hospital.Their urinary sediments were examined with phase-contrast microscopy; the 24 h urine proteins were measured.Based on urinary sediment features combined with urine protein amount,the spectra of the urine sediments were classified into four types,Type Ⅰ：hematuria-dominant,with multiple cells and casts; Type Ⅱ：proteinuria-dominant,with hyaline or finegranular casts but scanty cells; Type Ⅲ：renal tubular epithelial cell（RTEC）-dominant,minor proteinuria ; Type Ⅳ：non-specificurine sediments,minor proteinuria.According to the pathological lesions detected in renal biopsies,the renal diseases were classified into three patterns：proliferative glomerulopathy （P-GP）,non-proliferative glomerulopathy （NP-GP） and tubulointerstitial nephropathy （TIN）.The urinary sediment spectra of different pathological patterns and the correlation between urinary sediment types and pathological patterns were analyzed.Statistical analyses were performed using kappa test,and x2test,and significance was accepted at P ＜ 0.05.Results：（1） Of the 840 cases of matched urine samples and renal biopsies,419 cases were diagnosed with P-GP; 375 cases with NP-GP; 46 cases with TIN respectively.（2） The spectra of urine sediments were associated with pathological patterns of the renal biopsies,and 84.0％ of the patients with P-GP manifested type Ⅰ urine sediments; 93.1％ of the patients with NP-GP had type Ⅱ urine sediments; 67.4％ of the patients with TIN had type Ⅲ urine sediments.（3） The correlation between the urinary sediment types and renal pathological patterns was validated in an additional 300 matched samples.The positive predictive values of urinary sediment spectra in predicting renal pathological lesions were 84.8％ for type Ⅰ to P-GP,86.0％ for type Ⅱ to NP-GP and73.7％ for type Ⅲ to TIN,respectively.Conclusion：As a non-invasive diagnostic means,the urinary sediment analysis is valuable in the evaluation of pathological patterns of renal diseases.