尿培养结合尿沉渣涂片镜检在诊断尿路感染的作用研究

The diagnosis of urinary tract infection via combining urine culture with urine sediment smear microscopy

目的分析尿培养结合尿沉渣涂片镜检在诊断尿路感染中的意义。方法收集本院2015年1月至7月期间住院患者1500例定量尿培养结果,回顾性分析与临床实际尿路感染判断的符合率。结果将镜下WBC纳入尿路感染实验诊断后,其与临床诊断的一致率均显著提高(P<0.05),特别是尿培养阴性、镜下也无WBC时判断尿路无感染时的符合率显著高于定量尿培养组(P<0.001),除此之外,镜下白细胞对判断临床送检标本是否合格也显著高于单纯尿培养判断标准;447例定量尿培养阳性疾病分布中的糖尿病合并心脑血管疾病、心脑血管疾病、肾病或肾移植组联合镜下WBC诊断尿路感染菌显著高于单纯定量尿培养组(P<0.05);826例定量尿培养阴性结果分析中的尿培养结合镜下无WBC联合诊断尿路感染的阴性符合率在各种基础疾病患者中均显著高于单纯尿培养阴性对无尿路感染的判断(P<0.05);227例定量尿培养污染结果分析中的心脑血管疾病、糖尿病合并心脑血管疾病和尿路结石等疾病的患者排除是否为污染时具有统计学差异(P<0.05)。结论单纯的定量尿培养结果对尿路感染判断有一定的局限性,尿培养结果结合尿沉渣涂片镜检结果更能准地反映临床的尿路感染。

Objective To analyze the significance of combining urine culture with urine smear microscopy in the diagnosis of urinary tract infection. Methods The urine culture results of 1500 inpatients in our hospital from January to July in 2015 were collected,and the rate of coincidence with clinical actual urinary tract infection was analyzed by medical records and doctor's orders. Results The concordance rate with clinical diagnosis of urinary tract infection were significantly increased via combining urine culture with urine smear microscopy(P<0.05);Especially,the negative urine culture with no WBC to determine the urinary tract with the absence of infection rate was significantly higher than that of the quantitative urine culture group(P<0.001);In addition,under the microscope of WBC to determine whether qualified clinical specimens was significantly higher than that of pure urine standard culture;Combined with microscopic WBC,urinary tract infection was significantly higher than the simple quantitative urine culture group among diabetes and cardiovascular disease,cerebrovascular disease,nephropathy or renal transplantation group(P<0.05);The coincidence rate of urine culture negative combined with WBC in the analysis of urine culture were significantly higher than those of urine culture negative groups among 826 cases of quantitative urine culture negative results(P<0.05);among 227 cases of contamination quantitative urine results,there was a statistical difference between the patients with cardiovascular and cerebrovascular diseases,diabetes mellitus,cardiovascular and cerebrovascular diseases(P<0.05). Conclusion There are some limitations to diagnosis urinary tract infection by simple quantitative urine culture,it could accurately reflect the clinical judgment method of urinary tract infection clinical by combining urine culture results with the result of urinary sediment smear results.