尿沉渣评分对急性肾损伤诊断的临床应用研究

Research on clinical application of urine sediment score in the diagnosis of acute kidney injury

目的:评估尿沉渣评分(USS)在急性肾损伤(AKI)的早期诊断、病因鉴别、分期及预后判断中的临床应用,探讨独立的USS及其联合血尿素氮(Bun)、血清肌酐(sCr)和尿酸(UA)对AKI的诊断效能。方法:收集2023年8月23日至9月28日期间吉林大学第一医院住院患者9020份晨尿标本,经Sysmex UF5000检测,筛出小而圆形上皮细胞(SRC)>1/μl和/或管型(CAST)>1/μl 3226份进行尿沉渣镜检,选取肾小管上皮细胞和/或CAST阳性的404例入组,其中男218例,女186例,年龄59.5(49.0,71.0)岁。404例分组方法:依据镜检结果的USS分为USS AKI组(345例)和USS非AKI组(59例);依据改善全球肾脏病预后组织(KDIGO)标准,分为KDIGO标准AKI组(63例)和KDIGO标准非AKI组(341例);依据病历记载的临床诊断,分为临床诊断AKI组(29例)和临床诊断非AKI组(375例);通过查阅病历,对KDIGO标准AKI组按病因分为肾性AKI组(33例)和非肾性AKI组(30例)。采用χ^(2)检验或Fisher精确检验比较不同AKI病因、分期的USS。采用Logistic回归法计算发生肾性AKI及3期AKI的优势比。应用受试者工作特征曲线下面积评价USS、sCr、UA、Bun单独及联合诊断AKI的敏感度、特异度并计算诊断AKI的最佳截断值、敏感度与特异度。结果:以USS对KDIGO标准AKI组进行病因鉴别,肾性与非肾性AKI的USS比较差异有统计学意义(χ^(2)=11.070,P<0.001)。与USS=1相比,当USS≥2分时肾性AKI的优势比为8.125(95%CI 2.208~29.901)。以USS进行AKI分期研究,各期USS的组间比较差异有统计学意义(χ^(2)=15.724,P<0.05)。与USS=1分相比,当USS≥2分时发生3期AKI优势比为9.714(95%CI 1.145~82.390)。独立的USS诊断AKI的AUC为0.687(95%CI 0.618~0.757,P<0.001),特异度65.7%,敏感度61.9%;USS联合Bun、sCr、UA诊断AKI的AUC为0.794(95%CI 0.608~0.980,P<0.05),特异度82.4%,敏感度88.9%。结论:USS≥2分提示发生肾性AKI或3期AKI的可能性增加,USS联合Bun、sCr、UA可提高AKI诊断效能。

Objective To evaluate the clinical application of urine sediment score(USS)in early diagnosis,etiological differentiation,staging and prognosis of acute kidney injury(AKI),and to investigate the diagnostic efficacy of independent USS and its combination with blood urea nitrogen(Bun)serum creatinine(sCr)and uric acid(UA)in AKI.Methods From August 23 to September 28,2023,9020 morning urine samples of hospitalized patients in the First Hospital of Jilin University were detected by Sysmex UF5000.A total of 3226 ssamples with small and round cell(SRC)>1/μl and/or CAST>1/μl were screened for microscopic examination,and 404 cases with positive renal tubular epithelial cells and/or cast were enrolled in this study.There were 218 males and 186 females,aged 59.5(49.0,71.0)years.The 404 cases were divided into the USS AKI group(345 cases)and the USS non-AKI group(59 cases)according to the USS results based on the microscopic findings.According to Kidney Disease:Improving Global Outcomes(KDIGO)criteria,they were divided into KDIGO criteria AKI group(63 cases)and KDIGO criteria non-AKI group(341 cases),and the AKI group was divided into renal AKI group(33 cases)and non-renal AKI group(30 cases).According to the clinical diagnosis recorded in the medical records,they were divided into clinically diagnosed AKI group(29 cases)and clinically diagnosed non-AKI group(375 cases).Theχ^(2)test or Fisher exact test was used to compare USS in different AKI causes and stages.Logistic regression was used to calculate the odds ratio of renal AKI and stage 3 AKI.The area under the receiver operating characteristic curve was used to evaluate the sensitivity and specificity of USS,sCr,UA and Bun alone and in combination in the diagnosis of AKI,and the best cut-off value,sensitivity and specificity in the diagnosis of AKI were calculated.P<0.05 was considered statistically significant.Results The USS was used to identify the etiology of KDIGO standard AKI group,and there were significant differences in USS between renal AKI group and non-renal AKI group(χ^(2)=11.070,P<0.001).Compared to USS=1,the odds ratio of renal AKI was 8.125 when USS≥2(95%CI 2.208—29.901).There was a statistically significant difference in the comparison of USS between groups in each stage of the AKI staging study based on USS(χ^(2)=15.724,P<0.05).Compared to USS=1,the odds ratio of stage 3 AKI was 9.714 when USS≥2(95%CI 1.145-82.390).The AUC of independent USS in the diagnosis of AKI was 0.687(95%CI 0.618-0.757,P<0.001),the specificity was 65.7%and the sensitivity was 61.9%.The AUC of USS combined with Bun,sCr,UA in the diagnosis of AKI was 0.794(95%CI 0.608-0.980,P<0.05),the specificity was 82.4%,and the sensitivity was 88.9%.Conclusions There wasan increased likelihood of renal AKI or stage 3 AKI while USS≥2,and whose combination with Bun,sCr and UA will improve the diagnostic efficiency of AKI.