Value of routine urine test in diagnosis of systemic lupus erythematosus complicated with urinary tract infection
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摘要: 目的 探讨尿常规分析对系统性红斑狼疮(SLE)合并尿路感染(UTI)的临床诊断价值。方法 选取SLE患者116例, 根据是否合并UTI分为感染组(46例)和无感染组(70例), 收集所有患者年龄、性别、中段尿培养结果、尿常规、C反应蛋白(CRP)、SLE活动指数(SLEDAI)结果, 分析尿定量和定性指标对SLE合并UTI的诊断价值。结果 女性UTI发病率高于男性, 差异有统计学意义(P< 0.05)。46例感染患者共检出49株病原菌, 其中G-菌35株, 占71.43%, G+菌7株, 占14.29%, 真菌7株, 占14.29%。UTI患者临床表现以膀胱刺激症和发热为主。细菌计数预测SLE合并UTI患者的AUC为0.800(0.709~0.891), 最佳截断值为242.0个/μL, WBC计数预测SLE患者合并UTI的AUC为0.690(0.590~0.790), 最佳截断值为26.0个/μL, 联合细菌计数和白细胞(WBC)计数预测SLE患者合并UTI的AUC为0.862(0.784~0.940), AUC联合法>AUC细菌计数>AUCWBC计数, 差异均有统计学意义(均P< 0.05)。CRP与细菌计数、WBC计数、白细胞酯酶均呈正相关, SLEDAI与尿微量白蛋白/尿肌酐比值呈正相关。结论 SLE合并UTI发病率较高, 尿常规部分指标对UTI有较高的预测价值。Abstract: Objective To investigate the clinical diagnostic value of routine urine analysis in systemic lupus erythematosus(SLE) complicated with urinary tract infection(UTI).Methods A total of 116 SLE patients diagnosed and treated in our hospital were divided into infection group(46 cases) and non infection group(70 cases) according to whether they were complicated with UTI. The age, gender, midstream urine culture results, urine routine, C-reactive protein(CRP) and SLE activity index(SLEDAI) results of all patients were collected, and the diagnostic value of urine quantitative and qualitative indicators for SLE complicated with UTI was analyzed.Results The incidence of UTI in female patients was higher than that in males, and the difference was statistically significant(P< 0.05). A total of 49 strains of pathogens were detected in 46 SLE patients, including 35 strains of G- bacteria(71.43%), 7 strains of G+ bacteria(14.29%) and 7 strains of fungi(14.29%). The main clinical manifestations were bladder irritation and fever. The AUC of bacterial count in predicting UTI in SLE patients was 0.800(0.709-0.891), and the best cutoff value was 242.0/μL. The AUC of WBC count in predicting UTI in SLE patients was 0.690(0.590-0.790), and the best cutoff value was 26.0/μL. The AUC of combined bacterial count and WBC count in predicting UTI in SLE patients was 0.862(0.784-0.940). AUCcombined method>AUCbacterial count>AUC WBC count, the difference was statistically significant(allP< 0.05). CRP was positively correlated with bacterial count, WBC count and leukocyte, SLEDAI was positively correlated with ACR.Conclusion The incidence rate of SLE combined with UTI is higher, some indexes of urine routine test might have high predictive value for UTI.
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表 1 感染组患者中段尿培养结果
细菌类别 株数 构成比/% G-菌：大肠埃希菌 26 53.06 肺炎克雷伯菌 4 8.16 奇异变形杆菌 2 4.08 其他 3 6.12 G+菌：葡萄球菌 6 12.25 屎肠球菌 1 2.04 真菌 7 14.29 合计 49 100.00 
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表 2 感染组临床症状分析
临床症状 例数 构成比/% 发热 12 26.09 膀胱刺激征 26 56.52 发热+膀胱刺激征 4 8.70 无发热、无膀胱刺激征 4 8.70 合计 46 100.00
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表 3 不同指标对SLE合并UTI预测价值比较
检测方法 AUC差异 z P 细菌计数与WBC计数 0.110 3.961 0.002 联合法与细菌计数 0.062 2.525 0.028 联合法与WBC计数 0.172 4.578 < 0.001
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表 4 干化学指标对UTI诊断价值
中段尿培养 NIT LEU 感染提示 阳性 阴性 阳性 阴性 阳性 阴性 阳性 12 34 36 10 38 8 阴性 9 61 28 42 16 54 合计 21 95 64 52 54 62
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