Correlation analysis of urobilirubin and urine cast in hospitalized patients with liver disease
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摘要: 目的 收集肝病住院患者的尿常规结果，分析尿胆红素(BIL)与管型(CAST)之间的相关性，并探讨尿BIL阳性作为尿液分析的显微镜复检规则的临床意义。方法 选取352例2022年9月—12月华中科技大学附属协和医院的肝病住院患者的尿常规结果做回顾性分析。研究组300例，根据尿BIL结果将其分为2组，尿BIL阳性组73例，尿BIL阴性组227例。验证组52例，其尿BIL为阳性。显微镜复检规则一：干化学检测的隐血(BLD)、白细胞酯酶(LEU)和蛋白(PRO)与对应的尿流式检出的红细胞(RBC)、白细胞(WBC)、CAST结果不符以及PRO干化学阳性；复检规则二：干化学检测的BLD、LEU和PRO与对应的尿流式检出的RBC、WBC、CAST结果不符、PRO干化学阳性以及尿BIL阳性。收集研究组和验证组患者的相关生化检测和尿常规结果，分析尿BIL与CAST的相关性，评估各复检规则的CAST检测准确性。结果 ① 尿BIL阳性组的血总胆红素(TBIL)、血直接胆红素(DBIL)、尿RBP、尿β2-微球蛋白(β2-MG)和CAST阳性率依次为166.00(90.60，296.30) μmol/L、87.20(45.10，159.95) μmol/L、0.12(0.10，0.41) mg/L、0.24(0.10，1.00) mg/L和52.05%，均高于尿BIL阴性组(Z/χ2=-10.693、-10.158、-4.419、-2.542、22.35，P＜0.001、＜0.001、＜0.001、0.011、＜0.01)，差异有统计学意义；血尿氮素、血肌酐分别为4.19(3.10，6.70) mmol/L、66.50(52.25，76.15)μmol/L，与尿BIL阴性组比较差异无统计学意义(Z=-0.254、-0.899，P=0.800、0.369)。②单变量分析结果显示尿BIL阳性可有效预测CAST阳性[OR(95%CI)3.614(2.069~6.312)，P＜0.01]。③分别以尿PRO干化学阳性、UF-5000i计数CAST阳性、规则一、规则二为复检规则。4个规则对研究组的CAST假阴性率依次为15.33%、21.00%、12.67%和9.33%，对尿BIL阳性组的CAST假阴性率依次为19.18%、39.72%、13.70%和0；规则二对尿BIL阳性组的CAST假阴性率显著低于规则一(χ2=10.74，P＜0.01)，差异有统计学意义。④验证组的CAST阳性率为32.68%，规则二的CAST假阴性率显著低于规则一(0 vs 21.15%)，差异有统计学意义(χ2=12.30，P＜0.01)。结论 肝病患者的尿BIL阳性可用于预测CAST阳性，在现有的显微镜复检规则[干化学和尿流式检出的RBC、WBC、PRO(对应尿流细胞法的CAST)结果不相符合以及尿PRO干化学阳性]的基础上增加尿BIL阳性作为复检规则，可显著降低尿BIL阳性的肝病患者的CAST漏检。Abstract: Objective To collect the routine urinalysis results of hospitalized liver disease patients, study the correlation between urobilirubin and urine cast, and further assess the accuracy of positive urobilirubin as a new microscopic review rule for urinalysis.Methods A total of 352 hospitalized liver disease patients were selected as study group from Wuhan Union hospital during September, 2022 to December, 2022.A total of 300 patients were selected as study group and divided as 2 subgroups according to the results of urobilirubin: one group included 73 samples with positive urobilirubin and another group included 227 samples with negative urine urobilirubin. Fifty-two inpatients with positive urobilirubin were selected as verification group. Two microscope review rules were defined. Rule one: if any of WBC, RBC, PR0/CAST were different between the dry chemical system and urine sediments analyzer and the urine protein was positive by dry chemical analysis. Rule two: if any of WBC, RBC, PR0/CAST were different between the dry chemical system and urine sediments analyzer, the urine protein was positive by dry chemical analysis and urobilirubin was positive. We collected data about the liver function results, renal function results and the routine urinalysis results of the two groups.Results ① The serum TBIL, DBIL, urine RBP, urine β2-MG and cast positive rate of the group with positive urobilirubin were 166.00(90.60, 296.30) μmol/L, 87.20(45.10, 159.95) μmol/L, 0.12(0.10, 0.41) mg/L, 0.24(0.10, 1.00) mg/L and 52.05%, all higher than those of the group with negative urobilirubin(Z/χ2=-10.693, -10.158, -4.419, -2.542, 22.35, P < 0.001, < 0.001, < 0.001, 0.011, < 0.01), the serum BUN and Cr were 4.19(3.10, 6.70) mmol/L and 66.50(52.25, 76.15) μmol/L and were not different with those of the group with negative urobilirubin(Z=-0.254, -0.899, P=0.800, 0.369). ②On univariate analysis, a positive urobilirubin result was found to be a significant predictor of urine cast(OR[95%CI] 3.614[2.069-6.312], P < 0.01).③Four protocols were used: positive urine protein by dry chemical method, positive cast result by UF-5000i, rule one and rule two. As for the study group, the false negative rates of cast were 15.33%, 21.00%, 12.67% and 9.33% respectively. As for patients with positive urobilirubin, the false negative rates of cast were 19.18%, 39.72%, 13.70% and 0 respectively. The false negative rate of cast of the patients with positive urobilirubin by rule two was significantly lower than that of rule one(χ2=10.74, P < 0.01). ④ The positive cast rate of verification group was 32.68% and the false negative rate of cast by rule two were significantly lower than that of rule one(0 vs 21.15%, χ2=12.30, P < 0.01).Conclusion As for the hospitalized liver disease patients, positive urobilirubin could be used to predict urine cast and we recommended that the positive urobilirubin should be considered as a rule of microscopic review of urinalysis to decrease the false negative rate of cast detection of the hospitalized liver disease patients with positive urobilirun.
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Key words:
- liver disease /
- urobilirubin /
- urinalysis /
- chemistry analytical /
- microscopy /
- autoanalysis
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表 1 研究组患者的部分实验室检查结果分析
类型 尿BIL阳性组(73例) 尿BIL阴性组(227例) Z/χ2 P 血TIL/(μmol/L) 166.00(90.60，296.30) 16.80(12.60, 29.30) -10.693 ＜0.001 血DBIL/(μmol/L) 87.20(45.10，159.95) 8.10(4.10，15.95) -10.158 ＜0.001 血BUN/(mmol/L) 4.19(3.10，6.70) 4.70(3.70，6.10) -0.254 0.800 血Cr/(μmol/L) 66.50(52.25，76.15) 65.00(52.20，80.80) -0.899 0.369 尿RBP/(mg/L) 0.12(0.10，0.41) 0.10(0.10，0.11) -4.419 ＜0.001 尿β2-MG/(mg/L) 0.24(0.10，1.00) 0.10(0.10，0.30) -2.542 0.011 尿CAST/例(%) 38(52.05) 52(22.91) 22.350 ＜0.010 
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表 2 研究组的CAST检测准确性分析
n=300, 例(%) 复检方案 复检率 真阳性率 真阴性率 假阳性率 假阴性率 尿PRO干化学阳性 112(37.33) 44(14.67) 142(47.33) 68(22.67) 46(15.33) UF-5000i计数CAST阳性 64(21.33) 27(9.00) 173(57.67) 37(12.33) 63(21.00) 规则一 137(45.67) 52(17.33) 125(41.67) 85(28.33) 38(12.67) 规则二 163(54.33) 62(20.67) 109(36.33) 101(33.67) 28(9.33)
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表 3 尿BIL阳性组的CAST检测准确性分析
n=73, 例(%) 复检方案 复检率 真阳性率 真阴性率 假阳性率 假阴性率 尿PRO干化学阳性 41(56.16) 24(32.88) 18(24.66) 17(23.29) 14(19.18) UF-5000i计数CAST阳性 14(19.18) 9(12.33) 30(40.10) 5(6.85) 29(39.72) 规则一 47(64.38) 28(38.36) 16(21.92) 19(26.03) 10(13.70) 规则二 73(100.00) 38(52.05) 0 35(47.95) 0
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表 4 尿BIL阴性组的CAST检测准确性分析
n=227, 例(%) 复检方案 复检率 真阳性率 真阴性率 假阳性率 假阴性率 尿PRO干化学阳性 71(31.28) 19(8.37) 123(54.19) 52(22.91) 33(14.54) UF-5000i计数CAST阳性 46(20.26) 15(6.61) 144(63.44) 31(13.66) 37(16.30) 规则一 90(39.65) 24(10.57) 109(48.02) 66(29.07) 28(12.33) 规则二 90(39.65) 24(10.57) 109(48.18) 66(29.07) 28(12.33)
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表 5 验证实验结果分析
n=52, 例(%) 规则 复检率 真阳性率 真阴性率 假阳性率 假阴性率 规则一 21(40.38) 6(11.54) 20(38.46) 15(28.85) 11(21.15) 规则二 52(100.00) 17(52.38) 0 35(47.61) 0
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