多种尿液检测方法对尿路感染诊断价值的meta分析

doi:10.3969/j.issn.1004-583X.2016.01.024

摘要/Abstract

摘要： 目的采用Meta方法对比多种尿液分析检测方法在尿路感染诊断中的价值,检查方法包括细菌培养、尿沉渣镜检、尿液分析仪、尿液常规干化学法对细菌、白细胞、红细胞等。方法检索论文数据库PubMed、EMbase、Cochrane library、Springerlink、CNKI、万方数据库,检索时限为数据库建库至2014年12月,由两名系统评价员按照纳入排除标准对文献质量进行独立筛选,采用RevMan5.3、Meta-DiSc对纳入研究的文献进行分析,计算合并敏感度(Sen)、特异度(Spe)、阳性似然比(LR⁺)、阴性似然比(LR^-)、诊断比值比(DOR)、绘制SROC曲线。结果 ①按照纳入、排除标准最终纳入14篇文献,共9 518例患者(12 560例次);②尿液白细胞检测以尿沉渣镜检为金标准,尿常规干化学法检测AUC为0.9656、综合Sen为0.845(0.805,0.879)、综合Spe为0.944(0.929,0.957);尿液分析仪检测AUC为0.8983,综合Sen为0.631(0.591,0.669),综合Spe为0.929(0.911,0.944);③尿液红细胞检测以尿沉渣镜检为金标准,尿液常规干化学法检测AUC为0.9306、综合Sen为0.590(0.572,0.608),综合Spe为0.948(0.938,0.956);尿液分析仪检测AUC为0.7319,综合Sen为0.473(0.433,0.513),综合Spe为0.971(0.958,0.980);④尿液细菌检测以细菌培养为金标准,尿液分析仪AUC为0.9048,综合Sen为0.842(0.811,0.870),综合Spe为0.881(0.865,0.896)。结论在尿路感染白细胞、红细胞的检查中,尿液常规干化学法在AUC、Sen、Spe方面均优于尿液分析仪,在尿液白细胞、红细胞的检测中具有优势;尿液分析仪在尿液细菌检查诊断价值较高,同时较细菌培养周期短,可推荐用于尿液细菌的筛选,但Sen、Spe均在0.9以下,如需确诊还需要结合细菌培养。

关键词: 泌尿道感染, meta分析, 细菌培养, 尿沉渣镜检, 尿液分析仪, 尿液常规干化学法

Abstract: Objective To compare the value of multiple urine detection methods in urinary tract infection by Meta analysis, including bacterial culture, urinary sediment microscopic examination, urine analyzer and routine urine dry chemical method for bacteria, white blood cell and red blood cell.Methods The papers were retrieved from PubMed, EMbase, Cochrane library, Springerlink, CNKI and Wanfang database, with the time limit of retrieval from the establishment of database to December, 2014. Two system evaluators performed independent screening for the quality of references according to the inclusion and exclusion criteria in references. RevMan 5.3 and Meta-DiSc were adopted for reference analysis. The combination sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR⁺), negative likelihood ratio (LR^-) and diagnosis odds ratio (DOR) were calculated, and SROC curve was drawn.Results ① 14 references were included finally (the information of 9 518 patients in total) according to the inclusion and exclusion criteria ; ② urine while blood cell were detected by urinary sediment microscopic examination as the golden standard; according to the detection by the routine urine dry chemical method, the AUC (area under the curve) of SROC is 0.9656, the comprehensive sensitivity was 0.845 (0.805,0.879), and the comprehensive specificity 0.944(0.929,0.957); according to the detection by the urine analyzer, the AUC of SROC was 0.8983, the comprehensive sensitivity 0.631 (0.591,0.669), and the comprehensive specificity 0.929 (0.911,0.944); ③ urine red blood cell was detected by urinary sediment microscopic examination as the golden standard; according to the detection by the routine urine dry chemical method, the AUC of SROC was 0.9306, the comprehensive sensitivity 0.590 (0.572,0.608), and the comprehensive specificity 0.948 (0.938,0.956); according to the detection by the urine analyzer, the AUC of SROC was 0.7319, the comprehensive sensitivity 0.473 (0.433,0.513), and the comprehensive specificity 0.971 (0.958,0.980); ④ Urine bacteria were detectedby bacterial culture as the golden standard; according to the urine analyzer, the AUC of SROC curve fitting was 0.9048, the comprehensive sensitivity 0.842 (0.811,0.870), and the comprehensive specificity 0.881 (0.865,0.896).Conclusion In the examination of white blood cell and red blood cell under urinary tract infection, the routine urine dry chemical method was superior to urine analyzer in terms of AUC, sensitivity and specificity. In the urine bacterial examination, urine analyzer had higher diagnostic values and a shorter period of bacterial culture. Therefore, urine analyzer was recommended for screening of urine bacteria. However, in order to make a definite diagnosis, it was necessary for the combination of bacterial culture.

Key words: urinary tract infections, meta-analysis, bacterial culture, urinary sediment microscopic examination, urine analyzer, routine urine dry chemical method

中图分类号:

R691.3

王鹏, 罗春华, 陈童, 王娟. 多种尿液检测方法对尿路感染诊断价值的meta分析[J]. 临床荟萃, 2016, 31(1): 92-99.

Wang Peng, Luo Chunhua, Chen Tong, Wang Juan. Meta analysis on diagnostic value of multiple urine detection methods for urinary tract infection[J]. Clinical Focus, 2016, 31(1): 92-99.

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https://huicui.hebmu.edu.cn/CN/Y2016/V31/I1/92

参考文献

[1] Whiting P,Rutjes AW,Reitsma JB,et al. The development of QUADAS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews[J]. BMC Med Res Methodol,2003,3:25.
[2] Higgins JPT,Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration,2011[EB/OL]. http://www.cochrane- handbook.org.
[3] 龙洪森, 谭浩. UF-1000i全自动尿沉渣分析仪检测尿红细胞白细胞的性能评价[J]. 实用医技杂志, 2012,19(8):794-797.
[4] 徐新, 罗春丽, 蒲军, 等. 干化学法尿隐血检测的可靠性分析[J]. 重庆医学, 2012,41(18):1802-1804.
[5] 孙士欣, 陈建魁, 于农, 等. 尿沉渣人工显微镜镜检红细胞、白细胞与尿液干化学分析仪的结果比较分析[J]. 国际检验医学杂志, 2012,33(14):1729-1730.
[6] 杨珊珊, 王崇德. 尿干化学检测红细胞与镜检红细胞结果对比分析[J]. 检验医学与临床, 2012,9(19):2496-2497.
[7] 甘立新. 尿液白细胞、红细胞干化学法检查与镜检不一致性分析[J]. 检验医学与临床, 2012,9(2):234-235.
[8] 罗海霞. 干化学法联合沉渣镜检检测尿液红细胞和白细胞的比对研究[J]. 检验医学与临床, 2011,8(8):964-965.
[9] 李霞. 干化学法对尿液红细胞和白细胞筛查作用的分析[J]. 临床输血与检验, 2009,11(3):217-219.
[10] Roggeman S, Zaman Z. Safely reducing manual urine microscopy analyses by combining urine flow cytometer and strip results[J]. Am J Clin Pathol, 2001,116(6):872-878.
[11] Ben-Ezra J, Bork L, McPherson R A. Evaluation of the Sysmex UF-100 automated urinalysis analyzer[J]. Clin Chem, 1998,44(1):92-95.
[12] Chien T, Kao J, Liu H, et al. Urine sediment examination: a comparison of automated urinalysis systems and manual microscopy[J]. Clinica Chimica Acta, 2007,384(1/2):28-34.
[13] Pancholi P, Pavletich K, Della-Latta P. Rapid screening of urine specimens for bacteriuria by the cellenium system[J]. J Clin Microbiol, 2005,43(10):5288-5290.
[14] 邓金平, 谢波. 尿细菌培养与尿沉渣细菌定量计数筛查泌尿系统感染的临床比较分析[J]. 中华医院感染学杂志, 2014,(20):5195-5197.
[15] 李家华, 苏文锦, 杨艾华. 尿沉渣白细胞及细菌定量计数联合检测与尿细菌培养诊断尿路感染对比分析[J]. 中国卫生产业, 2013,11(4):155.
[16] 木克代斯, 阿孜古力, 卡米拉. 尿化学分析与尿细菌培养在泌尿系感染中的意义[J]. 海南医学, 2010,21(23):117-118.
[17] Devill WL, Buntinx F, Bouter LM, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines[J]. BMC Medical Research Methodology, 2002, 2: 9.
[18] 张俊, 徐志伟, 李克. 诊断性试验Meta分析的效应指标评价[J]. 中国循证医学杂志, 2013,13(7):890-895.
[19] 曾宪涛, 李胜, 雷晋, 等. Review Manager 5软件在诊断准确性试验的Meta分析中的应用[J]. 湖北医药学院学报, 2013,32(1):6-16.
[20] 张天嵩, 钟文昭. Meta-DiSc软件在诊断试验Meta分析中的应用[J]. 循证医学,2008,8(2):97-100.