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顧明軒 定義「適當收集尿液方式」:提高尿液檢查對於女性血尿評估的正確度 2022/1/26 下午 05:13:15 0
原 文 題  目 Defining Properly Collected Urine: Thresholds to Improve the Accuracy of Urinalysis for Microscopic Hematuria Evaluation in Women
作  者 Andrew Chen, Ashley Caron, Nicholas J. Jackson et al
出  處 February, 2022
出版日期
評 論

對於尿液檢查,如果尿液外觀顏色正常,但以顯微鏡檢發現有紅血球在顯微鏡高倍視野下三顆以上,此稱為「顯微性血尿」。相比於男性,女性有較高風險被檢測為顯微性血尿,此因女性尿液檢體較男性困難,容易受到陰道分泌物、月經、皮膚碰觸等因素汙染,尤其在年紀較大、較肥胖的女性更為容易。

此研究為單一醫學中心研究,以前瞻性方式收案,篩選因顯微性血尿由診所轉介至該醫院之女性。參與研究之女性,除需具最初診所尿液檢查報告,並經完整衛教正確留尿方式後,重新收集尿液檢體,並同日接受以尿道導管留取尿液,以比較三種尿液檢體結果。

文中敘述,建議女性正確留尿方式為先以濕紙巾清潔會陰部,以手指張開陰唇,避免留尿杯碰觸皮膚或陰道,留取中段尿液檢體。而顯微血尿是以導尿管留取之檢體檢驗結果為金標準,以該結果是否符合血尿定義為真正顯微血尿,若導管檢體為陰性,而其他任一檢體留取方式為血尿結果,視為偽陽性。

共46位女性加入此研究,比較轉診診所之尿液檢查結果,與經完整留尿衛教後的檢查結果,發現經衛教後於醫院再次留取的尿液檢體,符合「顯微性血尿」的比例顯著降低,尿液檢查含有皮膚或陰道汙染來的扁平細胞(定義高倍視野下超過2個扁平細胞)之汙染率亦顯著降低。若以尿液檢查結果是否具扁平細胞超過每一高倍視野2個細胞為標準,以少於2個扁平細胞視為良好品質的尿液檢體,重新回顧診所的尿液檢查報告,發現良好品質的尿液檢體對於符合真正顯微性血尿的陽性預測值,可以從46.1%進步到68.8%。

此研究提供一些發現:經良好衛教後改良收尿方式,可降低顯微性血尿的偽陽性;對於檢體結果為高倍視野下超過2個扁平細胞,應考慮為檢體留取方式不良,應以適當方式重新收集尿液,或改以導尿管方式留取檢體,如此應可幫助女性避免不必要之血尿檢查。

abstract

Introduction and hypothesis: Microscopic hematuria is one of the most common office consults for urologists. While revised guidelines have risk-stratified patients to reduce unnecessary screening, they do not provide guidance concerning specimen quality. We sought to define “properly collected” specimens using catheterized urine samples as a reference to improve the utility of hematuria screening in women.

Methods: We prospectively acquired same-visit voided and catheterized urine samples from 46 women referred for microscopic hematuria from September 2016 to March 2020. Characteristics of pre-referral urinalysis were compared to the matched specimens. True microscopic hematuria was defined as .≥ 3 red blood cells per high power field on catheterization

Results: Catheterized urinalyses had significantly fewer red blood and squamous epithelial cells in comparison to both referral urinalyses (p=0.006, p=0.001, respectively) and same-day void urinalyses (p=0.02, p=0.04, respectively). As no catheterized sample had >2 squamous epithelial cells, we applied this squamous epithelial cell threshold to referral urinalyses for analysis. Addition of this criterion for “properly collected specimen” increased the positive predictive value of referral urinalyses from 46.1% to 68.8% for true microscopic hematuria. Fewer than 2 squamous epithelial cells with elevated RBC was a significant predictor for true microscopic hematuria (p=0.003).

Conclusions: Voided specimens in the urology clinic had significantly lower red blood cells than referral samples, indicating improved collection technique may reduce false positive urinalyses. Matched collection suggested that repeat collection by catheterization in women who present with >2 squamous epithelial cells per high power field on referral urinalysis may prevent unnecessary future work-up.

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