晨尿标本和新鲜尿标本的脱落细胞学检查对尿路上皮癌早期诊断价值的研究

发布时间：2018-07-14 17:32

【摘要】：目的：收集195例疑似尿路上皮癌患者连续三天的晨尿标本及新鲜尿标本，进行脱落细胞学检查，比较两种尿标本检出尿路上皮癌的阳性率高低，以及对各级别尿路上皮癌检测阳性率的高低，探讨不同尿标本的诊断效能，为临床早期诊断尿路上皮癌提供可靠的检查方法以及理论依据。方法：收集青海大学附属医院泌尿外科2011年10月~2013年10月两年来，以血尿就诊的疑似尿路上皮癌患者195例,男性119例，女性76例，年龄为22~87岁，平均（45.26±18.54）岁，每例患者都连续三天送检晨尿标本和新鲜尿标本，以手术切除组织标本或膀胱镜下取活检结果的病理诊断作为对照，分为低度恶性倾向尿路上皮乳头状肿瘤，低分级尿路上皮癌及高分级尿路上皮癌三级[1]。经过组织病理学诊断证实尿路上皮癌98例中，男性68例，女性30例，年龄为25~84岁，平均（54.39±14.57）岁，11例低度恶性倾向尿路上皮乳头状肿瘤，39例低分级尿路上皮癌，48例高分级尿路上皮癌，比较两种尿标本检出尿路上皮癌的阳性率高低，以及对各级别尿路上皮癌检测阳性率的高低，探讨不同尿标本的诊断效能，检验数据进行统计分析，计数资料采用X2检验，得出P值，检测有无统计学意义。结果：1.两种标本三天脱落细胞学检查比较：三天晨尿组的阳性率分别为32.65%，31.63%，39.80%，新鲜尿组的阳性率为59.18%，57.14%，64.29%，新鲜尿组阳性率高于晨尿组，第一天两标本阳性率做X2检验（X2=13.89，P=0.00020.01)，有显著差异；第二天（X2=12.92，P=0.00030.01)，，有显著差异；第三天（X2=11.77，P=0.00060.01)，有显著差异，同时对晨尿组三天之间检查结果进行比较,（X2=2.171，P=0.3380.05)，无统计学差异，新鲜尿组（X2=5.062，P=0.0790.05)，无统计学差异。 2.两种标本对各级别尿路上皮癌检测阳性率比较：第一天晨尿组检出阳性率分别为1.02%、11.22%、20.41%，新鲜尿组分别为4.08%、24.49%、30.61%，可见新鲜尿组对三者检出的阳性率高于晨尿标本（X2=15.26，P=0.0090.01)，有显著差异。第二天晨尿组分别为0.00%、10.20%、21.43%，新鲜尿组分别为2.04%、24.49%、30.61%，（X2=15.81，P=0.0070.01)，有显著差异。第三天晨尿组分别为3.06%、13.27%、23.47%，新鲜尿组分别为4.08%、27.55%、32.65%，（X2=13.72，P=0.0180.05)，有统计学意义。同时晨尿组三天之间比较,（X2=6.346，P=0.7850.05)，无统计学差异。新鲜尿组三天之间比较，（X2=11.12，P=0.3480.05)，无统计学差异。 3.两种尿标本对尿路上皮癌的诊断效能比较：晨尿标本检测尿路上皮癌的灵敏度、特异度、假阴性率、假阳性率分别为39.80%、36.08%、60.20%、63.92%，新鲜尿标本四指标结果分别为64.29%、60.82%、35.71%、39.18%，两组四指标比较P值均0.01，有显著性差异。结论：1.新鲜尿标本的脱落细胞学检查检测出尿路上皮癌的阳性率要高于晨尿标本； 2.新鲜尿标本与晨尿标本三天之间阳性率比较没有太大波动，新鲜尿标本检测尿路上皮癌的灵敏度及特异度高于晨尿标本，假阳性率及假阴性率低于晨尿标本； 3.新鲜尿标本的脱落细胞学检查对各级别的尿路上皮癌检测阳性率高于晨尿标本； 4.尿路上皮癌的级别越高，晨尿标本与新鲜尿标本的脱落细胞学检查检测出的阳性率就越高，同时新鲜尿标本检测出的高级别尿路上皮癌的阳性率要高于晨尿标本； 5.新鲜尿标本的脱落细胞学检查对尿路上皮癌的早期诊断价值高于晨尿标本,在临床实践中我们在检测和诊断尿路上皮癌时多收集新鲜尿样本。
[Abstract]:Objective: to collect 195 consecutive morning urine specimens and fresh urine specimens for three days of suspected urothelial carcinoma, to examine the exfoliative cytology, to compare the positive rate of two urine specimens and to determine the positive rate of each grade urothelial carcinoma, to explore the diagnostic efficiency of different urine specimens, and to diagnose early clinical diagnosis. Urothelial carcinoma provides reliable examination methods and theoretical basis.
Methods: in the Department of Urology, Affiliated Hospital of Qinghai University, 195 cases of suspected urothelial carcinoma were collected for two years in October ~2013, October 2011, with hematuria, 119 males and 76 females. The age was 22~87 years old. The average age was (45.26 + 18.54) years old. Every patient was examined for the morning urine specimens and fresh urine specimens for three days, and the tissue specimens were excised by operation. Pathological diagnosis of biopsy results under cystoscopy was used as control, divided into low malignancy tendency urothelial papillary tumor, low grade urothelial carcinoma and high grade urothelial carcinoma three [1]. through histopathological diagnosis in 98 cases of urothelial carcinoma, 68 male, 30 female, age 25~84, average (54.39 + 14.57) years, 11 low There were 39 cases of low grade urothelial carcinoma and 48 cases of high grade urothelial carcinoma. The positive rates of urothelial carcinoma were detected in two urine samples and the positive rates of urinary tract carcinoma were detected. The diagnostic efficiency of different urine specimens was discussed, and the data were statistically analyzed and counted. X2 test was used to get P value and whether there was statistical significance.
Results: 1.. The cytological examination of two specimens on three days was compared.
The positive rate in the three day morning urine group was 32.65%, 31.63%, 39.80%, the positive rate of fresh urine group was 59.18%, 57.14%, 64.29%. The positive rate of fresh urine group was higher than that in the morning urine group. The positive rate of the first day of the urine was X2 test (X2=13.89, P=0.00020.01), and there were significant differences; there were significant differences on second days (X2=12.92, P=0.00030.01), third days (X2=11.77, P=0.000). 60.01), there were significant differences. At the same time, the results were compared between three days in the morning urine group (X2=2.171, P=0.3380.05), and there was no statistical difference. There was no statistical difference between the fresh urine group (X2=5.062, P=0.0790.05).
2. the positive rates of two kinds of specimens for various grades of urothelial carcinoma were compared.
The positive rate in the first day morning urine group was 1.02%, 11.22%, 20.41%, the fresh urine group was 4.08%, 24.49%, 30.61% respectively. The positive rate of the fresh urine group was higher than the morning urine samples (X2=15.26, P=0.0090.01), and there were significant differences. Second days morning urine group were 0%, 10.20%, 21.43%, respectively, 2.04%, 24.49%, 30.61%, respectively, fresh urine group, respectively, (X2=15 .81, P=0.0070.01), there were significant differences. Third days of morning urine group were 3.06%, 13.27%, 23.47%, fresh urine group was 4.08%, 27.55%, 32.65%, (X2=13.72, P=0.0180.05), with statistical significance. At the same time, the morning urine group was compared between three days, (X2=6.346, P=0.7850.05), no statistical difference. The fresh urine group was compared between three days (X2=11.12, P=0.3480.05), no unification. Study differences.
3. the diagnostic efficiency of two kinds of urine specimens for urothelial carcinoma:
The sensitivity, specificity, false negative rate and false positive rate of morning urine specimens were 39.80%, 36.08%, 60.20%, 63.92% respectively. The results of four indexes of fresh urine specimens were 64.29%, 60.82%, 35.71%, 39.18%, and two, 39.18% and two, respectively, and there were significant differences in P values.
Conclusion: 1. the positive rate of urothelial carcinoma detected by exfoliative cytology in fresh urine specimens is higher than that in morning urine samples.
2. the positive rate of the fresh urine specimens and the morning urine specimens for three days was not too large. The sensitivity and specificity of the fresh urine specimens were higher than those in the morning urine samples. The false positive rate and false negative rate were lower than those of the morning urine specimens.
3. the positive rate of cytological examination of fresh urine specimens was higher than that of morning urine samples for all levels of urothelial carcinoma.
The higher the grade of 4. urothelial carcinoma, the higher the positive rate of the exfoliative cytology examination of the morning urine specimen and the fresh urine specimen, and the positive rate of the high grade urothelial carcinoma detected by the fresh urine specimen is higher than that of the morning urine specimen.
The early diagnostic value of exfoliative cytology of 5. fresh urine specimens is higher than that of early morning urine specimens. In clinical practice, we collect more fresh urine samples in the detection and diagnosis of urothelial carcinoma.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.15

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