【摘要】：目的：收集195例疑似尿路上皮癌患者連續(xù)三天的晨尿標(biāo)本及新鮮尿標(biāo)本，進(jìn)行脫落細(xì)胞學(xué)檢查，比較兩種尿標(biāo)本檢出尿路上皮癌的陽性率高低，以及對各級別尿路上皮癌檢測陽性率的高低，探討不同尿標(biāo)本的診斷效能，為臨床早期診斷尿路上皮癌提供可靠的檢查方法以及理論依據(jù)。 方法：收集青海大學(xué)附屬醫(yī)院泌尿外科2011年10月~2013年10月兩年來，以血尿就診的疑似尿路上皮癌患者195例,男性119例，女性76例，年齡為22~87歲，平均（45.26±18.54）歲，每例患者都連續(xù)三天送檢晨尿標(biāo)本和新鮮尿標(biāo)本，以手術(shù)切除組織標(biāo)本或膀胱鏡下取活檢結(jié)果的病理診斷作為對照，分為低度惡性傾向尿路上皮乳頭狀腫瘤，低分級尿路上皮癌及高分級尿路上皮癌三級[1]。經(jīng)過組織病理學(xué)診斷證實(shí)尿路上皮癌98例中，男性68例，女性30例，年齡為25~84歲，平均（54.39±14.57）歲，11例低度惡性傾向尿路上皮乳頭狀腫瘤，39例低分級尿路上皮癌，48例高分級尿路上皮癌，比較兩種尿標(biāo)本檢出尿路上皮癌的陽性率高低，以及對各級別尿路上皮癌檢測陽性率的高低，探討不同尿標(biāo)本的診斷效能，檢驗(yàn)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析，計(jì)數(shù)資料采用X2檢驗(yàn)，得出P值，檢測有無統(tǒng)計(jì)學(xué)意義。 結(jié)果：1.兩種標(biāo)本三天脫落細(xì)胞學(xué)檢查比較： 三天晨尿組的陽性率分別為32.65%，31.63%，39.80%，新鮮尿組的陽性率為59.18%，57.14%，64.29%，新鮮尿組陽性率高于晨尿組，第一天兩標(biāo)本陽性率做X2檢驗(yàn)（X2=13.89，P=0.00020.01)，有顯著差異；第二天（X2=12.92，P=0.00030.01)，，有顯著差異；第三天（X2=11.77，P=0.00060.01)，有顯著差異，同時(shí)對晨尿組三天之間檢查結(jié)果進(jìn)行比較,（X2=2.171，P=0.3380.05)，無統(tǒng)計(jì)學(xué)差異，新鮮尿組（X2=5.062，P=0.0790.05)，無統(tǒng)計(jì)學(xué)差異。 2.兩種標(biāo)本對各級別尿路上皮癌檢測陽性率比較： 第一天晨尿組檢出陽性率分別為1.02%、11.22%、20.41%，新鮮尿組分別為4.08%、24.49%、30.61%，可見新鮮尿組對三者檢出的陽性率高于晨尿標(biāo)本（X2=15.26，P=0.0090.01)，有顯著差異。第二天晨尿組分別為0.00%、10.20%、21.43%，新鮮尿組分別為2.04%、24.49%、30.61%，（X2=15.81，P=0.0070.01)，有顯著差異。第三天晨尿組分別為3.06%、13.27%、23.47%，新鮮尿組分別為4.08%、27.55%、32.65%，（X2=13.72，P=0.0180.05)，有統(tǒng)計(jì)學(xué)意義。同時(shí)晨尿組三天之間比較,（X2=6.346，P=0.7850.05)，無統(tǒng)計(jì)學(xué)差異。新鮮尿組三天之間比較，（X2=11.12，P=0.3480.05)，無統(tǒng)計(jì)學(xué)差異。 3.兩種尿標(biāo)本對尿路上皮癌的診斷效能比較： 晨尿標(biāo)本檢測尿路上皮癌的靈敏度、特異度、假陰性率、假陽性率分別為39.80%、36.08%、60.20%、63.92%，新鮮尿標(biāo)本四指標(biāo)結(jié)果分別為64.29%、60.82%、35.71%、39.18%，兩組四指標(biāo)比較P值均0.01，有顯著性差異。 結(jié)論：1.新鮮尿標(biāo)本的脫落細(xì)胞學(xué)檢查檢測出尿路上皮癌的陽性率要高于晨尿標(biāo)本； 2.新鮮尿標(biāo)本與晨尿標(biāo)本三天之間陽性率比較沒有太大波動(dòng)，新鮮尿標(biāo)本檢測尿路上皮癌的靈敏度及特異度高于晨尿標(biāo)本，假陽性率及假陰性率低于晨尿標(biāo)本； 3.新鮮尿標(biāo)本的脫落細(xì)胞學(xué)檢查對各級別的尿路上皮癌檢測陽性率高于晨尿標(biāo)本； 4.尿路上皮癌的級別越高，晨尿標(biāo)本與新鮮尿標(biāo)本的脫落細(xì)胞學(xué)檢查檢測出的陽性率就越高，同時(shí)新鮮尿標(biāo)本檢測出的高級別尿路上皮癌的陽性率要高于晨尿標(biāo)本； 5.新鮮尿標(biāo)本的脫落細(xì)胞學(xué)檢查對尿路上皮癌的早期診斷價(jià)值高于晨尿標(biāo)本,在臨床實(shí)踐中我們在檢測和診斷尿路上皮癌時(shí)多收集新鮮尿樣本。
[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.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.15

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