- 學位論文
利用尿液常規沉渣篩檢之白血球數及細菌數進行尿液培養的確效
Validation and verification of urine sediment screening for leukocyte and bacteria prior to urine culture
摘要
背景與目的：尿液常規檢查是醫院快速方便的篩檢檢查，其結果是否能用於決定尿液培養仍須探討研，本篇研究目的，是想要建立一套以尿沉渣結果中的白血球數及細菌數來篩選尿液檢體是否有需要進行培養的標準，並評估臨床上使用此標準後的執行成效。 方法：本次分析藉檢驗數據資料庫進行資料篩選，將尿液常規尿沉渣分析與尿液培養做了相關性分析；統計期間從2011年1月至2月收集義大醫院急診無使用抗生素治療之病人中段尿液共215支檢體，先使用UF1000i進行尿沉渣分析後，再於2小時內進行尿液培養。利用SPSS軟體10.0版分析數據，以尿液培養結果為標準，繪製尿沉渣結果中的白血球數與細菌數之ROC曲線(Receiver operating characteristic curve)，並計算白血球數與細菌量之截止值及分析結果之敏感性、特異性、陰性預測率、陽性預測率等數據。以此標準設立泌尿道感染篩檢套餐，於2012年1月至12月共收集7550個檢體資料，並追蹤分析統計泌尿道感染篩檢套餐之結果成效。 結果：分析215支檢體中尿沉渣分析結果與尿液培養的關係，並以ROC曲線統計分析取得的標準閥值，設立成為泌尿道感染篩檢套餐標準，標準為當白血球數≥10 WBC/μl或細菌數≥100 Bac/μl時需進行尿液培養。經由該泌尿道感染篩檢套餐標準發現，7550支檢體中，有2862個(37.9%)，無須進行尿液培養。需要進行尿液培養的4688個(62.1%)檢體中尿液培養結果陰性有673個(14.4%)，陽性有2510個(53.5%)，懷疑檢體汙染有1505個(32.1%)。 結論：文獻指出一般尿液培養陰性率高達40%~70%，當義大醫院採用這套準則（白血球數≥10 WBC/μl或細菌數≥100 Bac/μl時需進行尿液培養），能有效降低陰性率為14.4%，尤其是在女性檢體該標準可以顯著提高陽性率及降低陰性率之效果。因此本研究發現，尿沉渣結果中的白血球數及細菌數可作為是否需進行尿液培養的建議。這套判斷標準應用於臨床後，可降低不必要的尿液培養比率可縮減發報告時間，並降低尿液培養陰性率，加快醫生對病人的後續診治，並能減少實驗室工作量與成本花費。
並列摘要
BACKGROUND and OBJECTIVE: The studies found that the routine urine sediment results can be used to screen the necessity of urine culture. The aim of this study us to establish a standard of urine sediment screening for leukocyte and bacteria prior to urine culture. METHOD: 215 specimens were collected for urine sediment analysis and urine culture. The cut-off value of WBC count and bacteria count was determined by ROC curve. After collecting 7550 specimens, the urine sediment analysis was performed first, and then the urine culture was determined by the cut-off value of WBC count and bacteria count, and the urine culture results were analyzed. RESULTS: The cut-off value obtained by the ROC curve was established. When WBC count ≥10 WBC/μl or t bacteria count ≥100 Bac/μl, urine culture was required. Of the 7,550 specimens, 2,862 (37.9%) did not require urine culture. Among the 4688 (62.1%) specimens requiring urine culture, urine culture showed no growth in 673 (14.4%) , and positive in 2510 (53.5%) , and specimen contamination in 1505 (32.1%). Conclusion: WBC count and bacteria count of the urine sediment results can be used as a method for screening urine culture. When applied to the clinic, it can reduce unnecessary urine culture ratio and reduce the negative rate of urine culture.