尿液髓过氧化物酶肌酐比值作为诊断泌尿系感染的新标志物

doi:10.24920/11814

摘要/Abstract

摘要：

目的探讨尿髓过氧化物酶与肌酐比值（MCR）是否可作为泌尿系感染（UTI）诊断的指标。方法将疑似UTI的患者根据尿培养结果分为培养阳性组和培养阴性组。并对两组患者尿液MCR、白细胞（WBC）和细菌进行检测和比较。结果 253例患者中有157例尿培养阳性,96例培养阴性。尿MCR、WBC和细菌分别以2为基数取对数。尿液培养阳性组和阴性组间log2MCR、log2WBC（定量）、log2bacteria、WBC（半定量）水平分别为（8.6±2.5比5.4±1.5,t=-12.453,P=0.001）、（8.0±2.5比5.2±1.8,t=-10.332,P=0.001）、（11.4±2.5比8.2±2.8,t=-9.297,P=0.001）、[2（1,3）比1（0.5,1）,Z=-7.580,P=0.001],差异均有统计学意义。在尿培养阳性组中,革兰阳性菌组与阴性菌组的log2MCR水平分别为7.2±2.5 和9.0±2.4,t=4.016,P=0.001,差异有统计学意义。log2MCR与log2WBC（定量）、log2bacteria、WBC（半定量）相关性（Pearson）分别为0.708（P=0.001）、0.381（P=0.001）、0.606 （P=0.001）。结论 MCR与WBC计数呈正相关,可作为诊断UTI新的标志物。MCR甚至可以用于初步推断UTI的细菌类型。

关键词: 尿液, 髓过氧化物酶, 诊断, 泌尿系感染

Abstract:

Objective To determine whether urinary myeloperoxidase to creatinine ratio (MCR) can serve as a marker for diagnosis of urinary tract infection (UTI).Methods Patients suspected of UTI were consecutively enrolled and further divided into the culture positive and the sterile groups according to urine culture results. Subsequently, MCR, white blood cell (WBC) and bacteria in the urinary samples from patients were detected and compared between the two groups.Results Finally, 253 patients were enrolled including 157 urine culture positive patients and 96 urine culture negative patients (sterile group). After logarithmic transformation in 2 as the base, the MCR, WBC, and bacteria were separately presented as log₂ ^MCR, log₂ ^WBC(quantitative) , and log₂ ^bacteria. The values of log₂ ^MCR(8.6±2.5 vs. 5.4±1.5, t=-12.453, P=0.001), log₂ ^WBC(quantitative) (8.0±2.5 vs. 5.2±1.8, t=-10.332, P=0.001), log₂ ^bacteria (11.4±2.5 vs. 8.2±2.8, t=-9.297, P=0.001) and WBC (semi-quantitative) [2 (interquartile range 1, 3) vs. 1 (interquartile range 0.5, 1), Z=-7.580, P=0.001] showed significant difference between the urine culture positive group and the sterile group. Among the urine culture positive group, the values of log₂ ^MCR of the gram positive and gram negative subgroups were 7.2±2.5 and 9.0±2.4 (t=4.016, P=0.001), respectively. The correlation between log₂ ^MCR and log₂ ^WBC (quantitative), log₂ ^bacteria, WBC (semi-quantitative) was 0.708 (Pearson correlation, P=0.001), 0.381 (Pearson correlation, P=0.001), and 0.606 (Spearman correlation, P=0.001), respectively. Conclusions MCR is positively correlated with WBC counts and could be served as a promising biomarker for diagnosis of UTI. MCR could be even used for initial inference of infectious bacteria types of UTI.

Key words: urine, myeloperoxidase, diagnosis, urinary tract infection

Bai Mingjian, Feng Jing, Liang Guowei. Urinary Myeloperoxidase to Creatinine Ratio as a New Marker for Diagnosis of Urinary Tract Infection[J].Chinese Medical Sciences Journal, 2018, 33(3): 152-159.

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Items	Number of positive case [n (%)]
Gram positive group (n=36)
E. faecalis	7 (4.46)
E. faecium	15 (9.55)
S. epidermidis	4 (2.55)
S. aureus	5 (3.18)
S. haemolyticus	2 (1.27)
S. hemolytic	2 (1.27)
E. casseliflavus	1 (0.64)
Gram negative group (n=121)
E. coli	86 (54.78)
P. mirabilis	3 (1.91)
K. pneumoniae	20 (12.74)
M. morganii	1 (0.64)
C. koseri	1 (0.64)
P. aeruginosa	1 (0.64)
S. marcescens	1 (0.64)
E. coli + K. pneumonia	1 (0.64)
E. coli + S. marcescens	2 (1.27)
P. mirabilis + S. marcescens	1 (0.64)
P. mirabilis + K. pneumonia	1 (0.64)
P. aeruginosa + P. mirabilis	1 (0.64)
E. coli + P. mirabilis	2 (1.27)

Groups	n	Gender (M/F)	Age^#(yrs)	log₂^MCR§	log₂^WBC§(quantitative)	log₂^bacteria§	WBC^# (semi-quantitative)
Sterile group	96	20/76	62 (45, 75)	5.4±1.5	5.2±1.8	8.2±2.8	1 (0.5, 1)
Culture positive group	157	23/134	52 (39, 64)	8.6±2.5	8.0±2.5	11.4±2.5	2 (1, 3)
P value		0.204	0.001	0.001	0.001	0.001	0.001

Items	AUC	SE	95% CI	Cutoff value	SEN (%)	SPE (%)	PPV (%)	NPV (%)	Accuracy (%)
log₂^MCR	0.854	0.0238	0.807-0.900	7.6 ng/g	66	95	95	63	80
log₂^WBC(quantitative)	0.818	0.0262	0.767-0.869	6.1 /μl	76	77	84	66	76
log₂^bacteria	0.796	0.0278	0.741-0.851	11.3 /μl	55	92	89	54	73
WBC (semi-quantitative)	0.774	0.0281	0.719-0.829	1	63	77	82	56	70

Items	AUC difference	SE	95% CI	Z	P value
log₂^WBC(quantitative)	0.0354	0.0270	-0.0176-0.0884	1.309	0.191
log₂^bacteria	0.0576	0.0345	-0.0100-0.1250	1.670	0.095
WBC(semi-quantitative)	0.0797	0.0302	0.0205-0.1390	2.638	0.008

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