肝硬化泌尿病理诊断的细胞学方法研究

E. G. Malaeva, L. P. Zaitseva, A. S. Knyazyuk, O. Osipkina
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摘要

目标。探讨尿细胞沉渣检查细胞学方法在肝硬化肾、尿路病理诊断和鉴别诊断中的应用价值。材料和方法。对50例住院肝硬化患者进行标准观察性研究。采用液体细胞学和细胞离心法对尿沉渣进行细胞学制备,固定后观察结果。肝硬化住院患者的细胞尿沉积物细胞学研究显示,31%的患者红细胞畸形(浸出),在疾病失代偿和30天死亡率患者中发生率更高(p< 0.05)。63%的患者尿液中发现了微生物群,更常见的是混合性(27%)。46%失代偿性肝硬化患者,包括急性肾损伤,尿沉积物的细胞学准备以多细胞成分为代表,存在浅、深尿路上皮和肾上皮。研究细胞尿液沉积物的细胞学方法是一种方便、信息丰富且廉价的诊断方法,其可能性是确定细胞成分(表层和深层尿路上皮、改变的红细胞)、微生物群及其来源(生殖道、泌尿道)的存在和起源,与其他方法相结合,可以验证患者的诊断,并对急性肾小管坏死和肝肾综合征进行鉴别诊断。
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Cytological method of research in the diagnosis of urinary pathology in liver cirrhosis
Objective. To determine the possibilities of cytological method of urine cellular sediment examination for diagnosis and differential diagnosis of renal and urinary tract pathology in liver cirrhosis.Materials and methods. A standard observational study of 50 inpatients with liver cirrhosis was performed. Cytological preparations of urine sediment were prepared by liquid cytology and cytocentrifugation methods and after fixation were Results. Cytological study of cellular urine sediment in hospitalized patients with cirrhosis revealed dysmorphic (leached) erythrocytes in 31% of cases, statistically significantly more frequently in patients with decompensation of the disease and 30-day mortality (p<0,05). Microflora in the urine was found in 63% of patients, more often of mixed nature (27%). In 46% of patients with decompensated liver cirrhosis, including acute renal injury, cytological preparation of urinary sediment is represented by multicellular elements with the presence of superficial and deep urothelium and renal epithelium.Conclusions. Cytological method of studying the cellular urine sediment is an accessible, informative and cheap diagnostic method, the possibilities of which are to determine the presence and origin of cellular elements (urothelium of the surface and deep layers, altered erythrocytes), microflora and its source (genital tract, urinary tract), which, in combination with other methods, allows to verify the diagnosis of the patient and to carry out differential diagnosis of acute tubular necrosis and hepatorenal syndrome.
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