目的:探讨胆汁淤积症患者的尿胆红素管型的检测及其临床意义.方法:回顾性分析2022年9月—2023年9月武汉协和医院的153例胆汁淤积症住院患者.根据显微镜镜检尿胆红素管型的结果将研究对象分为2组:尿胆红素管型阳性51例为研究组,包括39例肝内胆汁淤积症患者和12例肝外胆汁淤积症患者;尿胆红素管型阴性102例为对照组,包括69例肝内胆汁淤积症患者和33例肝外胆汁淤积症患者.收集2组患者的临床资料以及部分实验室检测数据,采用逻辑回归分析尿胆红素管型与总胆汁酸(TBA)、总胆红素(TBIL)、直接胆红素(DBIL)、白蛋白(ALB)和尿胆红素(UBIL)的相关性.结果:①研究组的肾功能不全发病率高于对照组(17.65％vs 1.96％,x2=12.54,P＜0.01),差异有统计学意义.②研究组与对照组比较,TBIL[245.30(139.50,380.70)μmol/L vs 26.15(12.58,62.55)μmol/L,Z=8.265,P＜0.001]、DBIL[150.20(83.00,212.40)μmol/L vs 12.75(5.60,32.35)μmol/L,Z=8.559,P＜0.001]、TBA[163.90(99.60,235.90)μmol/L vs 18.55(6.98,92.28)μmol/L,Z=6.274,P＜0.001]、血肌酐(sCr)[(80.94±41.14)μmol/L vs(66.76±20.83)μmol/L,t=2.835,P=0.005]、UBIL 阳性率(92.16％vs 12.75％,x2=89.95,P＜0.01)及管型计数(UF-5000i)[0.88(0.30,2.50)个/μL vs 0.37(0.14,0.73)个/μL,Z=3.028,P=0.002]均高于对照组;ALB[(32.21±5.73)g/L vs(34.48±6.62)g/L,t=2.085,P=0.039]低于对照组;差异有统计学意义.③单变量分析显示,TBIL[OR(95％CI)1.013(1.009～1.017),P＜0.001]、DBIL[OR(95％CI)1.026(1.018～1.035),P＜0.001]、TBA[OR(95％CI)1.011(1.007～1.016),P＜0.001]、ALB[OR(95％CI)0.942(0.889～0.997),P=0.041]和 UBIL(+)[OR(95％CI)42.727(13.877～131.557),P＜0.001]均可用于预测尿胆红素管型.多变量分析显示,UBIL(+)[OR(95％CI)7.883(1.939～32.059),P=0.004]可用于预测尿胆红素管型.结论:当胆汁淤积患者的UBIL(+)时,需通过显微镜镜检患者的离心尿中是否含有尿胆红素管型.尿胆红素管型阳性的胆汁淤积症患者的sCr较高,合并肾功能不全的概率更高.
Detection and clinical significance of urinary bilirubin cast in hospitalized cholestasis patients
Objective:To explore the detection and clinical significance of urinary bilirubin cast in hospitalized cholestasis patients.Methods:153 hospitalized cholestasis patients were collected as study objects in our hospital during September 2022 to September 2023 for a retrospective study.51 patients with urine bilirubin casts were se-lected as study group,including 39 intrahepatic cholestasis patients and 12 obstructive cholestasis patients;anoth-er 102 patients without urine bilirubin casts were selected as control group,including 69 intrahepatic cholestasis patients and 33 obstructive cholestasis patients.The clinical data and laboratory data were collected,and the rela-tionship between urinary bilirubin cast and the TBA,TBIL,DBIL,ALB and UBIL were analyzed by logistic re-gression.Results:①The incidence of renal dysfunction of study group(17.65％vs 1.96％,x2=12.54,P＜0.01)were higher than that of the control group and the difference was statistically significant.② TBIL(245.30[139.50,380.70]μmol/L vs 26.15[12.58,62.55]μmol/L,Z=8.265,P＜0.001),DBIL(150.20[83.00,212.40]μmol/L vs 12.75[5.60,32.35]μmol/L,Z=8.559,P＜0.001),TBA(163.90[99.60,235.90]μmol/L vs 18.55[6.98,92.28]μmol/L,Z=6.274,P＜0.001),sCr([80.94±41.14]μmol/L vs[66.76±20.83]μmol/L,t=2.835,P=0.005)and the positive rate of UBIL(92.16％vs 12.75％;x2=89.95,P＜0.01)and the cast values by UF-5000(0.88[0.30,2.50]/μL vs 0.37[0.14,0.73]/μL,Z=3.028,P=0.002)of the study group were higher than those of the control group;ALB([32.21±5.73]g/L vs[34.48±6.62]g/L,t=2.085,P=0.039)was lower than that of the control group.③On univariate analysis,TBIL(OR[95％CI]1.013[1.009-1.017],P＜0.001),DBIL(OR[95％CI]1.026[1.018-1.035],P＜0.001),TBA(OR[95％CI]1.011[1.007-1.016],P＜0.001),ALB(OR[95％CI]0.942[0.889-0.997],P=0.041)and UBIL(+)(OR[95％CI]42.727[13.877-131.557],P＜0.001)could be used to predict urinary bilirubin cast;On multivariate analysis,UB1L(+)(OR[95％CI]7.883[1.939-32.059],P=0.004)could be used to predict urinary bilirubin cast.Con-clusion:Detection of urinary bilirubin cast in centrifuged urine by microscope was necessary for hospitalized chole-stasis patients if the UBIL was positive by dry chemical method.Hospitalized cholestasis patients with urinary bil-irubin cast might suffer a higher risk of renal dysfunction with relatively higher sCr levels.
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