Tan Peng Chiong, King Anthonia Siaw Jia, Omar Siti Zawiah
Department of Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia.
J Obstet Gynaecol Res. 2012 Jan;38(1):145-53. doi: 10.1111/j.1447-0756.2011.01652.x. Epub 2011 Sep 28.
The aim of this study was to evaluate urine microscopy, dipstick analysis and urinary symptoms in screening for urinary tract infection (UTI) in hyperemesis gravidarum (HG).
A prospective cross-sectional study was performed on women at first hospitalization for HG. A clean-catch mid-stream urine sample from each recruit was sent for microscopy (for bacteria, leucocytes and erythrocytes), dipstick analysis (for leukocyte esterase, nitrites, protein and hemoglobin) and microbiological culture. The presence of current urinary symptoms was elicited by questionnaire. UTI is defined as at least 10(5) colony-forming units/mL of a single uropathogen on culture. Screening test parameters were analyzed against UTI.
UTI was diagnosed in 15/292 subjects (5.1%). Receiver-operator characteristic curve analysis of microscopic urine leucocytes revealed area under the curve=0.64, 95% confidence interval (CI) 0.5-0.79, P=0.063 and erythrocytes area under the curve=0.53, 95%CI 0.39-0.67, P=0.67 for UTI indicating the limited screening utility of these parameters. Microscopic bacteriuria (likelihood ratio [LR] 1.1, 95%CI 0.7-1.5) and urine dipstick leukocyte esterase (LR 1.4, 95%CI 1.1-1.8), nitrites (LR 2.3, 95%CI 0.3-17.2), protein (LR 1.0, 95%CI 0.7-1.6) and hemoglobin (LR 0.8, 95%CI 0.4-1.5) were not useful screening tests for UTI in HG. Elicited symptoms were also not predictive of UTI.
Urine microscopy, dipstick analysis and urinary symptoms were not useful in screening for UTI in HG. UTI should be established by urine culture in HG before starting antibiotic treatment.
本研究旨在评估尿镜检、试纸条分析及泌尿系统症状在妊娠剧吐（HG）患者尿路感染（UTI）筛查中的作用。
对首次因HG住院的女性进行一项前瞻性横断面研究。收集每位受试者的清洁中段尿样本，进行镜检（检测细菌、白细胞和红细胞）、试纸条分析（检测白细胞酯酶、亚硝酸盐、蛋白质和血红蛋白）及微生物培养。通过问卷调查了解当前泌尿系统症状。UTI定义为培养中单一尿路病原体菌落形成单位至少为10(5)/mL。针对UTI对筛查试验参数进行分析。
292名受试者中有15名（5.1%）被诊断为UTI。尿镜检白细胞的受试者工作特征曲线分析显示，曲线下面积=0.64，95%置信区间（CI）0.5 - 0.79，P = 0.063；红细胞曲线下面积=0.53，95%CI 0.39 - 0.67，P = 0.67，提示这些参数在UTI筛查中的作用有限。镜下菌尿（似然比[LR] 1.1，95%CI 0.7 - 1.5）、尿试纸条白细胞酯酶（LR 1.4，95%CI 1.1 - 1.8）、亚硝酸盐（LR 2.3，95%CI 0.3 - 17.2）、蛋白质（LR 1.0，95%CI 0.7 - 1.6）和血红蛋白（LR 0.8，95%CI 0.4 - 1.5）在HG患者UTI筛查中并非有效的检测方法。所引发的症状也不能预测UTI。
尿镜检、试纸条分析及泌尿系统症状在HG患者UTI筛查中并无作用。在HG患者开始抗生素治疗前，应通过尿培养确诊UTI。
