Ohsaki H, Hirouchi T, Hayashi N, Okanoue E, Ohara M, Kuroda N, Hirakawa E, Norimatsu Y
Department of Medical Technology, Ehime Prefectural University of Health Sciences, Japan.
Cytopathology. 2013 Feb;24(1):52-7. doi: 10.1111/j.1365-2303.2012.00958.x. Epub 2012 Feb 14.
To assess whether the morphology of urine erythrocytes can be an effective tool for distinguishing glomerular disease from lower urinary tract disease in SurePath™ liquid-based cytology (SP-LBC).
We examined four morphological parameters of erythrocytes: (1) irregular erythrocytes (of all types including fragmented forms) comprising greater than or equal to 20% of erythrocytes; (2) uniform erythrocytes (>80%); (3) doughnut or target-like shaped (D/T) erythrocytes (≥1%); and (4) acanthocytes (≥1%) in glomerular disease (n = 32) and lower urinary tract disease (n = 20) with SP-LBC slides in cases that had also been assessed by fresh urine sediment examination.
Sensitivity of D/T erythrocytes and acanthocytes (dysmorphic erythrocytes) for glomerular disease were 100% and 87.5%, respectively, with urine sediment examination, and 81.3% and 46.9%, respectively, in SP-LBC slides. Specificity was 100% for D/T erythrocytes and acanthocytes using either procedure. While irregular erythrocytes were specific for glomerular disease using urine sediment examination, they were seen in 70% of those with lower urinary tract disease using SP-LBC slides as a result of the deformation of erythrocytes by the fixative.
Although the sensitivity of D/T erythrocytes and acanthocytes for glomerular disease was lower in SP-LBC slides than fresh urine sediment examination, their specificity was equally high. Therefore, urine erythrocyte morphology is useful in the detection of glomerular disease with the SP-LBC slides. However, morphological features apart from D/T erythrocytes and acanthocytes are not useful in SP-LBC slides.
评估在SurePath™液基细胞学检查（SP-LBC）中，尿红细胞形态能否作为区分肾小球疾病和下尿路疾病的有效工具。
我们检查了红细胞的四个形态学参数：（1）不规则红细胞（包括所有类型，包括破碎形式）占红细胞总数的比例≥20%；（2）均一性红细胞（>80%）；（3）环形或靶形（D/T）红细胞（≥1%）；（4）棘形红细胞（≥1%）。对32例肾小球疾病和20例下尿路疾病患者的SP-LBC玻片进行检查，这些病例同时也进行了新鲜尿沉渣检查。
尿沉渣检查中，D/T红细胞和棘形红细胞（异形红细胞）对肾小球疾病的敏感性分别为100%和87.5%，在SP-LBC玻片中分别为81.3%和46.9%。两种检查方法中，D/T红细胞和棘形红细胞的特异性均为100%。虽然尿沉渣检查中不规则红细胞对肾小球疾病具有特异性，但在SP-LBC玻片中，由于固定剂导致红细胞变形，70%的下尿路疾病患者中也可见到不规则红细胞。
虽然在SP-LBC玻片中，D/T红细胞和棘形红细胞对肾小球疾病的敏感性低于新鲜尿沉渣检查，但其特异性同样很高。因此，尿红细胞形态在使用SP-LBC玻片检测肾小球疾病中是有用的。然而，除D/T红细胞和棘形红细胞外的形态学特征在SP-LBC玻片中并无用处。
