摘要目的 探讨尿液肝素结合蛋白(U-HBP)浓度对尿路感染(UTI)的诊断价值及临床意义.方法 病例对照研究.收集2016年6月至12月期间复旦大学附属华山医院北院就诊的119例UTI患者、18例疑似UTI患者、58例非UTI患者、52名健康体检者的尿液标本.采用酶联免疫吸附法检测尿液中肝素结合蛋白(U-HBP)浓度;尿液细菌定量培养鉴定检测病原菌;尿干化学分析仪检测尿白细胞酯酶(U-LE)、尿亚硝酸盐(U-NIT)水平;尿液沉渣分析仪检测尿液白细胞计数(U-WBC)水平.各组总体水平差异采用Kruskal-Wallis H检验.两个独立样本的比较采用Mann-Whitney U检验.Spearman相关检验分析U-HBP、U-LE和U-WBC的相关性.应用ROC曲线分析法评价U-HBP、U-LE、U-NIT和U-WBC水平在UTI诊断中的价值.结果 UTI组、疑似UTI组、非UTI组和健康体检组之间的U-HBP、U-LE、U-NIT及U-WBC浓度水平差异有统计学意义(HU-HBP=166.73、HU-LE=126.88、HU-NIT=47.92及HU-WBC=144.05,P<0.05).U-HBP、U-LE、U-NIT和U-WBC水平诊断尿路感染的曲线下面积(AUC)分别为0.948、0.836、0.671和0.897.当U-HBP的浓度在69.20 ng/ml时,对UTI的诊断灵敏度及特异度分别为89.9%(107/119)和89.1%(114/128).当U-LE的水平在4+时,对UTI的诊断灵敏度及特异度分别为76.5%(91/119)和81.3%(104/128).当U-NIT的水平在1+时,对UTI的诊断灵敏度及特异度分别为36.1%(43/119)和97.7%(125/128).当U-WBC计数为233.6个/μl时,对UTI的诊断灵敏度及特异度分别为82.4%(98/119)和82.8%(106/128).U-WBC与U-HBP相关系数r=0.896(P<0.05),U-LE与U-HBP相关系数r=0.798(P<0.05).结论 U-HBP对尿路感染的诊断价值高于U-LE、U-NIT及U-WBC.U-HBP浓度有可能作为判断尿路感染的新型感染标志物.

abstractsObjective To dectect urine level of heparin-binding protein(HBP)in screening urinary tract infection(UTI).Methods A case-control study was performed.From June 2016 to December 2016, urine levels of HBP were detected by enzyme linked immunosorbent assay in 119 patients with definite UTI, 18 patients with probable UTI,58 patients with no UTI and 52 normal controls who were enrolled at Fudan University Hua Shan Hospital North.Meanwhile,urine leukocyte esterase test(U-LE)and urine nitrite test (U-NIT)were performed by urine dipstick analyzer.And count of urine WBC(U-WBC)was performed by urine formed elements analyzer.The overall level of each group was compared using Kruskal-Wallis H test. Two independent samples were compared by Mann-Whitney U test.The correlation between U-HBP, U-LE and U-WBC were assessed using Spearman′s rank coefficient.Receiver operating characteristic curves were constructed to illustrate the diagnostic power of U-HBP, U-LE, U-NIT and U-WBC for UTI.Results In definite UTI group,probable UTI group,no UTI group and normal control group,the levels of U-HBP, U-LE,U-NIT and U-WBC were significantly different(H values were 166.73,126.88,47.92 and 144.05, respectively,P<0.05).Areas under the receiver-operating characteristics curves(AUC)of U-HBP, U-LE,U-NIT and U-WBC were 0.948,0.836,0.671 and 0.897 respectively for the diagnosis of UTI.When a cut-off value of 69.20 ng/ml was used in U-HBP, the sensitivity and specificity for detection of definite UTI were 89.9%(107/119)and 89.1%(114/128),respectively.When U-LE at a cut-off value of 4+, the sensitivity was 76.5%(91/119)and specificity was 81.3%(104/128).When U-NIT at a cut-off value of 1+,the sensitivity was 36.1%(43/119)and specificity was 97.7%(125/128).When U-WBC at a cut-off value of 233.6/μl,the sensitivity was 82.4%(98/119)and specificity was 82.8%(106/128). A strong correlation was detected between U-HBP and U-WBC(r=0.896, P<0.05).The correlation between U-HBP and U-LE was also strong(r=0.798, P<0.05).Conclusions Heparin-binding protein in the urine was significantly better in diagnosis of UTI,compared with the other markers.It could probably be acted as an important new biomarker for diagnosis of UTI.