요침사 현미경검사를 위한 표본제작의 표준화 연구
A Study on the Standardization of Sample Preparation for Urine Sediment Microscopic Examination
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초록
요검사는 검사실에서 일상적으로 수행되는 기본적인 검사이다. 연구에서 새로운 프로토콜을 포함한 두 가지 수동 현미경검사 방법을 표준화된 chamber 방법과 비교하였다. 시험지검사와 자동 침사물 분석기에서 적혈구 양성 201개와 백혈구 양성인 201개 검체로 구성된 총 402개 검체를 분석 대상으로 선정했다. 적혈구 및 백혈구에 대한 표준화된 chamber 방법과 새로운 프로토콜 방법 간의 상관계수는 모두 r=0.98로, 높은 수준의 상관관계를 나타냈다. 이 두 방법 간의 동일 등급에 대한 쌍별 일치율은 적혈구의 경우 86.1%, 백혈구의 경우 88.6%였으며, 한 등급 차이 내 일치율은 모두 99.5%였다. 반면, 표준화된 chamber 방법과 중·소규모 검사실 방법 간의 일치율은 적혈구의 경우 11.9%, 백혈구의 경우 13.4%로, 동일 등급 일치율이 현저히 낮았고, 한 등급 차이 내 일치율은 각각 67.2%와 74.1%로 나타났다. 급내상관계수 및 Bland-Altman plot을 사용한 분석에서는 새로운 프로토콜이 다른 세 가지 수동 현미경검사 방법에 비해 우수한 일치도를 보인 것으로 확인되었다. 표준화된 chamber 방법과의 높은 상관관계와 일치도를 고려해 볼 때, 새로운 프로토콜 방법을 소변 침사물 표본제작의 표준화된 절차로 권장한다.
Abstract
Urinalysis is a fundamental diagnostic test routinely performed in clinical laboratories. We evaluated two manual microscopy methods, including a novel protocol, against the standardized chamber method. A total of 402 specimens, comprising 201 positive each for red blood cells (RBCs) and white blood cells (WBCs) by the strip test and automated urine sediment analyzer, were selected for the analysis. The correlation coefficients between the standardized chamber method and the novel protocol RBC and WBC test were both r=0.98, indicating a high degree of correlation. The pair-wise agreement rates for the same grade between these two methods were 86.1% for RBCs and 88.6% for WBCs, with rates within one grade difference of both at 99.5%. In contrast, the agreement rates between the standardized chamber method and smaller or medium-sized laboratory methods were notably lower, with the same-grade rates at 11.9% for RBCs and 13.4% for WBCs, and within one grade difference at 67.2% and 74.1%, respectively. Additional analyses using the intraclass correlation coefficient and Bland-Altman plots confirmed that the novel protocol exhibited superior agreement compared to the other three manual microscopy methods tested. Therefore, we recommend the novel protocol as a standardized procedure for urine sediment preparation, given its high correlation and agreement with the standardized chamber method.
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