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成人血尿
Hematuria in Adults


Julie R. Ingelfinger ... 其他 • 2021.07.08
相关阅读
• 镜下血尿的新版指南 • 无症状镜下血尿患者的膀胱癌

肉眼血尿自古已有记载1,2,它们易引起注意,尤其是症状发生前无其他事件(如创伤、膀胱炎引起排尿困难或腰痛伴肾结石排出)可为其提供明确解释的情况下。而镜下血尿则可能持续数年未被发现2。许多患者是在因其他原因接受尿液分析时被检出镜下血尿。

在不同来源的报道中,镜下血尿的患病率差异很大,其范围从筛查中的一小部分患者到一些泌尿科诊所的40%以上,原因可能是在患者及其症状和体征方面有转诊偏倚3-5。美国泌尿学会(American Urological Association,AUA)指南提出的血尿患病率在2.1%~31.4%5。因此,讨论流行病学本身不如考虑个体患者的情况和地理区域重要。在世界上某些地区(如埃及血吸虫流行的北非),镜下血尿很常见,这反映出膀胱普遍受到侵袭。

此外,血尿原因存在性别差异,因此对血尿所做的评估应反映出这一差异6-8。血尿的意义因基础病因不同而有很大差异。鉴于肉眼血尿和镜下血尿与膀胱癌和肾癌之间的关联,长期以来,评估血尿的重点一直是排除癌症。男女因镜下血尿接受评估时,男性被检出癌症的可能性高于女性。根据GLOBOCAN(全球癌症发病率数据登记系统)9,全球男性和女性的肾癌估计发病率分别为每100,000人-年6.0例和每100,000人-年3.1例,膀胱癌估计发病率分别为每100,000人-年9.0例和每100,000人-年2.2例;2020年一项荟萃分析也得出了这一结果10。然而,女性接受评估的时间往往有延迟,这可能导致了女性较差的膀胱癌结局。

除癌症之外,血尿还与多种症状和原因相关。本综述重点讨论血尿的主要原因、评估及意义。由于治疗取决于病因,因此本文不讨论治疗。





作者信息

Julie R. Ingelfinger, M.D.

 

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