요중 백혈구 및 적혈구의 생존도에 관한 실험적 관찰

Abstract

[한글]

혈뇨 및 농뇨는 요로감염이나 기타 비뇨기계 질환의 진단적 근거가 되고 치료에 대한 경과를 추적하는데 중요한 임상적 지표가 된다 (Schreiner, 1957).

그러나 요의 물리 화학적 성상에 따라 요중 혈구(尿中血球)의 형태가 다양해지며 또한 급속한 용혈이나 퇴행성 변화가 야기될 경우에는 요중 적혈구 및 백혈구가 관찰되지 않는다. 따라서 혈뇨 및 농뇨에 의한 진단적 가치가 저하될 수 있다.

요성분이 알칼리성이거나 저장성일때 요중 백혈구나 적혈구의 생존율이 저하되어 혈구의 소실이 많다는 것은 이미 여러학자들에 의해 보고된 바 있다 (Free등, 1956:Cook등, 1956 :Rinsler와 Gray,1957 : Leonards,1962). 이는 분명한 요로 감염 특히 요소 분해세군에 외한 감염이나 기타 비뇨기계 질환이 존재함에도 불구하고 유의(有意)한 농뇨나 혈뇨가 관찰되지 않거나 실제보다 더욱 낮은 정량적 수치를 나타낼 수 있음을 의미한다(Brumfitt,1965: Litter 1965: Gnarpe와 Edebo,1965: Pryles와 Eliot,1965: Ambrose와 Hill,1965).

이와 같은 사실을 근거로 하여 정상인의 말초 정맥혈을 채취한후 Spriggs와 Alexander(1960)의 a1bumin gradient method에 의해 적혈구 및 백혈구 부유액을 만든 다음 무작위로 선정한 피검뇨를 원침하여 뇨침전물을 제거한 상청뇨에 각 혈구 부유액 한방울을 가하고

시간외 경과에 따른 각 혈구의 생존도를 관찰함으로써 요의 수소이온지수, 비중, 저장온도의 차이에 의한 혈구 소실율을 측정한 바 다음과 같은 결론을 얻었다.

1. 백혈구 및 적혈구가 다같이 알칼리성뇨 저장성뇨 중에서 가장 현저한 혈구 소실율을 나타냈으며 (P<0.01), 요 저장온도가 높을수륙 혈구 생존율의 현저한 감소를 나타냈다(P<0.0l)

2.동일 조건하에서는 적혈구의 소실율이 백혈구에 비해 더욱 현저하였다 (P<0.01)

3.시간이 경과할수록 각 혈구 소실율이 의의있게 증가하였으며 산성뇨, 저온 저장뇨중 백혈구 소실율이 2시간, 1시간에서 각각 통계적 유의치를 보였을뿐 기타의 경우 30분내에 이미 유의한 소실을 나타냈다 (P<0.01 ∼ 0.05)

Experimental Observations on Survival Rates of Erythrocyte and Leucocyte in Urine.

Chung Man Chung M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor Chong Soon Wang, M.D.)

Quantitative estimation of number of erythrocytes or leucocytes in urine is often

used as a clinical guide or a supportive evidence to urogenital tract infections

and other urologic diseases (Schreiner, 1957). Occasionally, however, patients with

acute urinary tract infection are found to have only small number of white cells in

the urine, particularly when the infecting organism is a Proteus strain and small

numbers of red cells appeared in hypotonic, alkaline urine psecimens due to

hemolysis. (Free et al. 1956 ; Cook, 1956 ; Rinsler and Gray, 1957 ; Leonards, 1962

; Brumfitt, 1956 ; Gnarpe and Edebo, 1956 ; Little, 1965 ; Pryles and Eliot, 1965 ;

Ambrose and Hill, 1965).

It is well known that blood cells in urine may be disiniegrated or hemolyzed and

these may occur despite refrigeration, particularly in alkaline specimens. In order

to investigate these, the survival of blood cells obtained from human blood was

examined in vitro under different conditions of specific gravity, pH, temperature

of incubation. The erythrocyte and leucocyte suspenious were made by Albumin

Gradient Methods (Sprions and Alexander, 1960).

The results obtaioned are summarized as follows ;

1. The rate at which blood cells in urine disappear was found to be accelerated

by raising the pH, decreasing the urine S.G., and by increasing the temperature at

which suspension were kept (p<0.01).

2. The most rapid disappearance of blood cells occurred in hyportonic, alkaline

medium at 37 C and there was little change in cell suspensions kept in acid (pH ;

4.5-5.5) or in hypertonic conditions (S.G.;above 1.024) over a period of 12

hours.(P<0.01)

3. Under the same conditions of suspending medium, the urinary erythrocytes

disappeared more rapidly than urinary leucocytes. (p<0.01)

[영문]

Quantitative estimation of number of erythrocytes or leucocytes in urine is often used as a clinical guide or a supportive evidence to urogenital tract infections and other urologic diseases (Schreiner, 1957). Occasionally, however, patients with

acute urinary tract infection are found to have only small number of white cells in the urine, particularly when the infecting organism is a Proteus strain and small numbers of red cells appeared in hypotonic, alkaline urine psecimens due to

hemolysis. (Free et al. 1956 ; Cook, 1956 ; Rinsler and Gray, 1957 ; Leonards, 1962 ; Brumfitt, 1956 ; Gnarpe and Edebo, 1956 ; Little, 1965 ; Pryles and Eliot, 1965 ; Ambrose and Hill, 1965).

It is well known that blood cells in urine may be disiniegrated or hemolyzed and these may occur despite refrigeration, particularly in alkaline specimens. In order to investigate these, the survival of blood cells obtained from human blood was

examined in vitro under different conditions of specific gravity, pH, temperature of incubation. The erythrocyte and leucocyte suspenious were made by Albumin Gradient Methods (Sprions and Alexander, 1960).

The results obtaioned are summarized as follows ;

1. The rate at which blood cells in urine disappear was found to be accelerated by raising the pH, decreasing the urine S.G., and by increasing the temperature at which suspension were kept (p<0.01).

2. The most rapid disappearance of blood cells occurred in hyportonic, alkaline medium at 37 C and there was little change in cell suspensions kept in acid (pH ; 4.5-5.5) or in hypertonic conditions (S.G.;above 1.024) over a period of 12 hours.(P<0.01)

3. Under the same conditions of suspending medium, the urinary erythrocytes disappeared more rapidly than urinary leucocytes. (p<0.01)