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目的：评价以肾小管上皮细胞及颗粒管型为基础建立的尿沉渣评分系统在肾前性急性肾损伤及急性肾小管坏死鉴别诊断中的应用价值。方法60例急性肾损伤患者，分为肾前性急性肾损伤及急性肾小管坏死组，取晨尿由专人双盲用相差显微镜计数肾小管上皮细胞及颗粒管型，依据尿沉渣评分系统予以评分，比较两组间临床指标差异，采用受试者工作特征曲线(ROC曲线)分析各指标对肾前性急性肾损伤及急性肾小管坏死的诊断价值。结果肾前性AKI患者尿沉渣评分较ATN患者明显降低，尿沉渣评分(AUC=0.906)具有较好的诊断价值。结论尿沉渣评分可作为肾前性急性肾损伤及急性肾小管坏死鉴别诊断的指标。“,”Objective To assess the value of urinary sediment scoring system on dif erential diagnosis of prerenal acute renal injury and acute tubular necrosis,and the urinary sediment scoring system is created on the basis of the number of renal tubular epithelial cel s and granular casts. Methods 60 patients consulted for prerenal acute renal injury or acute tubular necrosis,Fresh morning urine was examined by two experts with phase-contrast microscopy,who did not know clinical information,Counting the number of renal tubular epithelial cel s and granular casts, Scored on the basis of urinary sediment scoring system,Compared between two groups of clinical index dif erence,Using receiver operating characteristic curve (ROC curve) to evaluate the value of each clinical index in dif erential diagnose of prerenal acute renal injury or acute tubular necrosis. Results The urinary sediment scores were lower in prerenal acute renal injury than in acute tubular necrosis. Urinary sediment scoring system (AUC=0.906) has a bet er diagnosis value. Conclusion The urinary sediment score may be a useful tool to dif erential diagnosis of prerenal acute renal injury and acute tubular necrosis.