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[应用超敏试剂检测血浆内毒素诊断革兰阴性菌血症]

[Plasma endotoxin assay by supersensitive reagent for the diagnosis of gram-negative bacteremia].

作者信息

Tobita Tadasu, Ishihara Miyako, Mihara Toshihito

机构信息

Division of Hematology, Yaizu City Hospital, Yaizu 425-8505.

出版信息

Rinsho Byori. 2002 May;50(5):519-23.

Abstract

With a novel supersensitive reagent, we evaluated the utility of measuring plasma endotoxin level for the rapid and sensitive diagnosis of gram-negative bacteremia. Subjects were 112 febrile(more than 38 degrees C) patients suspected of having bacterial infection and 170 samples were collected. Venous blood was obtained aseptically before administering antibiotics. Blood culture and endotoxin assays were performed simultaneously with these materials. Plasma endotoxin levels were positive in 64 samples when the cut off index was postulated at 0.35 pg/ml, while only 5 samples when the cut off index was postulated at 5 pg/ml. When the cut off index was at 0.35 pg/ml, sensitivity was 86%, while it was 14% when the cut off index was 5 pg/ml. Gram-negative rods(GNR) were detected by blood culture in 14 cases and the average period to detect GNR was 14.8 hours. The presence of circulating viable bacteria is diagnosed by blood culture, but because of the serious consequence of bacterial sepsis, treatment is initiated even in the absence of an identifiable organism. Since plasma endotoxin level can be assayed in about 2 hours, it will be more practical if we adjust the cut off index according to the clinical situation.

摘要

使用一种新型超敏试剂,我们评估了检测血浆内毒素水平对革兰氏阴性菌血症进行快速灵敏诊断的效用。研究对象为112名疑似细菌感染的发热(体温超过38摄氏度)患者,并采集了170份样本。在使用抗生素之前无菌采集静脉血。同时对这些样本进行血培养和内毒素检测。当临界值设定为0.35 pg/ml时,64份样本的血浆内毒素水平呈阳性,而当临界值设定为5 pg/ml时,只有5份样本呈阳性。当临界值为0.35 pg/ml时,灵敏度为86%,而当临界值为5 pg/ml时,灵敏度为14%。血培养检测出14例革兰氏阴性杆菌(GNR),检测出GNR的平均时间为14.8小时。血培养可诊断循环中活菌的存在,但由于细菌性败血症后果严重,即使在未鉴定出病原体的情况下也会开始治疗。由于血浆内毒素水平检测大约需要两小时,如果根据临床情况调整临界值,将会更加实用。

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