运用快速尿液筛查试验诊断巴西东北部肝硬化患者的自发性细菌性腹膜炎
Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients in northeastern Brazil by use of rapid urine-screening test.
作者信息
Braga Lucia Libanez Bessa Campelo, Souza Marcellus Henrique Loiola Ponte de, Barbosa Alzira Maria de Castro, Furtado Felipe Magalhães, Campelo Paula Andréa Maia, Araújo Filho Antônio Haroldo de
机构信息
Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Rua Professor Costa Mendes 1.608, CEP 60436-170 Fortaleza, Ceará, Brazil.
出版信息
Sao Paulo Med J. 2006 May 4;124(3):141-4. doi: 10.1590/s1516-31802006000300006.
CONTEXT AND OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhotic patients with ascites. It has been proposed that the reagent strip for leukocyte esterase designed for the testing of urine (Combur test UX) could be a useful tool for diagnosing SPB. The aim of this study was to assess the sensitivity and specificity of urine test strips for diagnosing SBP in cirrhotic patients with ascites.
DESIGN AND SETTING
Prospective study, at a university hospital in northeastern Brazil.
METHODS
Forty-two unselected consecutive cirrhotic patients (32 males; mean age: 51.7 +/- years) were included, and a total of 100 paracenteses were performed. All ascitic fluid samples were analyzed using the reagent strip and cytology, neutrophils, lymphocyte count, appropriate biochemical tests and culturing. The strips were considered positive if the color became purple on a colorimetric scale.
RESULTS
Nine patients were diagnosed with SBP using cytology (> 250 neutrophils/mm(3)), and the strips were positive for all these nine patients with SBP. In one sample, the strip was positive but the neutrophil count was less than 250 cells/mm(3). For 86 samples, both the strips and cytology were negative. At the threshold of 250 neutrophils/mm(3) in ascitic fluid, the sensitivity, specificity, positive predictive value and negative predictive value for the strips were respectively 100%, 98.9%, 92.3% and 100%.
CONCLUSION
The Combur test UX urine screening test is a very sensitive and specific method for diagnosing SBP in cirrhotic patients with ascites.
背景与目的
自发性细菌性腹膜炎（SBP）是肝硬化腹水患者常见且严重的并发症。有人提出，用于尿液检测的白细胞酯酶试剂条（Combur test UX）可能是诊断SBP的有用工具。本研究的目的是评估尿液检测条对肝硬化腹水患者SBP诊断的敏感性和特异性。
设计与地点
前瞻性研究，在巴西东北部的一家大学医院进行。
方法
纳入42例未经选择的连续肝硬化患者（32例男性；平均年龄：51.7±岁），共进行了100次腹腔穿刺术。所有腹水样本均使用试剂条进行分析，并进行细胞学、中性粒细胞、淋巴细胞计数、适当的生化检测和培养。如果比色时颜色变为紫色，则试剂条被视为阳性。
结果
9例患者通过细胞学诊断为SBP（中性粒细胞>250/mm³），这9例SBP患者的试剂条均为阳性。在1个样本中，试剂条为阳性，但中性粒细胞计数低于250个细胞/mm³。对于86个样本，试剂条和细胞学检查均为阴性。在腹水中性粒细胞阈值为250/mm³时，试剂条的敏感性、特异性、阳性预测值和阴性预测值分别为100%、98.9%、92.3%和100%。
结论
Combur test UX尿液筛查试验是诊断肝硬化腹水患者SBP的一种非常敏感和特异的方法。
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