Gaya Daniel R, David B Lyon T, Clarke Joanna, Jamdar Saranaz, Inverarity Donald, Forrest Ewan H, John Morris A, Stanley Adrian J
Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
Eur J Gastroenterol Hepatol. 2007 Apr;19(4):289-95. doi: 10.1097/MEG.0b013e328013e991.
Spontaneous bacterial peritonitis, a potentially fatal complication of cirrhotic ascites, is diagnosed when the polymorphonuclear leucocyte count in the ascitic fluid is>250/mm. Manual laboratory counting of ascitic polymorphonuclear leucocytes is, however, labour-intensive, costly, results in diagnostic delay and it is not available in all hospitals as part of the 'out-of-hours' service. Thus, a rapid diagnostic screening test for spontaneous bacterial peritonitis would be beneficial in this condition. An exciting new development in the diagnosis of spontaneous bacterial peritonitis is the use of bedside reagent strips; yet, concerns regarding the inherent subjectivity of result reading have prevented the widespread adoption of this technique in clinical practice.
To evaluate the combined use of a leucocyte esterase strip together with an objective portable spectrophotometric reading device in the diagnosis of spontaneous bacterial peritonitis when compared with standard manual laboratory polymorphonuclear leucocyte counting.
Nonselected cirrhotic patients undergoing diagnostic paracentesis had an ascitic sample sent for a conventional polymorphonuclear leucocyte count, Gram stain and culture. In addition, a sample was tested with a bedside Multistix 10SG reagent strip and the result was analysed by the Clinitek Status. The strip test was considered positive if it read anything other than negative (i.e. 'trace', '+1', '+2' or '+3').
The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the reagent strips to diagnose correctly spontaneous bacterial peritonitis when compared with the manual laboratory polymorphonuclear leucocyte count were 100, 91, 50, 100 and 92%, respectively.
Bedside leucocyte esterase strips, spectrophotometrically read, can reliably exclude spontaneous bacterial peritonitis in patients with cirrhotic ascites. In our series, a negative strip result effectively ruled out this important condition, and suggests that the requirement for manual polymorphonuclear leucocyte counting in this setting could be removed.
自发性细菌性腹膜炎是肝硬化腹水的一种潜在致命并发症，当腹水多形核白细胞计数>250/mm时可确诊。然而，手工实验室计数腹水多形核白细胞劳动强度大、成本高，会导致诊断延迟，而且并非所有医院都能在“非工作时间”服务中提供此项检测。因此，针对自发性细菌性腹膜炎的快速诊断筛查试验对此情况将大有裨益。自发性细菌性腹膜炎诊断方面一项令人兴奋的新进展是使用床边试剂条；然而，对结果判读内在主观性的担忧阻碍了该技术在临床实践中的广泛应用。
与标准手工实验室多形核白细胞计数相比，评估白细胞酯酶试纸条与客观便携式分光光度读数装置联合用于诊断自发性细菌性腹膜炎的效果。
接受诊断性腹腔穿刺术的非选择性肝硬化患者，其腹水样本送去进行常规多形核白细胞计数、革兰氏染色及培养。此外，用床边Multistix 10SG试剂条检测一份样本，并通过Clinitek Status分析仪分析结果。如果试纸条检测结果不是阴性（即“微量”“+1”“+2”或“+3”），则视为阳性。
与手工实验室多形核白细胞计数相比，试剂条正确诊断自发性细菌性腹膜炎的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为100%、91%、50%、100%和92%。
经分光光度法读数的床边白细胞酯酶试纸条能够可靠地排除肝硬化腹水患者的自发性细菌性腹膜炎。在我们的研究系列中，试纸条阴性结果可有效排除这一重要病症，这表明在此情况下可无需进行手工多形核白细胞计数。
