Nguyen-Khac E, Cadranel J F, Thevenot T, Nousbaum J B
Hepato-Gastroenterology, Amiens University Hospital, CHU Nord, place Victor Pauchet, France.
Aliment Pharmacol Ther. 2008 Aug 1;28(3):282-8. doi: 10.1111/j.1365-2036.2008.03735.x.
Spontaneous bacterial peritonitis (SBP) can be diagnosed via leucocyte esterase reagent strips, although diagnostic performances vary.
To perform critical review of literature on the use of reagent strips in SBP.
Nineteen studies were analysed (Medline search), comparing reagent strips in cirrhotic ascites vs. cytobacteriological methods. Diagnostic grades (G) were: GO = 0 leucocytes/mm3; G1 = 15; G2 = 70; G3 = 125; G4 = 500 for Multistix, GO = 0; G1 = 25; G2 = 75; G3 = 500 for Nephur, Combur, UriScan, and GO = 0; G1 = 25; G2 = 75; G3 = 250; G4 = 500 for Aution.
Medians per study were: 75 patients (range: 31-1041), 136 ascites (47-2123), 17 SBP (5-117). For Multistix (12 studies), the sensitivities fell within the ranges 64.7-100% (G > or = 1), 45.7-83% (G > or = 2) and 45.3-89% (G > or = 3). For Nephur (n = 2), Combur (n = 6), UriScan (n = 1), sensitivities ranged 80.4-100% (G > or = 1), 63-100% (G > or = 2) and 67.7-97% (G > or = 3). For Aution (n = 3), sensitivities ranged 93-96% (G > or = 2) and 89% (G > or = 3). Nephur, Combur, UriScan displayed higher sensitivities than Multistix. However, in larger studies, sensitivities dramatically fell at 45.3% for Multistix (G > or = 3) if ascites polymorphonuclear count <1000/mm3 and 22.2% for bacterascites or 16.7-25% for asymptomatic patients.
Use of reagent strips for the diagnosis of SBP cannot be recommended, in view of low sensitivity and a high risk of false negatives, especially in patients with SBP and low polymorphonuclear count.
尽管诊断性能有所不同，但自发性细菌性腹膜炎（SBP）可通过白细胞酯酶试剂条进行诊断。
对关于试剂条在SBP诊断中的应用的文献进行批判性综述。
分析了19项研究（通过医学文献数据库检索），比较了肝硬化腹水患者使用试剂条与细胞细菌学方法的情况。诊断分级（G）为：对于尿十项试纸条，G0 = 0个白细胞/mm³；G1 = 15；G2 = 70；G3 = 125；G4 = 500；对于Nephur、Combur、UriScan试纸条，G0 = 0；G1 = 25；G2 = 75；G3 = 500；对于Aution试纸条，G0 = 0；G1 = 25；G2 = 75；G3 = 250；G4 = 500。
每项研究的中位数为：75例患者（范围：31 - 1041），136份腹水样本（47 - 2123），以及17例SBP患者（5 - 117）。对于尿十项试纸条（12项研究），敏感性范围为64.7 - 100%（G≥1）、45.7 - 83%（G≥2）和45.3 - 89%（G≥3）。对于Nephur（2项研究）、Combur（6项研究）、UriScan（1项研究），敏感性范围为80.4 - 100%（G≥1）、63 - 100%（G≥2）和67.7 - 97%（G≥3）。对于Aution（3项研究），敏感性范围为93 - 96%（G≥2）和89%（G≥3）。Nephur、Combur、UriScan试纸条显示出比尿十项试纸条更高的敏感性。然而，在更大规模的研究中，如果腹水多形核细胞计数<1000/mm³，尿十项试纸条（G≥3）的敏感性急剧下降至45.3%，对于菌腹水患者为22.
