Balagopal Sithara K, Sainu Ashik, Thomas Varghese
Department of Gastroenterology, Calicut Medical College, Kerala, India.
Indian J Gastroenterol. 2010 Mar;29(2):74-7. doi: 10.1007/s12664-010-0017-0. Epub 2010 May 5.
Spontaneous bacterial peritonitis (SBP) is a common serious complication of cirrhosis, and carries a high morbidity and mortality. Rapid diagnosis and prompt treatment of this condition may improve survival of such patients.
To validate the diagnostic efficacy of a leukocyte esterase reagent (LER) strip test for rapid, bedside diagnosis of SBP.
We prospectively studied 175 patients with liver cirrhosis and ascites [mean age 48 (SD 16.4) years; 146 men] between August 2007 and December 2008. Alcohol was the most common (124 of 175; 70.8%) cause of liver cirrhosis. All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, LER strip (Magistik 10) test and culture. Two different cut-offs for calling the LER strip test positive were tried, namely when the color turned light blue [grade 2: >125 polymorphonuclear leucocytes (PMNL)/microL] or it turned purple (grade 3: >500 PMNL/microL). Sensitivity, specificity, positive predictive value, negative predictive value were calculated, using PMN count by microscopy exceeding 250 PMNL/microL.
LER strip using the more stringent purple-color cut off to diagnose SBP had a sensitivity of 92% and specificity of 100%. The corresponding figures using the light-blue color cut-off were 97% and 89%, respectively.
LER strip testing of ascitic fluid is a rapid, cheap and sensitive bed side tool for the diagnosis of SBP.
自发性细菌性腹膜炎(SBP)是肝硬化常见的严重并发症,发病率和死亡率高。快速诊断并及时治疗该病可提高此类患者的生存率。
验证白细胞酯酶试剂(LER)试纸条检测对SBP进行快速床旁诊断的效能。
我们对2007年8月至2008年12月期间的175例肝硬化腹水患者[平均年龄48(标准差16.4)岁;男性146例]进行了前瞻性研究。酒精是肝硬化最常见的病因(175例中的124例,占70.8%)。所有患者均接受腹腔穿刺,对腹水进行细胞计数、LER试纸条(Magistik 10)检测和培养。尝试了两种不同的判定LER试纸条检测为阳性的临界值,即颜色变为浅蓝色时[2级:多形核白细胞(PMN)>125/微升]或变为紫色时(3级:PMN>500/微升)。以显微镜下PMN计数超过250/微升为标准,计算敏感性、特异性、阳性预测值、阴性预测值。
使用更严格的紫色临界值诊断SBP时,LER试纸条的敏感性为92%,特异性为100%。使用浅蓝色临界值时,相应数字分别为97%和89%。
腹水LER试纸条检测是一种快速、廉价且敏感的SBP床旁诊断工具。