Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy.
Clin Chim Acta. 2013 Mar 15;418:59-62. doi: 10.1016/j.cca.2012.12.020. Epub 2013 Jan 12.
Manual microscopy remains the gold standard for enumeration and classification of nucleated cells in peritoneal fluids, especially for diagnosing bacterial peritonitis. However, this approach carries several drawbacks, so that the use of simple and automated tests may be a viable option for initial screening of peritoneal fluids.
Neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase (LDH), proteins and glucose were assessed in peritoneal fluids from patients with new onset nonmalignant ascites, along with nucleated cell count and differentiation.
One hundred and eleven specimens were analyzed, 26 of which (23%) with polymorphonuclear leukocyte (PMN) count≥250/μL, thus compatible with bacterial peritonitis. The median concentration of LDH and NGAL was 3.4 and 3.7-fold higher in samples with ≥250 PMN/μL. The concentration of proteins was also higher in samples with ≥250 PMN/μL, whereas that of glucose was lower. The PMN count significantly correlated with peritoneal fluid values of LDH (r=0.859), NGAL (r=0.774) and proteins (r=0.268), but not with glucose (r=-0.069). The area under ROC curve was 0.88 for LDH, 0.89 for NGAL and 0.94 for their combination (both tests positive), whereas that of proteins and glucose was 0.80 and 0.71, respectively. Sensitivities and specificities were 0.81 and 0.87 for LDH≥227 U/L, 0.96 and 0.75 for NGAL≥120 ng/mL, 0.77 and 0.95 for their combination. The agreement with PMN count was 0.86 for LDH, 0.80 for NGAL, and 0.91 for their combination.
These results suggest that assessment of NGAL in peritoneal fluids, especially in combination with LDH, may be a reliable approach for screening of bacterial peritonitis in patients with new onset nonmalignant ascites.
手动显微镜仍然是计数和分类腹腔液有核细胞的金标准，特别是用于诊断细菌性腹膜炎。然而，这种方法有几个缺点，因此使用简单和自动化的测试可能是初步筛选腹腔液的可行选择。
评估了新发生非恶性腹水患者的腹腔液中的中性粒细胞明胶酶相关脂质运载蛋白 (NGAL)、乳酸脱氢酶 (LDH)、蛋白质和葡萄糖，并进行了有核细胞计数和分化。
分析了 111 份标本，其中 26 份（23%）中性粒细胞计数≥250/μL，因此符合细菌性腹膜炎。PMN 计数≥250/μL 的样本中 LDH 和 NGAL 的中位数浓度分别高 3.4 和 3.7 倍。PMN 计数≥250/μL 的样本中蛋白质浓度也较高，而葡萄糖浓度较低。PMN 计数与 LDH（r=0.859）、NGAL（r=0.774）和蛋白质（r=0.268）的腹腔液值显著相关，但与葡萄糖无关（r=-0.069）。LDH 的 ROC 曲线下面积为 0.88，NGAL 为 0.89，两者联合检测为 0.94（两种检测均为阳性），而蛋白质和葡萄糖的曲线下面积分别为 0.80 和 0.71。LDH≥227 U/L 的灵敏度和特异性分别为 0.81 和 0.87，NGAL≥120ng/mL 的灵敏度和特异性分别为 0.96 和 0.75，两者联合检测的灵敏度和特异性分别为 0.77 和 0.95。与PMN 计数的一致性分别为 LDH 的 0.86、NGAL 的 0.80 和两者联合检测的 0.91。
这些结果表明，评估腹腔液中的 NGAL，特别是与 LDH 联合评估，可能是筛查新发生非恶性腹水患者细菌性腹膜炎的可靠方法。
