尿液试剂条检测脑脊液化学和细胞成分的诊断准确性。
Diagnostic accuracy of urinary reagent strip to determine cerebrospinal fluid chemistry and cellularity.
作者信息
Joshi Deepti, Kundana Keerthi, Puranik Apurva, Joshi Rajnish
机构信息
Department of Pathology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India.
出版信息
J Neurosci Rural Pract. 2013 Apr;4(2):140-5. doi: 10.4103/0976-3147.112737.
BACKGROUND
The gold standard for diagnosis of meningitis depends on cerebrospinal fluid (CSF) examination by microscopy, biochemistry, and culture, which require an experienced microscopist and laboratory support. We conducted this study to determine if urinary reagent strip is useful to make a semi-quantitative assessment of protein, glucose, and presence of leukocyte esterase in CSF.
MATERIALS AND METHODS
All consecutive CSF samples were evaluated in a blinded fashion. CSF was tested using Combur-10 urinary reagent strip as an index test, and CSF microscopy and biochemistry as reference standards. Combur-10 (Boehringer Mannheim) is a urinary reagent strip used to estimate ten parameters including protein, glucose, and leukocytes. We estimated diagnostic accuracy of each index test using corresponding cut-off levels (glucose 1 + vs. CSF glucose >50 mg/dL; protein 1 + and 2 + vs. CSF protein >30 mg/dL and >100 mg/dL; leukocyte esterase positivity vs. >10 granulocytes in CSF sample). We constructed receiver operating curves (ROC) to evaluate overall performance of index tests and estimated area under the curve (AUC).
RESULTS
CSF samples of 75 patients were included in the study. All the three indicator tests (CSF cells, protein, and glucose) were normal in 17 (22.6%) samples. Of the three tests, diagnostic accuracy of protein estimation (1 + or more on reagent strip) was best for detection of CSF proteins greater than 30 mg/dL [sensitivity 98.1% (95% CI 90.1-100%); specificity 57.1% (95% CI 34-78.2%)], with AUC of 0.97. Sensitivity and specificity for 2 + on reagent strip and CSF protein > 100 mg/dL were 92.6% (95% CI 75.1-99.1) and 87.5% (95% CI 74.8-95.3), respectively, with AUC of 0.96 (95% CI 0.92-1.01). Leukocyte esterase positivity by test strip had a sensitivity of 85.2 (95% CI 66.3-95.8%) and specificity of 89.6 (95% CI 77.3-96.5%) for detection of CSF granulocytes of more than 10/mm(3).
CONCLUSION
Existing urinary reagent strips can be used to diagnose meningitis in low-resource settings.
背景
脑膜炎诊断的金标准依赖于通过显微镜检查、生物化学和培养进行的脑脊液（CSF）检测，这需要经验丰富的显微镜检查人员和实验室支持。我们开展这项研究以确定尿试剂条是否有助于对脑脊液中的蛋白质、葡萄糖和白细胞酯酶进行半定量评估。
材料与方法
所有连续的脑脊液样本均采用盲法评估。使用Combur - 10尿试剂条检测脑脊液作为指标检测，脑脊液显微镜检查和生物化学检测作为参考标准。Combur - 10（勃林格殷格翰公司）是一种用于估计包括蛋白质、葡萄糖和白细胞在内的十个参数的尿试剂条。我们使用相应的临界值（葡萄糖1 + 对比脑脊液葡萄糖>50mg/dL；蛋白质1 + 和2 + 对比脑脊液蛋白质>30mg/dL和>100mg/dL；白细胞酯酶阳性对比脑脊液样本中>10个粒细胞）来估计每项指标检测的诊断准确性。我们构建受试者工作特征曲线（ROC）以评估指标检测的整体性能，并估计曲线下面积（AUC）。
结果
75例患者的脑脊液样本纳入本研究。17份（22.6%）样本的所有三项指标检测（脑脊液细胞、蛋白质和葡萄糖）均正常。在这三项检测中，对于检测脑脊液蛋白质大于30mg/dL，蛋白质估计（试剂条上显示1 + 或更高）的诊断准确性最佳[灵敏度98.1%（95%CI 90.1 - 100%）；特异性57.1%（95%CI 34 - 78.2%）]，AUC为0.97。试剂条上显示2 + 且脑脊液蛋白质>100mg/dL的灵敏度和特异性分别为92.6%（95%CI 75.1 - 99.1）和87.5%（95%CI 74.8 - 95.3），AUC为0.96（95%CI 0.92 - 1.01）。检测脑脊液中粒细胞超过10/mm³时，试纸条检测白细胞酯酶阳性的灵敏度为85.2（95%CI 66.3 - 95.8%），特异性为89.6（95%CI 77.3 - 96.5%）。
结论
现有的尿试剂条可用于资源匮乏地区的脑膜炎诊断。
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