Omar Mohamed, Ettinger Max, Reichling Moritz, Petri Maximilian, Lichtinghagen Ralf, Guenther Daniel, Suero Eduardo M, Jagodzinski Michael, Krettek Christian
Trauma Department (M.O., M.E., M.R., M.P., D.G., E.M.S., M.J., and C.K) and Institute of Clinical Chemistry (R.L.), Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany. E-mail address for M. Omar:
J Bone Joint Surg Am. 2014 Dec 17;96(24):2032-7. doi: 10.2106/JBJS.N.00173.
Most currently used tools to diagnose septic arthritis are either not readily available or fail to provide real-time results. Reagent strip tests have identified infections in various body fluids. We hypothesized that combined leukocyte esterase and glucose strip tests can aid in diagnosing septic arthritis in native synovial fluid because (1) leukocyte esterase concentrations would be elevated at the infection site because of secretion by recruited neutrophils, and (2) glucose concentrations would be reduced because of bacterial metabolism.
We prospectively investigated synovial fluid from consecutive patients with an atraumatic joint effusion who underwent arthrocentesis in our emergency department during a one-year period. Leukocyte esterase and glucose strip tests were performed on the synovial fluid. Synovial fluid leukocyte count, crystal analysis, Gram staining, culture, and glucose concentration results were also assessed.
Nineteen fluids were classified as septic and 127 as aseptic. Considering septic arthritis to be present when the leukocyte esterase reading was positive (++ or +++) and the glucose reading was negative (-) yielded a sensitivity of 89.5% (95% confidence interval [CI], 66.9% to 98.7%), specificity of 99.2% (95% CI, 95.7% to 99.9%), positive predictive value of 94.4% (95% CI, 72.7% to 99.9%), negative predictive value of 98.4% (95% CI, 94.5% to 99.8%), positive likelihood ratio of 114, and negative likelihood ratio of 0.11. The synovial leukocyte counts and polymorphonuclear cell percentages were consistent with the semiquantitative readings on the leukocyte esterase strip tests, and the glucose concentrations were consistent with the glucose strip test results.
Combined leukocyte esterase and glucose strip tests can be a useful additional tool to help confirm or rule out a diagnosis of septic arthritis.
目前大多数用于诊断化脓性关节炎的工具要么不易获得，要么无法提供实时结果。试剂条检测已在各种体液中检测出感染。我们推测，联合白细胞酯酶和葡萄糖试纸检测有助于诊断天然滑液中的化脓性关节炎，原因如下：（1）由于募集的中性粒细胞分泌，感染部位的白细胞酯酶浓度会升高；（2）由于细菌代谢，葡萄糖浓度会降低。
我们前瞻性地研究了在一年期间于我们急诊科接受关节穿刺术的连续性非创伤性关节积液患者的滑液。对滑液进行白细胞酯酶和葡萄糖试纸检测。还评估了滑液白细胞计数、晶体分析、革兰氏染色、培养及葡萄糖浓度结果。
19份滑液被分类为感染性，127份为无菌性。当白细胞酯酶读数为阳性（++或++++）且葡萄糖读数为阴性（-）时诊断为化脓性关节炎，其敏感性为89.5%（95%置信区间[CI]，66.9%至98.7%），特异性为99.2%（95%CI，95.7%至99.9%），阳性预测值为94.4%（95%CI，72.7%至99.9%），阴性预测值为98.4%（95%CI，94.5%至99.8%），阳性似然比为114，阴性似然比为0.11。滑液白细胞计数和多形核细胞百分比与白细胞酯酶试纸检测的半定量读数一致，葡萄糖浓度与葡萄糖试纸检测结果一致。
联合白细胞酯酶和葡萄糖试纸检测可作为一种有用的辅助工具，有助于确诊或排除化脓性关节炎的诊断。
