Chugh Kiran, Agrawal Yuthika, Goyal Vipin, Khatri Vinod, Kumar Pradeep
Department of Biochemistry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Department of Chest and TB, Shree Guru Gobind Singh Tricentenary Medical College, Budhera, Gurgaon, Haryana, India.
Int J Crit Illn Inj Sci. 2015 Jan-Mar;5(1):32-7. doi: 10.4103/2229-5151.152337.
Spontaneous bacterial peritonitis (SBP) requires rapid diagnosis for the initiation of antibiotics. Its diagnosis is usually based on manual examination of ascitic fluid (AF) having long reporting time. AF infection is diagnosed when the fluid polymorphonuclear leukocyte (PMNL) concentration ≥250 cells/mm(3).
Aim was to evaluate the diagnostic utility of leukocyte esterase (LE) reagent strip for rapid diagnosis of SBP in patients who underwent abdominal paracentesis and to calculate the sensitivity, specificity, positive, and negative predictive values.
The study was carried out on 103 patients with ascites. Cell count of AF as determined by colorimetric scale of Multistix 10 SG reagent strip was compared with counting chamber method (PMNL count ≥250 cells/mm(3) was considered positive).
Of the 103 patients SBP was diagnosed in 20 patients, 83 patients were negative for SBP by manual cell count. The sensitivity and specificity of the LE test for detecting neutrocytic SBP taking grade 2 as cut off were 95% and 96.4% respectively, with a positive predictive value of 86.4% and a negative predictive value of 98.8%. Diagnostic accuracy of LE test was 96.1%.
There was a good correlation between the reagent strip result and PMNL count. The LE strip test is based on the esterase activity of activated granulocytes which reacts with an ester-releasing hydroxyphenylpyrrole causing a colour change in the azo dye of reagent strip. It is a very sensitive and specific method for the prompt detection of elevated PMNL count, and represents a convenient, inexpensive, simple, and bedside method for diagnosis of SBP. A negative LE test result excludes SBP with a high degree of certainty.
自发性细菌性腹膜炎（SBP）需要快速诊断以便开始使用抗生素。其诊断通常基于对腹水（AF）的人工检查，报告时间较长。当腹水多形核白细胞（PMNL）浓度≥250个细胞/mm³时，诊断为AF感染。
评估白细胞酯酶（LE）试剂条在接受腹腔穿刺术患者中快速诊断SBP的诊断效用，并计算敏感性、特异性、阳性和阴性预测值。
对103例腹水患者进行研究。将通过Multistix 10 SG试剂条比色法测定的AF细胞计数与计数室法进行比较（PMNL计数≥250个细胞/mm³被视为阳性）。
103例患者中，20例被诊断为SBP，83例通过人工细胞计数SBP为阴性。以2级为临界值，LE检测中性粒细胞性SBP的敏感性和特异性分别为95%和96.4%，阳性预测值为86.4%，阴性预测值为98.8%。LE检测的诊断准确性为96.1%。
试剂条结果与PMNL计数之间存在良好的相关性。LE试纸条检测基于活化粒细胞的酯酶活性，其与释放酯的羟基苯基吡咯反应，导致试纸条偶氮染料颜色变化。这是一种非常敏感和特异的方法，可迅速检测PMNL计数升高，是一种方便、廉价、简单的床边诊断SBP的方法。LE检测结果为阴性可高度确定排除SBP。
