Honar Naser, Geramizadeh Bita, Dehghani Seyed-Mohsen, Kalvandi Gholamreza, Shahramian Iraj, Rahmani Asghar, Javaherizadeh Hazhir
Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, IR.
Gastroenterohepatology Research Center|Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, IR.
Arq Gastroenterol. 2015 Jul-Sep;52(3):195-9. doi: 10.1590/S0004-28032015000300008.
Spontaneous bacterial peritonitis is defined as an ascetic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate; therefore, early diagnosis and treatment of spontaneous bacterial peritonitis is necessary for survival. Leukocyte esterase reagent can rapidly diagnose the spontaneous bacterial peritonitis.
This study aimed to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis.
A single centered hospital-based cross-sectional study was conducted during July 2013 to August 2014 on children with cirrhotic liver disease and ascites who were admitted in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated to Shiraz University of Medical Sciences (Iran). All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (Combiscreen SL10) and culture. Spontaneous bacterial peritonitis was defined as having a polymorphonuclear count (PMN ≥250/m3) in ascitic fluid. Sensitivity, specificity, positive predictive value and negative predictive value of leukocyte esterase test were calculated according to the formula.
Totally, 150 ascitic fluid sample of cirrhotic male patients (53.2%) and their mean age (4.33±1.88 years) were analyzed. Biliary atresia (n=44, 29.4%) and idiopathic neonatal hepatitis (n=29, 19.3%) were the most frequent etiology of cirrhosis. Also, abdominal pain (68.6%) and distension (64%) were the most common presenting complaint. Of all cases, 41 patients (27.35%) were diagnosed to have spontaneous bacterial peritonitis (PMN ≥250/mm3). Sensitivity and specificity of leukocyte esterase reagent test according to PMNs ≥250 mm3 were 87.80% and 91.74%, also on ascitic fluid culture results were 88.23% and 77.44%. Positive predictive value and negative predictive value of this test in PMNs ≥250 mm3 were 80% and 95.23% and in cases with positive culture 33.33% and 98.09% were obtained, respectively. Efficiency of leukocyte esterase reagent test in diagnosing spontaneous bacterial peritonitis, according to PMNs ≥250 mm3 and culture results were 90.66% and 78.66%.
The leukocyte esterase strip test may be used as rapid test for diagnosis of spontaneous bacterial peritonitis due to its high diagnostic validity.
自发性细菌性腹膜炎被定义为腹水感染且无明显的腹腔内外科可治疗性病因。自发性细菌性腹膜炎是肝硬化腹水患者的严重并发症之一。若不进行早期抗生素治疗，该并发症的死亡率很高；因此，早期诊断和治疗自发性细菌性腹膜炎对患者存活至关重要。白细胞酯酶试剂可快速诊断自发性细菌性腹膜炎。
本研究旨在探讨白细胞酯酶试纸条检测对自发性细菌性腹膜炎的诊断准确性。
2013年7月至2014年8月，在设拉子医科大学附属内马齐医院儿科胃肠病科，对肝硬化腹水患儿进行了一项单中心医院横断面研究。所有患者均接受腹腔穿刺，腹水进行细胞计数、白细胞酯酶试剂条检测（Combiscreen SL10）及培养。自发性细菌性腹膜炎定义为腹水多形核白细胞计数（PMN≥250/m3）。根据公式计算白细胞酯酶检测的敏感性、特异性、阳性预测值和阴性预测值。
共分析了150份肝硬化男性患者的腹水样本（53.2%），平均年龄为（4.33±1.88岁）。胆汁淤积性肝病（n=44，29.4%）和特发性新生儿肝炎（n=29，19.3%）是肝硬化最常见的病因。此外，腹痛（68.6%）和腹胀（64%）是最常见的就诊主诉。所有病例中，41例（27.35%）被诊断为自发性细菌性腹膜炎（PMN≥250/mm3）。根据PMN≥250 mm3计算白细胞酯酶试剂检测的敏感性和特异性分别为87.80%和91.74%，根据腹水培养结果分别为88.23%和77.44%。该检测在PMN≥250 mm3时的阳性预测值和阴性预测值分别为80%和95.23%，在培养阳性病例中的阳性预测值和阴性预测值分别为33.33%和98.09%。根据PMN≥250 mm3和培养结果计算白细胞酯酶试剂检测诊断自发性细菌性腹膜炎的效率分别为90.66%和78.66%。
白细胞酯酶试纸条检测因其较高的诊断有效性，可作为诊断自发性细菌性腹膜炎的快速检测方法。
