试剂条可有效排除肝硬化患者的自发性细菌性腹膜炎。

Reagent strips are efficient to rule out spontaneous bacterial peritonitis in cirrhotics.

作者信息

Oey R C, Kuiper J J, van Buuren H R, de Man R A

机构信息

Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.

出版信息

Neth J Med. 2016 Jul;74(6):257-61.

PMID:27571723

Abstract

BACKGROUND

The gold standard to diagnose spontaneous bacterial peritonitis (SBP) is a polymorphonuclear neutrophil count ≥ 250 cells/µl in ascitic fluid. This test is laborious and expensive. Urine reagent strips measuring leukocyte esterase activity have been proposed as a rapid and inexpensive alternative. The aim of this study was to assess the diagnostic accuracy of the Combur reagent strip for diagnosing SBP. Furthermore the possible advantage of a photospectrometer reading over visual reading of the strip was investigated.

METHODS

This prospective study includes all ascitic fluid samples of cirrhotic patients undergoing diagnostic or therapeutic paracentesis over a 12-month period. The samples were collected for the standard diagnostic work-up and in addition tested with a bedside Combur reagent strip. The strip was read visually and with an automated spectrometer.

RESULTS

A total of 157 samples were obtained from 53 patients, and spontaneous bacterial peritonitis was diagnosed in 12 patients based on the ascitic polymorphonuclear neutrophil count. The sensitivity, specificity, positive predictive value and negative predictive value of the reagent strip according to the photospectrometer were 100%, 93%, 55% and 100% respectively, and 75%, 99%, 82% and 98%, respectively, for visual interpretation. The diagnostic accuracy of the photospectrometer was found to be higher than visual interpretation (p = 0.007).

CONCLUSION

The diagnostic accuracy of leucocyte esterase reagent strips read out by a photospectrometer was comparable with the gold standard test and was excellent for excluding SBP. Our results support implementation of reagent strips in the diagnostic work-up of ascitic fluid.

摘要

背景

诊断自发性细菌性腹膜炎（SBP）的金标准是腹水多形核中性粒细胞计数≥250个细胞/微升。该检测既费力又昂贵。有人提出用检测白细胞酯酶活性的尿试剂条作为一种快速且廉价的替代方法。本研究的目的是评估Combur试剂条诊断SBP的诊断准确性。此外，还研究了用光谱仪读数相对于试剂条目视读数可能具有的优势。

方法

这项前瞻性研究纳入了在12个月期间接受诊断性或治疗性腹腔穿刺术的肝硬化患者的所有腹水样本。采集样本用于标准诊断检查，此外还用床边Combur试剂条进行检测。试剂条采用目视读数和自动光谱仪读数。

结果

共从53例患者中获取了157份样本，根据腹水多形核中性粒细胞计数诊断出12例自发性细菌性腹膜炎。根据光谱仪检测，试剂条的灵敏度、特异性、阳性预测值和阴性预测值分别为100%、93%、55%和100%，目视判读时分别为75%、99%、82%和98%。发现光谱仪的诊断准确性高于目视判读（p = 0.007）。