Mazumder Sujaya, Ramya B S, Biligi Dayananda S
Department of Pathology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Indian J Pathol Microbiol. 2018 Jul-Sep;61(3):356-359. doi: 10.4103/IJPM.IJPM_821_16.
The provision of initial treatment to a patient with suspected meningitis depends greatly on early recognition and rapid diagnostic evaluation of cerebrospinal fluid (CSF) leukocytes, proteins, and glucose. The diagnosis is time critical and timely intervention has an implication on the prognosis and outcome. Reasonably, sound laboratorial setups are not available in our country in the primary health-care level and, even in the settings where they are available, long waiting periods precede the availability of results.
We conducted this study to emphasize the role of urine reagent strip test as a rapid diagnostic tool in CSF analysis.
: This is a prospective single-blinded study on 100 consecutive CSF samples received with in 1h of tap.
All the 100 samples were subjected to definitive test being CSF microscopy and biochemical analysis of proteins and sugar and index test being a semi quantitative analysis of CSF leukocytes, proteins, and sugar by urinary reagent strips.
The diagnostic accuracy of the reagent strip for different cutoff levels was estimated and tabulated in the form of sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio.
77% of cases were in the pediatric age group and 23% cases were adults. The sensitivity and specificity for leukocytes by the strip method for ≥15 cells/cumm were 89.28% and 98.61%, respectively, which increased to 100% with an increase in the counts. The reagent strip test had a sensitivity of 85.71% and a specificity of 95.65% for the protein levels >30 mg/dl which increased to 100% with an increase in protein levels. The reagent strip test for glucose was highly specific (100%) but less sensitive.
The results indicate that urine reagent strip is instrumental in bedside CSF analysis and has a future stand in the diagnosis of meningitis.
对疑似脑膜炎患者进行初始治疗很大程度上取决于对脑脊液（CSF）白细胞、蛋白质和葡萄糖的早期识别及快速诊断评估。该诊断对时间要求严格，及时干预对预后和结局有影响。合理地讲，我国基层医疗卫生机构没有完善的实验室设施，即使在有这些设施的地方，获得检测结果也需要很长的等待时间。
我们开展这项研究以强调尿液试纸条检测作为脑脊液分析快速诊断工具的作用。
这是一项前瞻性单盲研究，对连续100份在穿刺后1小时内收到的脑脊液样本进行研究。
所有100份样本均接受作为确诊检测的脑脊液显微镜检查以及蛋白质和糖的生化分析，作为指标检测的是通过尿液试纸条对脑脊液白细胞、蛋白质和糖进行半定量分析。
以灵敏度、特异度、阳性预测值、阴性预测值和似然比的形式估计并列出不同临界值下试纸条的诊断准确性。
77%的病例为儿童年龄组，23%为成人。当白细胞计数≥15个/立方毫米时，试纸条法检测白细胞的灵敏度和特异度分别为89.28%和98.61%，随着计数增加，灵敏度和特异度均增至100%。当蛋白质水平>30毫克/分升时，试纸条检测的灵敏度为85.71%，特异度为95.65%，随着蛋白质水平增加，灵敏度和特异度均增至100%。葡萄糖试纸条检测具有高度特异性（100%）但灵敏度较低。
结果表明尿液试纸条有助于床边脑脊液分析，在脑膜炎诊断中具有应用前景。
