Elin R J, Knowles R, Barth W F, Wolff S M
J Infect Dis. 1978 May;137(5):507-13. doi: 10.1093/infdis/137.5.507.
The diagnosis of pyogenic arthritis may be difficult to confirm since culture results are sometimes negative. This study attempted to evaluate the utility of the limulus lysate assay for the early detection of pyogenic arthritis due to gram-negative organisms. Seven-one specimens of synovial fluid from 46 patients were evaluated for reactivity in the limulus test, pyrogenic responses in rabbits, total white blood cell count, total neutrophil count, total red blood cell count, and protein and glucose concentrations. All patients with culture-proven septic arthritis or presumptive septic arthritis had joint fluid specimens that yielded a positive result in the limulus assay (12 patients). However, 52.9% of patients (18 of 34) who had a nonseptic cause for their joint effusion also had a joint fluid specimen that was positive in the limulus test. A positive limulus test result showed a significant correlation with an elevated total white blood cell count (P less than 0.0005), an elevated absolute neutrophil count (P less than 0.0005), and a decreased concentration of glucose (P less than 0.005) in synovial fluid, and the production of fever in rabbits after injection of synovial fluid (P less than 0.05). Thus, this study suggests that a positive result in the limulus test on joint fluid is nonspecific for a septic process, but a negative result would be evidence against it.
由于培养结果有时为阴性，化脓性关节炎的诊断可能难以确定。本研究试图评估鲎试剂检测法在早期检测革兰氏阴性菌所致化脓性关节炎中的作用。对46例患者的71份滑液标本进行了鲎试剂检测反应性、家兔发热反应、白细胞总数、中性粒细胞总数、红细胞总数以及蛋白质和葡萄糖浓度的评估。所有经培养证实为化脓性关节炎或疑似化脓性关节炎的患者，其关节液标本在鲎试剂检测中均呈阳性结果（12例患者）。然而，52.9%（34例中的18例）关节积液由非感染性原因引起的患者，其关节液标本在鲎试剂检测中也呈阳性。鲎试剂检测结果呈阳性与滑液中白细胞总数升高（P小于0.0005）、中性粒细胞绝对计数升高（P小于0.0005）、葡萄糖浓度降低（P小于0.005）以及注射滑液后家兔发热（P小于0.05）显著相关。因此，本研究表明，关节液鲎试剂检测结果呈阳性对感染性过程无特异性，但阴性结果可作为排除感染性过程的证据。
