Sellors J W, Mahony J B, Pickard L, Jang D, Groves D, Luinstra K E, Chernesky M A
Hamilton-Wentworth Department of Public Health Services, McMaster University, Hamilton, Ontario, Canada.
Sex Transm Dis. 1993 May-Jun;20(3):152-7. doi: 10.1097/00007435-199305000-00007.
The detection of asymptomatic urethritis using a leukocyte esterase (LE) strip may have a role in primary care screening to select men who need diagnostic testing for Chlamydia trachomatis and Neisseria gonorrhoeae.
Eight-hundred and eighty-two men, 16 to 35 years of age were studied when they attended their family physician or university health clinic for nongenitourinary complaints. First void urine (FVU) was tested by an LE strip (Chemstrip 2 LN, Boehringer Mannheim Corp., Indianapolis, IN), Chlamydiazyme (Abbott Laboratories, N. Chicago, IL) enzyme immunoassay with confirmatory blocking and polymerase chain reaction (PCR) with chlamydial plasmid primers.
Forty-five men (5.1%) were positive (> trace) by LE strip. Of the LE-positive urines, 9 (20.0%) were positive by EIA or PCR, and none of the LE-negatives were positive by EIA or PCR. Twenty-three LE positives (5 EIA/PCR-positive; 1 PCR-positive; 17 EIA/PCR-negative) were able to be followed with a second urine and 2 urethral swabs. All of the 6 chlamydia-positives who had follow-up tests were positive by both immunoassay and PCR on urine. Based on the FVU results, the prevalence of asymptomatic chlamydial infection was 1.0% (9/88) (95% CL, 0.5 to 1.9) for which the LE urine strip was 100% (9/9) sensitive and 95.9% (837/873) specific. Analyses based on screening 1,000 men, 16 to 25 years of age, showed that the cost per case detected was $192.00 using the LE strip (> 1+) to select urine specimens for EIA testing, compared to $1,326.00 using the EIA to test all urine specimens.
In this low prevalence, primary care setting, the LE urine strip was an accurate screening test, which if used to preselect urine specimens for subsequent chlamydial testing, would be less costly per case detected than assaying each specimen for chlamydia.
使用白细胞酯酶（LE）试纸检测无症状尿道炎可能在基层医疗筛查中发挥作用，以筛选出需要进行沙眼衣原体和淋病奈瑟菌诊断检测的男性。
882名年龄在16至35岁的男性因非泌尿生殖系统疾病就诊于家庭医生或大学健康诊所时接受了研究。首次晨尿（FVU）通过LE试纸（Chemstrip 2 LN，德国宝灵曼公司，印第安纳波利斯，印第安纳州）、衣原体酶免疫测定法（Chlamydiazyme，雅培实验室，伊利诺伊州北芝加哥）以及使用衣原体质粒引物的聚合酶链反应（PCR）进行检测。
45名男性（5.1%）LE试纸检测呈阳性（>微量）。在LE阳性尿液中，9例（20.0%）酶免疫测定法（EIA）或PCR检测呈阳性，而LE阴性者中无EIA或PCR检测呈阳性者。23例LE阳性者（5例EIA/PCR阳性；1例PCR阳性；17例EIA/PCR阴性）能够进行第二次尿液及2次尿道拭子检测。所有6例接受随访检测的衣原体阳性者尿液免疫测定法和PCR检测均呈阳性。基于FVU检测结果，无症状衣原体感染的患病率为1.0%（9/882）（95%可信区间，0.5至1.9），对于该患病率，LE尿试纸的敏感性为100%（9/9），特异性为95.9%（837/873）。对1000名年龄在16至25岁男性进行筛查的分析表明，使用LE试纸（>1+）选择尿液标本进行EIA检测时，每检测出一例的成本为192.00美元，而使用EIA检测所有尿液标本时，每检测出一例的成本为1326.00美元。
在这种低患病率的基层医疗环境中，LE尿试纸是一种准确的筛查检测方法，如果用于预先选择尿液标本进行后续衣原体检测，每检测出一例的成本低于对每个标本进行衣原体检测。
