Huicho L, Garaycochea V, Uchima N, Zerpa R, Guerrant R L
Instituto de Salud del Niño, Lima, Peru.
Pediatr Infect Dis J. 1997 Jul;16(7):644-7. doi: 10.1097/00006454-199707000-00004.
To compare fecal screening tests in the diagnostic approach to childhood invasive diarrhea.
We assessed 125 consecutive children with acute diarrhea for fecal lactoferrin, fecal leukocytes and occult blood from November, 1995, to June, 1996.
Lactoferrin showed a greater overall sensitivity than fecal leukocytes or occult blood for detecting invasive pathogens. Combinations of lactoferrin or fecal leukocytes and of lactoferrin or occult blood or both yielded sensitivities and negative predictive values close to 100%, being superior to all other combinations. All patients with full breast-feeding and mixed feeding had a positive lactoferrin test with a 1:50 dilution used as the cutoff. In controls without diarrhea being exclusively bottle-fed, 3 of 15 (20%) still showed a positive lactoferrin result at the dilution of 1:50. This compared with 15 of 15 (100%) positive results among controls fully breast-fed, 14 of 15 (93%) among controls predominantly breast-fed and 11 of 15 (73%) among control children predominantly bottle-fed.
This study confirms the usefulness of lactoferrin testing as a negative predictor. Breast-feeding lowers the specificity of the test but does not alter the sensitivity. Fecal lactoferrin may be viewed as the screening test of choice to avoid expensive stool cultures in the diagnostic approach to invasive diarrhea.
比较粪便筛查试验在儿童侵袭性腹泻诊断方法中的作用。
1995年11月至1996年6月，我们对125例连续的急性腹泻儿童进行了粪便乳铁蛋白、粪便白细胞和潜血检测。
在检测侵袭性病原体方面，乳铁蛋白的总体敏感性高于粪便白细胞或潜血。乳铁蛋白与粪便白细胞的组合、乳铁蛋白与潜血的组合或两者的组合，其敏感性和阴性预测值接近100%，优于所有其他组合。所有纯母乳喂养和混合喂养的患者，以1:50稀释度作为临界值时，乳铁蛋白检测均为阳性。在非腹泻的人工喂养对照中，15例中有3例（20%）在1:50稀释度时乳铁蛋白结果仍为阳性。相比之下，纯母乳喂养对照中15例全部为阳性（100%），主要母乳喂养对照中15例中有14例（93%）阳性，主要人工喂养对照儿童中15例中有11例（73%）阳性。
本研究证实了乳铁蛋白检测作为阴性预测指标的有用性。母乳喂养会降低该检测的特异性，但不改变敏感性。在侵袭性腹泻的诊断方法中，粪便乳铁蛋白可被视为避免昂贵粪便培养的首选筛查试验。
