PCR在腹膜透析相关性腹膜炎中的应用

Application of PCR in diagnosis of peritoneal dialysis-associated peritonitis

目的探讨PCR在腹膜透析相关性腹膜炎(PDAP)诊断中的应用价值。方法收集2013年1月-2016年6月PDAP患者的腹膜透析液标本97例。分别用常规细菌培养方法和PCR方法检测,同时比较2种方法在PDAP诊断上的差异。结果常规细菌培养方法的阳性率为42.3%(41/97),主要菌种为凝固酶阴性葡萄球菌(34.1%)、大肠埃希菌(17.1%)、金黄色葡萄球菌(12.2%)和肺炎克雷伯菌(9.8%)。PCR法诊断PDAP的敏感度、特异度、阳性预测值、阴性预测值、约登指数分别为71.1%、97.5%、98.6%、58.2%、0.686。属符合率为94.9%,种符合率为74.4%。结论 PCR是一种敏感性和特异性均较高的快速诊断PDAP的检测方法,可用于培养阴性腹膜炎的辅助诊断。

Objective To investigate the clinical application value of polymerase chain reaction（ PCR） in the diagnosis of peritoneal dialysis-associated peritonitis（ PDAP）. Methods 97 cases of peritoneal fluid in PDAP patients were collected from January 2013 to June 2016. Conventional bacterial culture and PCR detection were used respectively,and their differences in diagnosing PDAP were compared. Results The traditional culture results showed that positive rate was 42. 3%（ 41/97）,and main species were Coagulase negative staphylococcus（ 34. 1%）,Escherichia coli（ 17. 1%）,Staphylococcus aureus（ 12. 2%）,Klebsiella pneumonia（ 9. 8%）. The PCR results showed that the sensitivity,specificity,positive predictive value,negative predictive value,and the Youden index of diagnosing PDAP were 71. 1%,97. 5%,98. 6%,58. 2%,0. 686. Meanwhile,the study showed a genus-level concordance rate of 94. 9% and a species-level concordance rate of 74. 4%. Conclusion PCR assay for PDAP diagnosis is a rapid method with high sensitivity and specificity,and may be used to supplement the diagnosis of culture negative peritonitis.