白细胞酯酶试纸在成人急性化脓性关节炎诊断中的应用研究

Application research of leukocyte esterase strip test in diagnosing adult acute septic arthritis

目的探讨白细胞酯酶(1eukocyte estemse,LE)试纸在成年急性化脓性关节炎(acute septic arthritis)诊断中的应用价值。方法选择43例急性单关节炎患者,根据细菌学培养结果,分为培养阳性组和培养阴性组,所有患者抽取关节液用试纸条对关节滑液中的白细胞酯酶进行检测,并比较2组间白细胞计数(white blood cell count,WBC)、C-反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、血清降钙素原(procalcitonin,PCT)、关节液白细胞计数(synovial fluid leukocyte count,SF-WBC)、多形核中性粒细胞百分比水平以及不同诊断指标的灵敏度及特异性。结果 43例患者,培养阳性18例,阴性25例。培养阳性组CRP、ESR、PCT、多形核中性粒细胞百分比水平明显高于培养阴性组,差异有统计学意义(P<0.05),2组间WBC、SF-WBC比较差异无统计学意义(P>0.05)。LE试纸检测的灵敏度和特异度分别为94.4%和84.0%,Youden指数高于其他检测指标。结论 LE试纸应用于成年急性化脓性关节炎的诊断具有较高的灵敏度和特异性,是一种相对准确且经济、简便、快捷的检测方法。

Objective To investigate the value of leukocyte esterase（LE） strips in the diagnosis of adult acute septic arthritis.Methods Forty-three patients with acute monoarticular arthritis were collected and divided into two groups（culture-positive group and culture-negative group） according to the results of bacterial culture. Joint fluid was sampled from all patients and test strip was used to detect the leukocyte esterase in synovial fluid. The levels of white blood cell count（WBC）,C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,procalcitonin（PCT）,synovial fluid leukocyte count（SF-WBC）,polymorphonuclear neutrophils（PMN%）,and different diagnostic indicators and specificity were compared between the two groups. Results There were 18 patients in culture-positive group and 25 patients in culture-negative group. The levels of CRP,ESR,PCT and PMN% in culture-positive group were significantly higher than that in culture-negative group,with the differences statistically significant（P〈0. 05）,while there was no statistical significance on the difference in WBC or SF-WBC（P〈0. 05）. The sensitivity and specificity of LE strip test was 94. 4% and 84. 0%,respectively. And the Youden index was higher than other indicators. Conclusion There is a high sensitivity and specificity in the diagnosis of adult acute septic arthritis by LE strip,which is accurate,simple,quick and cost-saving.