血浆内毒素检测在革兰阴性菌引起肺部感染诊断中的应用

Application of Plasma Endotoxin Dynamic Turbidimetry in Diagnosis of Pulmonary Infection Caused by Gram-Negative Bacteria

目的探讨血浆内毒素检测在革兰阴性菌引起肺部感染诊断中的应用价值。方法选取2017年6月至2018年5月上海市杨浦区控江医院住院部临床确诊的277例肺部感染患者作为研究对象,分别进行血浆内毒素动态光度法和痰培养同时检测。结果 277肺部感染患者中,根据痰培养鉴定结果分为革兰阴性菌感染196例,革兰阳性菌感染81例,革兰阴性菌感染患者血浆内毒素水平高于革兰阳性感染患者[(0. 283±0. 108) EU/m L比(0. 034±0. 010) EU/m L](P <0. 01)。以细菌培养出革兰阴性菌结果为金标准,内毒素检测的灵敏度为97. 44%,特异度为83. 95%,阳性预测值为94. 08%,阴性预测值为93. 24%,准确度为93. 86%。结论与细菌培养相比,血浆内毒素检测法的优点在于快速、准确性高,可用于革兰阴性菌感染的早期辅助诊断。

Objective To explore the application of plasma endotoxin detection in the diagnosis of pulmonary infection caused by gram-negative bacteria. Methods From Jun. 2017 to May 2018,277 cases of pulmonary infection clinically confirmed in the inpatient department of Shanghai Yangpu District Kongjiang Hospital were included in the study,and the plasma endotoxin dynamic spectrophotometry and sputum culture were conducted for simultaneous detection. Results Among the 277 patients with pulmonary infection,196 cases were identified as the gram-negative bacterial infection group and 81 cases were as the gram-positive bacterial infection group according to sputum culture results. The plasma endotoxin level in the gram-negative bacterial infection group was higher than that in the gram-positive infection group[( 0. 283 ± 0. 108) EU/m L vs( 0. 034 ± 0. 010) EU/m L]( P < 0. 01). With the Gram-negative bacteria culture result as gold standard,the sensitivity and specificity of endotoxin detection were 97. 44%,83. 95%,and 94. 08% for the postitive,93. 24% for the negative and the accuracy was 93. 86%,respectively. Conclusion Compared with bacterial culture,plasma endotoxin detection has the advantages of high speed and accuracy,and can be used for as early auxiliary diagnosis of Gram-negative bacterial infections.