PCR方法在自发性细菌性腹膜炎快速诊断中的应用  

Clinical application of PCR in the rapid diagnosis of spontaneous bacterial peritonitis

作　　者：赵莹莹[1] 全敏[2] 王琦[1,3] 程丹颖[1] 段英[1] 李贲[1] 杨松[1] 吴淑玲[1] 刘顺爱[1,3] 邢卉春[1] 成军[1,3] 

机构地区：[1]首都医科大学附属北京地坛医院,北京100015 [2]北京大学北京地坛医院教学医院 [3]新发突发传染病研究北京市重点实验室

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第2期19-22,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都医学发展科研基金(No.2007-3054)

摘　　要：目的探讨PCR法在快速诊断自发性细菌性腹膜炎中的临床应用价值。方法本研究选取64例肝硬化失代偿期伴腹水的住院患者作为研究对象,收集其血液标本及腹水标本,用基于细菌16S rRNA基因的聚合酶链反应(PCR)方法检测患病组(A组,15例)、非患病组(B组,6例)以及临床感染组(C组,43例)腹水中的细菌;并比较PCR方法与腹水培养法的灵敏度和特异度等。结果 PCR法检测A组、B组和C组患者腹水细菌的阳性率分别为100%(15/15)、0(0/6)和83.7%(36/43)。PCR法诊断自发性细菌性腹膜炎的方法学指标显示,A组:灵敏度和阳性预测值分别为100%(15/15)和100%(15/15);C组:灵敏度、特异度、阳性预测值和阴性预测值分别为97.1%(33/34)、77.8%(7/9)、94.3%(33/35)和87.5%(7/8)。PCR法诊断非感染性腹水的特异度和阴性预测值分别为100%(6/6)和100%(6/6)。PCR法与腹水培养鉴定细菌种属的差异无统计学意义(χ2=5.625,P=0.25)。结论 PCR法优于腹水培养,其阳性率、灵敏度、特异度、阳性预测值、阴性预测值均较高,具有早期、快速诊断自发性细菌性腹膜炎的重要的临床应用价值。Objective To investigate the clinical application value of polymerase chain reaction （PCR） in the rapid diagnosis of spontaneous bacterial peritonitis （SBP）. Methods Blood and ascitic fluid samples were both collected from 64 hospitalized patients with liver cirrhosis and ascitic; bacterial DNA in ascitic fluid was isolated by PCR based on 16S rRNA gene, and identified from these subjects： 15 patients with positive culture （Group A）, 6 patients with non-infectious ascites （Group B） and 43 culture negative patients with clinical infection （Group C）. Methodological parameters such as positive rate, sensitivity, specificity, positive predictive value and negative predictive value of PCR assay were evaluated, respectively. The statistical difference in bacterial colonization identification between ascitic fluid culture and PCR was also analyzed. Results Positive rate of PCR assay for detecting bacterial DNA was 100% （Group A, 15/15）, 0 （Group B, 0/6） and 83.7% （Group C, 36/43）. Methodological parameters for PCR assay of diagnosis SBP： Group A： sensitivity was 100% （15/15）, positive predictive value was 100% （15/15）; Group C： sensitivity was 97.1% （33/34）, specificity was 77.8% （7/9）, positive predictive value was 94.3% （33/35）, negative predictive value was 87.5% （7/8）. PCR assay for the diagnosis of ascites with no infection： specificity was 100% （6/6）, negative predictive value 100% （6/6）. There was no significant difference between the two assays applied in bacterial colonization identification （x2 = 5.625, P = 0.25）. Conclusions PCR assay for SBP diagnosis is a rapid method with higher positive rate, sensitivity, specificity, positive predictive value and negative predictive value, and is superior to ascitic fluid culture.

关 键 词：自发性细菌性腹膜炎 16SRRNA基因 聚合酶链反应 腹水培养 诊断 

分 类 号：R575.2[医药卫生—消化系统]