血清内毒素检测对布鲁氏菌病诊断和疗效评价的效能分析  

Efficacy analysis of serum endotoxin test in diagnosis and evaluation of brucellosis

作　　者：缪淑贤 许雨乔 宋为娟 MIAO Shuxian;XU Yuqiao;SONG Weijuan(Department of Laboratory Medicine,the First Affiliated Hospital of Nanjing Medical University,Branch of National Clinical Research Center for Laboratory Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院检验学部,国家医学检验临床医学研究中心分中心,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第11期1534-1540,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：“十四五”省医学重点学科(ZDXK2022394)。

摘　　要：目的:分析布鲁氏菌病(简称布病)患者流行病学特征,探究内毒素脂多糖(lipopolysaccharide,LPS)检测对布病的诊断价值以及LPS检测联合血培养在布病疗效评价中的作用。方法:收集临床布病患者61例,分为现症布病组(n=39)和布病治疗有效组(n=22),现症布病组包括32例首诊组和7例治疗无效组,健康体检者20例为正常对照组。回顾性分析患者临床特征,对LPS进行定量检测,分析血培养、虎红平板凝集试验(rose Bengal plate agglutination test,RBT)和LPS检测结果,比较3种检测方法的阳性率,评估诊断的灵敏度、特异度、准确度、阴/阳性预测值以及联合诊断的诊断效能。结果:39例现症患者中,LPS阳性检出率为100%,高于血培养(82.05%)和RBT(97.44%);治疗有效患者22例,血培养结果均为阴性;LPS和RBT假阳性率分别为45.45%和90.91%。治疗有效组LPS水平显著低于首诊组和治疗无效组,并与正常对照组差异无统计学意义。血培养联合RBT、血培养联合LPS、RBT联合LPS和三项联合诊断的受试者工作特征曲线的曲线下面积分别为0.914、0.957、0.779和0.959,三项联合诊断的AUC值较血培养联合LPS增加不显著,故选择血培养联合LPS作为布病疗效评价的指标。结论:LPS检测对于现症布病的诊断以及布病治疗效果的评价具有较高价值,可用于重点人群布病的诊断,提高布病诊断率的同时预测疾病转归。Objective:To analyze the epidemiological characteristics of brucellosis patients,and to explore the diagnostic value of lipopolysaccharide(LPS)testing for brucellosis and the therapeutic effect of LPS combined with blood culture on brucellosis.Methods:A total of 61 clinical patients with brucellosis was collected and divided into the current brucellosis group(n=39)and the brucellosis treatment effective group(n=22),the current brucellosis group consisted of 32 cases in the initial diagnosis group and 7 cases in the treatment ineffective group,twenty healthy subjects were used as the normal control group.The clinical characteristics of the patients were retrospectively analyzed,and LPS content was examined quantitatively.The results of blood culture,rose Bengal plate agglutination test(RBT)and LPS level were analyzed.The positive rates of the three detection methods were compared,and the diagnostic sensitivity,specificity,accuracy,negative/positive predictive values,and the diagnostic efficacy of combined diagnosis were evaluated.Results:Among 39 present patients,and the positive rate of LPS test was 100%,higher than those of blood culture(82.05%)and RBT tes(t 97.44%).In 22 patients with effective treatment,the blood culture results were all negative.The false positive rates of LPS and RBT tests were 45.45%and 90.91%,respectively.The LPS level in the treatment effective group were significantly lower than those in the initial diagnosis group and the treatment ineffective group,and there was no statistically significant difference compared to the normal control group.The area under curve(AUC)values of blood culture combined with RBT,blood culture combined with LPS,RBT combined with LPS,and the combination of all three were 0.914,0.957,0.779,and 0.959,respectively.Since the AUC value for the combination of all three did not show a significant increase compared to the combination of blood culture with LPS,we choose the combination of blood culture with LPS as the indicator for evaluating the efficacy of brucellosis t

关 键 词：布鲁氏菌病 脂多糖 血培养 虎红平板凝集试验 

分 类 号：R446.1[医药卫生—诊断学]