자발성 세균성 복막염 환자의 진단에 있어서 시험지봉(Reagent Strips)검사의 유용성
Usefulness of Reagent Strips for the Diagnosis of Spontaneous Bacterial Peritonitis
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목적: SBP는 복수를 동반한 간경변 환자에서 흔히 보는 심각한 합병증이다. 신속한 진단과 치료로 생존율의 많은 향상이 있어 왔으나 아직도 병원 내 사망률이 20%를 넘는 중한 질환이다. 본 연구의 목적은 간경변증 환자에 있어서 소변 시험지봉으로 SBP를 신속하고 정확하게 진단할 수 있는지 그 유용성을 평가하는 데 있다. 대상과 방법: 2004년 3월부터 9월까지 입원한 간경변증 환자 중 복수를 동반하여 진단 목적의 복수천자를 시행한 257명의 환자(남자 187명, 여자 70명, 진단 당시 평균 연령 54세)를 대상으로 하였다. 복수는 천자 후 즉시 시험지봉 지시부에 묻혀 90초 간 기다린 후 발색 정도를 제조사가 제공한 비색지와 비교하여 0, 1+, 2+, 또는 3+ 의 4등급으로 판정하였다. 복수는 또한 세포검사, 백혈구 수, 다형핵 백혈구 수, 배양검사, 화학적 검사를 시행하였다. 결과: 복수 내 다형핵 백혈구 수 측정으로 79명의 SBP 환자와 2명의 2차성 세균성 복막염 환자를 진단하였다. 시험지봉 3+ (PMN 500/mm3)를 양성 기준으로 하였을 때 민감도는 86% (70/81), 특이도는 100% (176/176), 양성예측값은 94%였다. 시험지봉 2+ (PMN 75/ mm3) 이상을 양성 기준으로 하였을 때 민감도는 100% (81/81), 특이도는 99% (174/176), 음성예측값은 100%였다. 결론: 간경변증 환자에서 시험지봉으로 SBP를 진단하는 방법은 매우 민감하고 특이적이며 빠르고 간편하게 응급으로 시행될 수 있다. 복수천자와 동시에 결과를 알 수 있으므로 양성 결과를 보이면 복수의 다형핵 백혈구 수치가 나오기 전에 바로 경험적으로 항생제 사용을 시작할 수 있고 또한 음성일 경우 SBP의 가능성은 배제할 수 있겠다.
Abstract
Background/Aims: Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications for patients with liver cirrhosis, and it has a mortality rate of over 20%. Early diagnosis of SBP and immediate use of an adequate antibiotic therapy are very important for achieving a better prognosis. The aim of our study was to assess the usefulness of reagent strips for making the rapid diagnosis of SBP. Methods: A diagnostic paracentesis procedure was performed upon hospital admission in 257 cirrhotic patients (187 males, 70 females; mean age: 54 years) with ascites. Each fresh sample of ascitic fluid was tested using a reagent strip, and the result was scored as 0, 1+, 2+ or 3+. The leukocyte count, polymorphonuclear cell count, blood bottle culture, and chemistry of ascites were also done. Results: We diagnosed 79 cases of SBP and 2 cases of secondary bacterial peritonitis by means of the polymorphonuclear cell count and the classical criteria. When a reagent strip result of 3+ was considered positive, the test’s sensitivity was 86% (70 of 81), the specificity was 100% (176 of 176), and the positive predictive value was 94%. Furthermore, when a reagent strip result of 2+ or more was considered positive, the test sensitivity was 100% (81 of 81), the specificity was 99% (174 of 176), and negative predictive value was 99%. Conclusions: The use of reagent strips is a very sensitive and specific tool for the rapid diagnosis of SBP in cirrhotic patients. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
참고문헌 (19)
- "treatment and prophylaxis of spontaneous bacterial peritonitis", 32, pp.142~153 (2000)
- "Garcia-Tsao G. Current management of the complication of cirrhosis and portal hypertension", 200, pp.726~748 (2001)
- "Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology 1988", pp.1351~1355
- "et al. Comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis. Am J Gastroenterol 1990", pp.1605~1608
- "et al. Bacterial infections in cirrhosis epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002", 35, pp.140~148 (2002)
- "et al. Recent increase in antibiotic-resistant microorganisms in patients with spontaneous bacterial peritonitis adversely affects the clinical outcome in Korea.", 18, pp.927~933 (2003)
- "et al. Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis", pp.388~392
- "Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology 1991", pp.1737~1742
- "et al. Spontaneous bacterial peritonitis in cirrhosis predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology 1993", pp.251~257
- "predictors of survival and health care costs from 1988 to 1998. Am J Gastroenterol 2001", 96, pp.1232~1236 (2001)
- "et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips. Hepatology 2003", 37, pp.893~896
- "Klemmer L. Chemical detection of leukocytes in urine by means of a new multiple test strip. J Clin Chem Clin Biochem 1987", pp.91~94
- "Ibrahim MD. Rapid diagnosis of bacterial meningitis with reagent strips. Lancet 1995", 345, pp.1290~1291 (1995)
- "et al. Rapid diagnosis of infectious pleural effusions by use of reagent strips. Clin Infect Dis 2000", 31, pp.914~919 (2000)
- "Yeni P. Evaluation of screening tests for urinary infection in hospital patients. Lancet 1989", tour(t f), pp.384~385
- "Gandhi VC. Utility of a peritoneal dialysis leukocyte test strip in the diagnosis of peritonitis. Artif Organs 2002", 26, pp.546~548 (2002)
- "et al. Diagnosis accuracy of a rapid urine-screening test in cirrhotic patients with spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol 2002", 14, pp.1257~1260 (2002)
- "et al. Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients by use of two reagent strips. Eur J Gastroenterol Hetatol 2004", 16, pp.579~83 (2004)
- Korean J Hepatol 2004, , 2004, 61A~