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
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南京医科大学第一附属医院/江苏省人民医院

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“十四五”省医学重点学科(ZDXK2022394)


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

    目的:分析布鲁氏菌病(Brucellosis)患者流行病学特征,探究内毒素(LPS)检测对布病的诊断价值以及LPS联合血培养对布病疗效的评价。方法:收集临床布病患者61例,分为现症布病组(39例)和布病治疗有效组(22例),现症布病组包括32例首诊组和7例治疗无效组。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(RBT)和LPS检测结果,比较3种检测方法的阳性率,比较诊断的灵敏度、特异度、准确度、阴/阳性预测值以及联合诊断的诊断效能及治疗疗效评价。结果:61例患者中男性45例,女性16例,中位年龄52岁。39例现症患者,LPS试验阳性检出率为100%,高于血培养(82.05%)和RBT试验(97.44%);治疗有效患者22例,血培养结果均为阴性;LPS和RBT试验假阳性率分别为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和三项联合的AUC分别为0.914、0.957、0.779和0.959,血培养联合LPS具有较高的诊断价值。结论:LPS检测对于现症布病诊断以及布病治疗疗效具有较高的价值,可用于重点人群布病的诊断和治疗过程,提高布病诊断率的同时预测疾病转归。

    Abstract:

    Objective: Analyze the epidemiological characteristics of Brucellosis patients, explore the diagnostic value of LPS testing for brucellosis, and evaluate the therapeutic effect of LPS combined with blood culture on brucellosis. Methods: Collect 61 clinical patients with brucellosis, divide them into the current brucellosis group (39) and the brucellosis treatment effective group (22), The current brucellosis group consisted of 32 cases in the initial diagnosis group and 7 cases in the treatment ineffective group. retrospectively analyze the clinical characteristics of the patients; Quantitative detection of LPS content; Analyze the results of blood culture, RBT testing, and LPS testing in the two groups, compare the positive rates of the three detection methods, and compare the diagnostic sensitivity, specificity, accuracy, negative/positive predictive values, and the diagnostic efficacy of combined diagnosis. Results: Among the 61 patients, there were 45 males and 16 females, with a median age of 52 years.. Among the 61 patients, 39 were present patients, and the positive rate of LPS test was 100%, higher than that of blood culture (82.05%) and RBT test (97.44%). 22 patients with effective treatment, and 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 levels in the effective treatment group were significantly lower than those in the first diagnosis group and the ineffective treatment group, and there was no statistically significant difference compared to the normal control group. The AUC of blood culture combined with RBT, blood culture combined with LPS, RBT combined with LPS, and the three combinations were 0.914, 0.957, 0.779, and 0.959, respectively. Blood culture combined with LPS has high diagnostic value. Conclusion: LPS detection has a high diagnostic value for the present brucellosis and the therapeutic effect of brucellosis. It can be widely used in the diagnosis and treatment of key population brucellosis, improve the diagnosis rate and predict the outcome of the disease.

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  • 收稿日期:2024-03-22
  • 最后修改日期:2024-09-06
  • 录用日期:2024-11-06
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