血内毒素快速定量测定对革兰氏阴性菌败血症的诊断意义.docVIP

精品论文 参考文献 血内毒素快速定量测定对革兰氏阴性菌败血症的诊断意义 刘芳(沈阳市第四人民医院 呼吸内科 沈阳辽宁 110031) 　　【摘要】目的 探讨血内毒素定量测定对革兰氏阴性菌败血症的诊断意义。方法 对临床可疑革兰氏阴性菌败血症的患者同时采取血标本及无热源污染血标本各一份，分别作细菌培养和血内毒素定量测定。血内毒素测定采用MB-80微生物快速动态检测系统进行测定，统计学分析比较两种方法的一致性。结果 革兰氏阴性菌生长组血内毒素含量（105.56plusmn;147.4pg/ml）与无细菌生长组（8.89plusmn;12.86pg/ml）比较有显著统计学差异（t=﹣7.059,Plt;0.001）。以20.0pg/ml作为血内毒素定量测定判断革兰氏阴性菌败血症的cutoff值，其准确率84%、灵敏度81.08%、特异度85%。结论 血浆内毒素对于早期判断革兰氏阴性菌败血症有一定意义，有利于临床合理应用抗菌药物、及时对症处理。 　　【关键词】内毒素；革兰氏阴性菌；测定方法 　　【中图分类号】RA 【文献标识码】A 【文章编号】1672-5085（2013）42-0054-02 　　Diagnosis significance of plasma endotoxin detecting of patient with gram negative bacillus infection Liu Fang Respiratory medicine department,The fourth people hospital of shenyang , Liaoning ,110001,P.R.China 　　【Abstract】OBJECTIVE To study the Diagnosis significance of plasma endotoxin detecting of patient with gram negative bacillus infection. METHODS Concentration of blood plasma endotoxin were measured by Microbiology Kinetic Rapid Reader MB-80 within patients Suspected with gram negative bacillus infection. At the same time to detect blood culture .RESULTS Mean plasma entoxin of all negative patient was 8.89plusmn;12.86pg/ml.In gram negative bacillus infection group, the result was 105.56plusmn;147.4pg/ml .T-test analysis indicates the mean plasma entoxin of four groups have notable difference(t=﹣7.059,Plt;0.001). Based on the content of 20pg/ml, blood plasma endotoxin showed accurate rate ,sensitivity, specificity of 84%、81.08%、85% respectively.CONCULION Plasma endotoxin detecting is helping to estimate what kind of bacteria infected. It is helpful to select antibacterial and handle syndrome on time. 　　【Key words】Endotoxin；Gram negative bacillus；Detecting method 　　近年国内外报道革兰阴性菌感染有逐年增加的趋势，快速诊断革兰氏阴性菌败血症已越来越受到重视。许多研究证实革兰阴性菌败血症是住院病人死亡的重要原因之一，而造成革兰阴性菌败血症的真正元凶是内毒素血症，它能导致机体多器官功能的损伤及衰竭。内毒素是革兰阴性菌细胞壁中的一种脂多糖[1]，它经细菌胞壁合成后，被转运到细胞表面构成胞壁外膜，在细菌死亡溶解后释放出来。主要致病机理是内毒素及其活性中心（类脂A）对宿主发挥毒害作用，例如产生发热现象、影响白细胞功能及施瓦兹曼（Shwartzman）反应、激活补