风湿性心脏病急性期应用链球菌菌壁多糖抗体的诊断价值

目的探讨应用A组链球菌菌壁多糖抗体（ASP）对慢性风湿性心脏病患者风湿活动的判断价值。方法入选2008年6月至2012年5月间住院的92例慢性风湿性心脏病患者，入院时进行血沉（ESR）、C反应蛋白（CRP）、抗链球菌溶血素O（ASO）常规检测，以及心电图、超声心动图等检查，应用酶联免疫吸附试验（ELISA）测定人院时患者血清ASP，根据临床综合判断风湿性心脏病患者有无风湿活动，计算并比较ASP及ASO／ESR／CRP串联试验对风湿活动的判断价值。结果对于风湿性心脏病风湿活动的诊断：（1）ASO／ESR／CRP串联试验对诊断的敏感性68．0％，特异性50．0％，假阳性率50．0％，假阴性率32．0％，阳性预测值61．8％，阴性预测值56．8％，准确度59．8％，阳性似然比1．36。（2）ASP对诊断的敏感性83．3％，特异性73．7％，阳性预测值81．8％，阴性预测值75．7％，准确度79．3％，阳性似然比3．17；经Kappa检验，ASP检测与临床诊断的一致性，K=0．572，阳=0．087，P〈0．01。（3）ASP检测的敏感性与特异性均高于ASO／ESR／CRP串联试验。结论ASP是判断风湿性心脏病的风湿活动的较可靠指标，优于ASO／ESR／CRP串联试验。

The diagnostic value of ASP detection to rheumatic heart disease in acute stage

Objective To explore the value of antibody to group A streptococcal polysaccharide （ASP） in judging rheumatic activity of chronic rheumatic heart disease. Methods A total of 92 patients with chronic rheumatic heart disease admitted between June 2008 and May 2012 were involved in this study. Erythrocyte sedimentation rate （ESR） , C-reactive protein （CRF） , antistreptolysin O （ ASO ） , ASP （ tested by ELISA assay ） , electrocardiogram and echocardiogram at admission were routinely detected. The rheumatic activity was judged by clinical comprehensive analysis, and the diagnostic value of ASP and ASO/ESR/CRP paiallel test to rheumatic activity were compared. Results For judging rheumatic activity, the diagnostic sensitivity, specificity, false positive rate, false negative rate, positive predictive value, negative predictive value, accuracy rating, and positive likelihood ratio of ASO/ESR/CRP paiallel test were 68.0% ,50.0% ,50.0% ,32.0% ,61.8% ,56.8% ,59.8% and 1.36, respectively ; while the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, accuracy rating,positive likelihood ratio of ASP were 83.3% ,73.7% ,81.8% ,75.7% ,79.3% and 3. 17, respectively. The consistency of ASP with clinical diagnosis by Kappa test was K = 0. 572, SE = 0.087, P 〈 0. 01. The sensitivity and specificity of ASP detection were all higher than those of ASO/ESR/CRP paiallel test. Conclusion ASP is a reliable indicator superior to ASO/ESR/CRP paiallel test in judging rheumatic activity in chronic rheumatic heart disease.