内毒素检测在上、下尿路革兰氏阴性杆菌感染中的诊断价值

目的：探讨内毒素在鉴别上、下尿路革兰氏阴性杆菌感染中的价值，为患者的早期诊断和治疗及抗生素的合理使用提供依据。方法采用动态浊度法检测患者尿液内毒素含量，同时进行尿培养；检测患者血液白细胞和 CRP水平。结果379例泌尿系革兰氏阴性杆菌感染患者中，上尿路感染132例，下尿路感染247例。上尿路革兰氏阴性杆菌感染组的WBC，CRP和内毒素水平分别为11.25（7.98，13.99）×10^9／L，81.36（76.64，83.50）mg／L和49.57（17.28，78.37）pg／ml，下尿路革兰氏阴性杆菌感染组的WBC，CRP和内毒素水平分别为10.24（7.94，12.24）×10^9／L，70.46（70.46，77.32）mg／L和21.18（21.18，37.31）pg／ml，上尿路革兰氏阴性杆菌感染组的 CRP和内毒素水平明显高于下尿路感染组，差异有统计学意义（P值均＜0.05）。ROC曲线分析，以39.7pg／ml为诊断 Cut-off值，内毒素用于分辨上、下尿路革兰氏阴性杆菌感染的敏感度为84.1％，特异度为90.3％。结论动态浊度法测定尿液内毒素含量具有速度快，操作简便等优点，在鉴别上、下尿路革兰氏阴性杆菌感染中具有重要价值。

Value of Quantitative Detection of Urinary Endotoxin for the Diagnosis of Gram-negative Bacteria Infection in Urinary System

Objective To survey the value of quantitative detection of urinary endotoxin for the diagnosis of gram-negative bacteria infection in urinary system,in order to provide evidences for early diagnosis and treatment.Methods The levels of urinary endotoxin were detected by kinetic turbidimetric technique,at the same time urine was cultured and WBC,CRP were detected.Results In 379 patients with gram-negative bacteria infection in urinary system,132 patients were upper urinary tract infection and 247 were lower urinary tract infection.The level of WBC,CRP and endotoxin were 11.25（7.98,13.99）×10^9/L,81.36（76.64,83.50）mg/L and 49.57（17.28,78.37）pg/ml in upper urinary tract infection patients and in lower uri-nary tract infection patients were 10.24（7.94,12.24）×10^9/L,70.46（70.46,77.32）mg/L and 21.18（21.18,37.31）pg/ml. The group of upper urinary tract infection was higher than lower urinary tract infection on CRP and endotoxin,and have sig-nificant difference between the two groups of patients （P〈0.05）.Analysis of ROC,the diagnostic Cut-off value of 39.7pg/ml,the sensibility and specificity of endotoxin for the diagnosis of gram-negative bacteria infection on upper or lower urinary system were 84.1% and 90.3%.Conclusion The levels of urinary endotoxin detected by kinetic turbidimetric technique is simple and efficient,and have significant diagnosis value of gram-negative bacteria infection on upper or lower urinary sys-tem.