Research On Urinary Antigen Detection Of Streptococcus Pneumonia’s Applied Value In The Diagnosis And Treatment Of Patients With Community-acquired Pneumonia

Objective To investigate the clinical value of urinary antigen detection of streptococcus pneumonia in the initial stage of treatment in adult patients with community-acquired pneumonia(CAP).Methods From September2012and September2012200adult patients with CAP in the emergency department,outpatient service, respiratory medicine ward (general wards and respiratory ICU) of Tianjin medical university general hospital was investigated. The diagnosis of CAP was performed according to the following criteria based on Chinese CAP guidelines published in2006. Table records of the patient’s clinical data observed by a unified cases. Analyze the cases of data collected. Comparing the sensitivity of patients with traditional streptococcus pneumonia laboratory diagnostic methods(sputum specimens cultivation, blood culture, sputum culture combined blood cultures and thoracic fluid) and urinary antigen detection of streptococcus pneumonia methods. With the diagnosis significance of sputum culture(By fiber bronchoscope or artificial airway attract sputum specimens, Semi-quantitative training++) and blood culture for reference, Compare their urine antigen detection sensitivity, specificity, accuracy, and with reference to the test.At the same time,59CAP patients without the use of antimicrobial agents were choosed. Use of antibiotics in patients and72hours of the initial treatment are completed prior to initial treatment urinary antigen detection of streptococcus pneumoniae to check. For grouping results exist positive patients. According to initial treatment effectively and initial treatment is invalid for conditions are divided into two groups A and B (In the application of antibiotic72hours to evaluate the effect of the treatment, patients are still not clinically stable state is defined as the initial treatment is invalid). Compared two groups of patients before and after the initial treatment of urinary antigen detection of streptococcus pneumonia sensitivity changes. Application SPSS17.0statistical software for statistical analysis. Measurement data to mean±standard deviation. Compares the2x2list of X2test, McNemar test and likelihood ratio test. P value less than0.05was considered to be statistically significant. Correlation between two variables analysis using2x2matching data correlation analysis method.Results1. Selected200patients with CAP average age (55.4±8),male96,female104.120patients with CAP urinary antigen streptococcus pneumoniae,16positive for urinary antigen.10positive in sputum samples for169patients.1positive in blood culture for89patients.1positive in thoracic fluid for14patients. Urinary antigen positive rate higher than that of sputum culture, blood culture and sputum culture combined blood cultures, the difference was statistically significant (x24.71,8.63and4.93, all P<0.05). But compared with chest liquid cultivation is still can’t believe that there is a difference (x20.05,P>0.10)2.67cases with sputum culture is confirmed in169cases of sputum culture,55cases complete urinary antigen detection at the same time. Sputum culture results of2cases of streptococcus pneumoniae, urinary antigen test results positive for8cases. Measured urinary antigen detection sensitivity, specificity and accuracy were100%,88.68%and89.09%, respectively. And there are more positive rate differences between the sputum culture and urinary antigen(x2为4.17, P<0.05), the correlation coefficient is0.27. At the same time43patients completed blood culture and urinary antigen detection. Blood culture result of streptococcus pneumoniae in1case,7cases of urinary antigen detection results positie. Measured urinary antigen detection sensitivity, specificity and accuracy were100%,85.71%and86.05%, respectively. And there are more positive rate differences between the blood culture and urinary antigen (x24.17, P<0.05), the correlation coefficient of0.30.3. Initial treatment of59patients did not use of antimicrobial agents in patients with urinary antigen detection of streptococcus pneumoniae is9cases of positive results.Initial treatment group (group A),4cases were effectively. Initial treatment group (group B) invalid in5cases.2cases in group A before and after the initial treatment of urinary antigen detection are all positive.2cases before initial treatment for positive negative after treatment.5cases in group B before and after the initial treatment urinary antigen detection are all positive.0cases before initial treatment for positive, negative after treatment.After treatment group A’positive rate was lower than group B, the difference was statistically significant (likelihood ratio G3.99, P<0.05).Conclusion1.Urinary antigen detection of streptococcus pneumonia method compared with sputum culture, blood culture and sputum culture combined blood cultures sensitivity is higher.2.At the same time in the use of effective antibiotic therapy after urinary antigen detection sensitivity decreases.3.CAP effective antibiotics may be prompted the initial treatment.,when urinary antigen detection of streptococcus pneumoniae turns shade.4.Urinary antigen detection of streptococcus pneumoniae can provide the reference basis of bacteriology for CAP initial treatment.