【摘要】：目的分析瘧原蟲鏡檢、抗原檢測(快速診斷試驗,RDT)和核酸檢測(PCR)3種方法在瘧疾病例檢測應(yīng)用中的效果。方法對2012-2015年上海市送檢的瘧疾病例和疑似瘧疾病例血樣的檢測結(jié)果進行回顧性分析,以確診病例為金標準,比較鏡檢、RDT和PCR等3種方法的診斷指標、蟲種特異性鑒定能力和成本效益。不同檢測方法的兩兩比較用χ2檢驗。結(jié)果 3種方法平行分析血樣212份,結(jié)果顯示,綜合判定為陽性的167份,占78.8%,陰性45份,占21.2%。陽性血樣中,120份為惡性瘧原蟲(Plasmodium falciparum)感染,占71.9%;22份為間日瘧原蟲(P.vivax)感染,占13.2%;17份為卵形瘧原蟲(P.ovale)感染,占10.2%;6份為三日瘧原蟲(P.malariae)感染,占3.6%;2份為混合感染,占1.2%。3種檢測方法的診斷效率以PCR最高,為96.2%(204/212),RDT次之,為93.2%(192/206),鏡檢最低,為88.2%(187/212);鏡檢與RDT和PCR比較,差異具有統(tǒng)計學(xué)意義(P0.05);RDT與PCR比較,差異無統(tǒng)計學(xué)意義(P0.05)。與確診病例比較,3種方法的總符合率以PCR最高,為95.3%(202/212),RDT次之,為93.2%(192/206),鏡檢最低,為88.2%(187/212);鏡檢與PCR比較,差異有統(tǒng)計學(xué)意義(P0.05)。對非惡性瘧原蟲的3種瘧原蟲的種特異性鑒定能力,以PCR最高,為95.6%(43/45),鏡檢次之,為91.1%(41/45),RDT最低,為68.9%(31/45);PCR與RDT比較,差異有統(tǒng)計學(xué)意義(P0.05);PCR與鏡檢比較,差異無統(tǒng)計學(xué)意義(P0.05)。對惡性瘧原蟲單一蟲種的鑒定能力,以RDT最優(yōu),為100%(116/116);PCR次之,為93.3%(112/120);鏡檢最低,為84.2%(101/120)。根據(jù)是否納入診斷標準、對儀器設(shè)備和技術(shù)的要求、診斷效能、檢測的成本耗時、應(yīng)用培訓(xùn)以及技術(shù)推廣等14項指標綜合評測顯示,RDT得分為37分(滿分42分),成本效益最高,鏡檢和PCR得分分別為26和27分。結(jié)論在以輸入性惡性瘧為主的疫情形勢下,3種檢測方法比較,檢測效果以PCR和RDT較高,種特異性鑒定能力以PCR和鏡檢較好,成本效益以RDT最佳。
[Abstract]:Objective to analyze the effect of three methods of Plasmodium falciparum microscopic examination, rapid diagnostic test (PCR) and nucleic acid detection (PCR) in the detection of malaria cases. Methods the results of blood samples of malaria and suspected malaria cases from 2012 to 2015 in Shanghai were analyzed retrospectively. The diagnostic indexes of the three methods were compared using confirmed cases as gold standard. Ability and cost benefit of specific identification of insect species. 蠂 2 test was used to compare different detection methods. Results 212 blood samples were analyzed in parallel by three methods. The results showed that 167 samples were positive, accounting for 78.8%, and 45 samples were negative, accounting for 21.22%. Of the positive blood samples, 120 were infected with Plasmodium falciparum (Plasmodium falciparum), 22 were infected with Plasmodium vivax (P.vivax), 17 were infected with Plasmodium ovum (P.ovale), 6 were infected with Plasmodium falciparum (P.malariae), and 2 were mixed infection. The diagnostic efficiency of 1.2.3 methods was the highest (96.2% (204 / 212), 93.2% (1922 / 206), 88.2% (1872 / 212), respectively), and the difference was statistically significant (P0.05) compared with RDT and PCR (P0.05). Compared with the confirmed cases, the total coincidence rate of the three methods was the highest (95.3% (2023 / 212), 93.2% (1922 / 206) and 88.2% (1872 / 212), respectively. There was significant difference between PCR and PCR (P0.05). PCR was the highest (95.6%) (43 / 45), followed by microscopic examination (91.1% (41 / 45), the lowest was 68.9% (31 / 45) compared with RDT, the difference was statistically significant (P0.05) compared with microscopic examination (P0.05). The identification ability of single species of Plasmodium falciparum was 100% (116 / 116), followed by 93. 3% (112 / 120) and 84.2% (101 / 120) respectively. According to whether the diagnostic criteria are included, the requirements for instrument, equipment and technology, the diagnostic effectiveness, the cost and time consuming of testing, the comprehensive evaluation of 14 indicators, such as application training and technical popularization, shows that the RDT score is 37 (a full score of 42), and the cost benefit is the highest. Microscopic examination and PCR scores were 26 and 27, respectively. Conclusion under the situation of imported falciparum malaria, the results of three detection methods are higher in PCR and RDT, better in specific identification ability in PCR and microscopic examination, and the best in cost benefit in RDT.
【作者單位】： 上海市疾病預(yù)防控制中心上海市預(yù)防醫(yī)學(xué)研究院;
【分類號】：R531.3

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