病原学和血清学检验方法在大山区血吸虫病流行区的应用  

Comparison of Aetiological and Serological Diagnosis Methods in Schistosomiasis Mountainous Endemic Area

作　　者：陈绍荣 陈凤 周晓农[2] 李宏军 Peter Jacob Steinmann 杨忠 李远林 

机构地区：[1]大理州血吸虫病防治研所,云南大理671000 [2]中国疾病预防控制中心寄生虫病预防控制所 [3]云南省洱源县血吸虫病防治站 [4]瑞士热带病研究所

出　　处：《寄生虫病与感染性疾病》2007年第1期1-4,共4页Parasitoses and Infectious Diseases

基　　金：国家自然科学基金(批准号30590370)

摘　　要：目的了解血吸虫病病原学及血清学检测方法在大山区流行区应用的效果,为制定防治对策提供科学依据。方法采用随机抽样法在大山区血吸虫病未控制县抽取流行程度轻、中、重的1个自然村,每村抽取35户作为调查对象。采用孵化法及Kato-Katz法进行病原学检查,同时采用检测抗体的ELISA和DDIA法对受试者进行血清学检查。结果总感染率为8.26%(29/351),孵化法三送三检与Kato-Katz法三送十二检2种病原学检查方法差异无统计学意义(χ2=1.831,P>0.05),孵化法一送一检与Kato-Katz法一送四检差异也无统计学意义(χ2=0.313,P>0.05)。不同流行程度村的查病结果Kato-Katz法差异无统计学意义(χ2=2.188,P>0.05),孵化法差异有统计学意义(χ2=7.203,P<0.05),DDIA和ELISA法在不同流行程度村的查病结果间差异均有统计学意义(χ2=22.36、36.282,P均<0.01)。ELISA、DDIA2种血清学筛检方法的敏感性、特异性和约登指数分别为65.52%、59.35%、0.25和44.83%、69.79%、0.15。ELISA法优于DDIA法(χ2=19.253,P<0.01)。ELISA结果与粪检有关联,但一致性较差(χ2=5.772,P<0.05,Kappa=0.076762),DDIA结果与粪检无关联(χ2=2.019,P>0.05)。结论防治实际工作中采用收集一次粪便孵化或制作三张Kato-Katz片,分别有62.07%、72.41%的感染者漏检,必将严重低估病情现状。检测血吸虫抗体的ELISA和DDIA2种血清学筛查方法将漏检34.48%、55.17%感染者,成为血吸虫病病情反弹的原因之一。Objective To compare the diagnostic effect of immuno-assays, collective egg incubation and Kato- Katz methods so as to provide scientific strategy for schistosomiasis control. Method 3 villages with hypo-, meso- and hyper-endemic level were selected by random sampling from an uncontrolled county, and 35 house- holds per village were selected as study object. ELISA and DDIA assays, egg incubation and Kato-Katz meth-ods were conducted and compared. Result The positive rate was 8.26% （29 /351 ） of aetiological diagnosis. There were no significant differences between 3 feces samples, 3 examinations of egg incubation method and 3 feces samples, 12 smears of Kato-Katz method（Χ^2 = 1. 831 ,P 〉 0. 05）, or between 1 feces sample, 1 examination of incubation method and 1 feces sample, 4 smears of Kato- Katz method （Χ^2 = 0. 313, P 〉 0. 05 ）. In three villageswith different endemic levels, there were no significant differences in Kato-Katz method （Χ^2 = 2. 188, P 〉 0. 05 ）, but there were significant differences in egg hatching method （Χ^2= 7.203, P 〈 0. 05 ）, ELISA and DDIA （Χ^2 = 22. 936,36. 282 ,P all 〈0. 01 ）. The sensitivity, specificity and Yorden Index of ELISA were 65.52 %, 59. 35 % and 0. 25, of DDIA were 44. 83%, 69. 79 % and 0. 15, respectively. ELISA was better than DDIA （Χ^2= 19. 253, P 〈 0. 01 ）. ELISA had correlation with feces examination but consistency was weaker （Χ^2 = 5.772 ,P 〈 0. 05, Kappa = 0. 076 762 ）. DDIA had no correlation with feces examination （Χ^2 = 2. 019, P 〉 0. 05 ）. Conclusion The false negative rate of accustomed examination method i. e. 1 feces sample of hatching method or 1 feces sample, 3 smears of Kato-Katz were 62.07% and 72. 41% and that of ELISA and DDIA were 34.48% and 55.17%, and misdiagnosis would be one of the reasons of epidemic situation rising.

关 键 词：血吸虫病 诊断 病原学 血清学 大山区 

分 类 号：R532.21[医药卫生—内科学]