日本血吸虫病常用诊断方法现场查病效果的评估  

Effectiveness of Routinely Used Assays for the Diagnosis of Schistosomiasis japonica in the Field

作　　者：许静[1] 陈年高 冯婷[1] 王恩木[3] 吴晓华[1] 陈红根 汪天平[3] 周晓农[1] 郑江[1] 

机构地区：[1]中国疾病预防控制中心寄生虫病预防控制所,上海200025 [2]江西省寄生虫病防治研究所,南昌330046 [3]安徽省血吸虫病防治研究所,芜湖241000

出　　处：《中国寄生虫学与寄生虫病杂志》2007年第3期175-179,共5页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：国家"十五"攻关项目(No.2004BA718B12)~~

摘　　要：目的评估几种常用血吸虫病诊断方法现场查病的效果。方法2005年11月,选取江西省鄱阳湖沿岸3个血吸虫病流行村的6～65岁居民为调查对象,用改良加藤厚涂片法(Kato-Katz法,3张涂片)和尼龙绢集卵孵化法进行病原学检测的同时,分别用胶体染料试纸条法(DDIA)、快速酶联免疫吸附试验(F-ELISA)及2种间接红细胞凝集试验(IHA-A和IHA-B)进行血清学检测,以评价该几种检测方法的效果。结果3村共检测居民1864人,平均粪检阳性率为9.7%。改良加藤法在血吸虫病中度、重度流行区的漏检率相对稳定,为20.0%～27.8%;尼龙绢集卵孵化法的漏检率在每克粪便虫卵数(EPG)>100时相对稳定(约25%)。DDIA、F-ELISA、IHA-A和IHA-B的平均阳性率分别为47.8%、50.0%、66.3%和40.1%。以病原学检测结果为金标准,DDIA、F-ELISA、IHA-A和IHA-B的敏感性分别为75.3%、65.8%、85.6%和76.0%;特异性为55.1%、51.7%、35.7%和63.6%。与其他几种免疫血清学诊断方法相比,IHA-B试剂的特异性、Youden指数、阳性似然比及粪检符合率最高。DDIA法与IHA-B法的符合率最高(77.3%),而F-ELISA和IHA-A的符合率最低(61.5%)。结论在血吸虫病中、重度流行区,改良加藤法虫卵检出率和稳定性均优于尼龙绢集卵孵化法;IHA-A的敏感性最高,IHA-B的4个指标最高,具有较高的现场使用价值,但需进一步提高其敏感性。Objective To evaluate the effectiveness of routinely used assays for schistosomiasis diagnosis in the field. Methods From late November to early December 2005, 6-65 years old inhabitants from 3 endemic villages were examined by Kato-Katz technique （3 thick smears） and nylon bag sedimentation/hatching method. At the same time, dipstick dye immunoassay（DDIA）, fast enzyme linked immunosorbent assay （F-ELISA）, indirect haemagglutination test A （IHA- A） and B （IHA-B） were carried out in parallel Results 1 864 people were examined by stool examination with an average positive rate of 9.7%. The missing rate of DDIA was relatively stable in medium and heavily endemic areas of schistosomiasis. The missing rate of nylon bag sedimentation/hatching method was 25% and relatively stable when the number of eggs per gram of feces（EPG） was larger than 100. The average positive rate of DDIA, F-ELISA, IHA-A and IHA-B was 47.8%, 50.0%, 66.3% and 40.1% respectively. Using stool examination as the gold standard, the sensitivity of DDIA, F-ELISA, IHA-A and IHA-B was 75.3%, 65.8%, 85.6% and 76.0%; and the specificity was 55.1%, 51.7%, 35.7% and 63.6%, respectively. Among the four sero-diagnostics, the specificity, Youden index, positive likelihood rate and coincidence of IHA-B were the highest. Conclusion Kato-Katz method is more stable and effective than nylon bag sedimentation/hatching method in medium and heavily endemic areas of schistosomiasis japonica. The sensitivity and specificity of these four diagnosis kits are lower than 90%.

关 键 词：日本血吸虫病 改良加藤厚涂片法 尼龙绢集卵孵化法 胶体染料试纸条法(DDIA) F-ELISA 间接红细胞凝集试验(IHA) 

分 类 号：R532.21[医药卫生—内科学]