结核和肺吸虫抗体快速联检的鉴别诊断价值  

The potential of rapid co-detection for differential diagnosis of pulmonary tuberculosis and paragonimiasis

作　　者：夏晓华[1] 何月龙[2] 王越[3] 施晓华[3] 张伟民[1] 干小仙[3] 

机构地区：[1]浙江省临床检验中心,杭州310014 [2]杭州市预防保健门诊部 [3]浙江省医学科学院寄生虫病研究所

出　　处：《中国人兽共患病学报》2008年第8期741-744,共4页Chinese Journal of Zoonoses

基　　金：浙江省医药卫生重点科技项目(No.2003ZD001);浙江省自然科学基金项目(No.M303823)联合资助

摘　　要：目的探索结核抗体、肺吸虫抗体快速联合检测技术的诊断和鉴别诊断价值。方法结核分枝杆菌脂阿拉伯甘露糖(LAM)抗原、肺吸虫成虫可溶性抗原分别点样在硝酸纤维素膜上,以胶体金-蛋白A结合物为检测标志物,建立结核抗体、肺吸虫抗体联合检测的金标免疫渗滤法(TB/Pw-DIGFA);用TB/Pw-DIGFA检测肺结核病人、肺吸虫病人及健康人血清样本,以敏感性、特异性、灵敏度等指标考核其诊断价值。结果TB/Pw-DIGFA检测涂阳肺结核病人、涂阴肺结核病人和肺吸虫病人抗体的敏感性分别为85.9%(134/156)、83.0%(44/53)和95.6%(22/23);对肺结核病和肺吸虫病的特异性分别为92.6%(100/108)和99.1%(107/108);与TB-Dot平行检测结核病人和健康人群血清共94人份,符合率达96.8%(91/94),经Kappa检验,两者有高度一致性(K=0.935,P<0.001);与ELISA肺吸虫抗体检测试剂盒平行检测肺吸虫病人和健康人群血清共90人份,检测结果完全一致;未发现结核病和肺吸虫病人血清之间有交叉反应。结论TB/Pw-DIGFA诊断肺结核病和肺吸虫病具有较高的敏感性和特异性;该方法一次操作同时完成结核和肺吸虫二项特异性抗体测定,不仅检测效率高而且便于临床医生鉴别诊断。To evaluate the potential of a new rapid immunoassay for diagnosis and differential diagnosis of tuberculosis and paragonimiasis, Dot immunogold filtration assay for rapid co-detection of specific antibodies against Paragonimus spp and Mycobacterium tuberculosis （Pw/TB-DIGFA） was developed using lipoarabinomannan（LAM） of M. tuberculosis and adult worm soluble antigen of P. westermani as diagnostic reagents dotted on the nitrocellulose （NC） membrane and protein A conjugated with colloid gold as the detecting marker. The sera from patients suffering from tuberculosis,paragonimiasis and healthy donors were detected to estimate its sensitivities and specificities. It was found that the sensitivities of this new immunoassay were 85.9% （134/156）,83.0% （44/53） and 95.6% （22/23）for smear-positive tuberculosis, smear-negative tuberculosis and paragonimiasis respectively, and the specificities were 92.6 % （100/108） and 99.1 % （107/108） for tuberculosis and paragonimi- asis respectively. The coincidence rate of Pw/TB-DIGFA and TB-Dot was 96.8 % （91/94）and there was high consistency between two immunoassays （K=0. 935,P〈0. 001）. The results of 90 sera detection by Pw/TB-DIGFA were in complete agreement to that of Pw-ELISA. No cross reaction was observed between the sera from pulmonary tuberculosis and paragonimiasis. Pw/TB-DIGFA for co-detection of specific antibodies against M. tuberculosis LAM and Paragonimus in serum was sensitive and specific for diagnosis for tuberculosis and paragonimiasis. This immunoassay was not only more effective but also favorable to differntial diagnosis of pulmonary tuberculosis and paragonimuiasis.

关 键 词：肺结核 肺吸虫病 抗体 金标免疫渗滤法 鉴别诊断 

分 类 号：R383.2[医药卫生—医学寄生虫学]