流感疫情的快速实验室诊断与分析  

Rapid laboratory diagnosis of the influenza epidemic in a unit of PLA

作　　者：王晗[1] 徐军[1] 马洪滨[1] 李波[1] 崔恩博[1] 姜天俊[2] 李伯安[1] 毛远丽[1] 

机构地区：[1]解放军302医院临检中心,北京100039 [2]解放军302医院感染一科,北京100039

出　　处：《解放军医学杂志》2010年第3期246-248,共3页Medical Journal of Chinese People's Liberation Army

基　　金：军队"十一五"科技攻关项目(06G143)

摘　　要：目的通过实验室病原学检查,结合流行病学史及临床症状,初步确定某部集体发热疫情的致病病原体。方法采集患者的血液、结膜分泌物及鼻、咽拭子等标本,分别通过间接免疫荧光法、酶联免疫吸附试验(ELISA)、反转录巢氏聚合酶链反应(RT-PCR)实验、病毒分离培养和细菌培养等实验室诊断方法,筛查致病病原体。结果所有鼻、咽拭子、结膜分泌物及血细菌培养未见致病菌生长。3例最后退热患者咽拭子的病毒分离培养结果为阴性。20种呼吸道病原体免疫荧光IgM抗体筛查结果显示,流感A型阳性率为68.4%(39/57),其余病原体抗体阳性率的升高无统计学意义。ELISA流感病毒总IgM抗体阳性率70.2%(40/57)、流感病毒A型IgM抗体阳性率64.9%(37/57)、B型为35.1%(20/57)。所有鼻、咽拭子及结膜分泌物RT-PCR扩增结果未见特异扩增带。结论初步诊断此次群体发热由流感病毒感染引起。该疫情的实验室快速诊断为今后疫情的早期诊治及医院实验室开展传染病防治工作积累了经验。Objective Based on laboratory pathogen detection, epidemic evidence and clinical symptoms, to primarily determine the pathogen responsible for a mass febrile event in a certain unit of PLA. Methods Indirect immunofluorescence method, enzyme-linked immunosorbent assay （ELISA）, reverse transcription-polymerase chain reaction （RT-PCR）, virus isolation and culture and bacterial culture were performed to examine different samples collected from patients, such as blood, conjunctival secretion, throat and nose swabs and so on, for screening the pathogen responsible for the mass febrile event. Results All the bacterial cultures of throat and nose swabs, conjunctiva secretion and blood samples showed negative results. The throat swabs of patients who were among the last to be afebrile also showed negative results. The indirect immunofluorescence detection, which allowed screening as many as twenty respiratory pathogens, showed that the positive rate of antibodies （lgM） against influenza A virus was 68.4% （39/57）, while no significant increase was found in the positive rate of other pathogens. The positive rate, detected by ELISA, of the total antibodies against influenza virus was 70.2% （40/57）, and of the antibodies （lgM） against influenza A and B virus was 64.9% （37/57） and 35.1% （20/57）, respectively. No specific amplification pattern was detected by RT-PCR for all the samples of throat and nose swabs and conjunctiva secretion. Conclusions Influenza virus has been preliminarily proved to be the pathogen responsible for this cpisode of mass febrile event. The rapid laboratory diagnostic procedure performed in the present survey provides a helpful measure for the grass roots hospitals to carry out early diagnosis, prophylaxis and treatment of infectious disease.

关 键 词：酶联免疫吸附测定 流感 人 逆转录聚合酶链反应 

分 类 号：R446.5[医药卫生—诊断学]