应用巢式PCR评价低流行区疟疾诊断结果  

Evaluating malaria diagnosis results in low malaria epidemic area with nest-PCR

作　　者：陈玉凤[1] 王艳艳[1] 姜杰[1] 李美[2] 

机构地区：[1]大连市疾病预防控制中心,大连116021 [2]中国疾病预防控制中心寄生虫病预防控制所卫生部寄生虫病原与媒介生物学重点实验室世界卫生组织疟疾、血吸虫病和丝虫病合作中心,上海200025

出　　处：《国际医学寄生虫病杂志》2013年第6期311-316,共6页International JOurnal of Medical Parasitic Diseases

基　　金：质检公益性行业科研专项项目（2012424056）

摘　　要：目的初步评价大连市疾控人员对疟疾的诊断能力，为低流行区疟疾诊断方法的选择提供理论依据。方法收集2010--2012年大连市上报的27例疟疾阳性病例的血液样本．应用巢式PCR（nest—PCR）方法对诊断结果进行复核：以复核结果为标准，比较镜检和快速诊断试剂盒（rapid diagnosistest．RDT）方法的检测敏感性及对虫种鉴定的正确率。结果27份样本的巢式PCR结果为恶性疟23份，间日疟2份，卵形疟l份，阴性1份，无混合感染。镜检对阳性样本的敏感度为76．9％（20／26），远低于RDT方法的96．2％（25／26）；镜检和RDT联合使用，敏感度可达100％。对虫种的鉴别，镜检对阳性样本的正确检测率为50％（13／26）：RDT方法仅能鉴别恶性疟和非恶性疟．对恶性疟阳性样本的正确检测率为100％（23／23）。结论采用镜检和RDT联合应用的方法，能够提高检测的敏感性。建议在有条件的疾控单位建立人体疟原虫的分子检测体系．更有效地防止对疟疾病例的漏诊和误诊。Objective To evaluate the diagnostic results in Dalian City to offer reference for selection of malaria diagnosis methods in low malaria epidemic area. Methods Blood samples of 27 malaria cases which were microscopy positive or rapid diagnosis test（RDT） positive were collected during 2010-2012 and reviewed with method of nest-PCR. Taking the reviewed results as criterion, sensitivity of microscopy and RDT was calculated. At the same time, the number and rate of samples which were accurately diagnosed applying microscopy and RDT were also counted and compared. Results The reviewed results showed that, 27 samples consisted of 23falciparum malaria, 2 vivax malaria, 1 ovale malaria and 1 malaria negative case. Taking this result as criterion, the sensitivity of microscopy method （76.9%, 20/26） was far lower than that of RDT （96.2%, 25/26）. The accuracy rate of microscopy was 50%（13/26） in detecting positive cases. The sensitivity and accuracy rate of RDT test in detecting P. falciparum samples were both 100%. Combining microscopy and RDT, the sensitivity to positive cases could achieve 100% （23/23）. Conclusion The application of microscopy combined with RDT could improve the sensitivity of detection so that no positive samples were missed and no P. falciparum malaria samples were false diagnosed. Molecular detection was recommended in the conditional units, for more accurate review and confirmation of malaria cases and more effective prevention of misdiagnosis of malaria cases.

关 键 词：疟疾诊断 恶性疟原虫 卵形疟原虫 巢式PCR 消除疟疾 

分 类 号：R512.6[医药卫生—内科学]