不同标本对于麻疹诊断的意义探讨  

Discussion on the significance of different specimens in measles diagnosis

作　　者：毛雯雯[1] 王中战[1] 董晓根[1] 邢洪光[1] 

机构地区：[1]丰台区疾病预防控制中心免疫预防科,北京100071

出　　处：《现代预防医学》2014年第23期4366-4367,4380,共3页Modern Preventive Medicine

摘　　要：目的通过比较不同标本在麻疹病例早期诊断和疫情控制中的优劣,探讨采集急性期疑似病例的病原学标本(咽拭子或尿液)进行病原学检测在麻疹监测中的应用意义。方法选取2013年1-12月丰台区88例麻疹病例开展流行病学调查,从不同标本的采样易操作性、小月龄病患依从性、实验室检测灵敏度、是否有助于鉴别疫苗相关病例和确定流行株等方面进行比较。结果 1岁以内儿童病例中,15.79%的儿童家长拒绝医院为孩子采血,5.26%的家长拒绝为孩子采集病原学标本,在首诊采血麻风疹双阴性的情况下,只有20%的家长同意采集恢复期血,80%的家长同意采集病原学标本。在79例既采集血标本又采集病原学标本的病例中,急性期麻疹Ig M抗体阳性检出率为65.8%(52/79),病原学标本的病毒核酸阳性检出率为96.2%(76/79)。结论通过采集咽拭子或尿液的方法进行病原学检测灵敏度高、便于采集、小月龄病患依从性更好,且有助于鉴别麻疹疫苗相关病例、确定流行株、追溯传染源,故较采血更适合做为消除麻疹阶段急性期病例首要采样方法。Objective To discuss the application and significance of collecting etiological specimens（throat swab or urine） in measles surveillance by comparison of advantages and disadvantages of different types of specimens in early diagnosis and epidemic control. Methods From Jan. to Dec. in 2013, epidemiological investigations were conducted to 88 measles cases whose blood serums and etiological specimens in Fengtai were collected by comparison of the convenience of collecting, patient compliance,laboratory detection sensitivity, contributions to identify vaccine-associated measles cases or wild-strain cases, and epidemic strains. Results Among patients under 1 year old, 15.79% patients＇ parents refused hospitals to collect their children＇s blood while5.26% patients refused etiological specimens. Only 20% patients agreed to collect second blood when first detection showed negative results while 80% with regard to etiological specimens. Among 79 cases who had both blood serums and etiological specimens collected, the positive detection rate was 65.8%（52/79） in blood and 96.2%（76/79） in etiological specimens.Conclusion Collecting etiological specimens is more easily operated, has better compliance with its detection has higher sensitivity and is helpful for identifying adverse effects and epidemic strains. Therefore, it is more suitable as the primary sampling method in early stage than collecting blood serum during measles elimination period.

关 键 词：麻疹 病原学 咽拭子 尿液 

分 类 号：R115[医药卫生—公共卫生与预防医学]