463例疑似登革热病例实验室监测结果分析  

Laboratory monitoring results of 463 cases of suspected dengue fever

作　　者：蔡亮[1] 张恒娇[1] 何方玲[1] 王娟 胡世雄[1] 李亮 岳文芳[1] 湛志飞[1] 高立冬[1] 马海玲[1] CAI Liang;ZHANG Heng-jiao;HE Fang-ling;WANG Juan;HU Shi-xiong;LI Liang;YUE Wen-fang;ZHAN Zhi-fei;GAO Li-dong;MA Hai-ling(key laloratory of Microbial Molecular Bology of hunun PFrowine,lunan Prowincial Cener for LDisense Control aund Prerention/Htunan Worlstationfor Emerging lnfectious Disease Control and Prerention,Chinese Aecademy of Medical Sciences,Changsha,Hunan 410005,China;Xiangnan University,Chenzhou,Hunan 423000,China)

机构地区：[1]湖南省疾病预防控制中心,湖南省微生物分子生物学重点实验室,中国医学科学院湖南新发突发传染病防治工作站,湖南长沙410005 [2]湘南学院,湖南郴州423000

出　　处：《实用预防医学》2021年第9期1045-1048,共4页Practical Preventive Medicine

基　　金：科技部十三五科技重大专项(2018ZX10713002001003);湖南省卫生健康委员会重点课题(202112061732)。

摘　　要：目的对463例疑似登革热病例开展血清学和病原学监测,了解NS1抗原、IgM/IgG抗体及病毒核酸在不同病程的产生规律。方法对疑似登革热病例血清应用胶体金免疫层析法(gold immunochromatographic assay, GICA)和荧光免疫层析法(fluorescence immunochromatography assay, FICA)检测NS1抗原,比较两种方法的特异性和敏感性。用GICA检测IgM和IgG抗体,分析不同病程抗体产生规律。用Real-time RT PCR检测病毒核酸,了解不同病程核酸检测阳性的时间分布。结果 463例疑似登革热病例实验室确诊353例。353例病例在发病的0~3 d内以核酸的检出率最高,达97.08%(133/137);其次是NS1抗原,检出率为91.97%(126/137);在发病的8~14 d内NS1抗原和IgM抗体的检出率最高,检出率均为78.94%(45/57);病程≥15 d NS1抗原、IgM抗体、IgG抗体、核酸的检出率分别为58.06%(18/31)、61.29%(19/31)、54.84%(17/31)、87.10%(27/31);GICA与FICA检测NS1抗原的阳性符合率、阴性符合率、总符合率分别为94.88%(278/293)、85.00%(51/60)、93.20%(329/353),kappa值为0.768,具有较好的一致性。结论登革病毒NS1抗原和核酸在感染早期具有较高的检出率和一致性;IgM/IgG抗体随病程延长检出率增高,在发病的第二周后检出率最高;GICA与FICA检测NS1抗原均适合基层早期诊断与筛查。Objective To perform a serological and etiological surveillance in 463 cases of suspected dengue fever,and to understand the production of NS1 antigen,IgM/IgG antibody and viral nucleic acid in different courses of the disease.Methods Gold immunochromatographic assay(GICA)and fluorescence immunochromatography assay(FICA)were used to detect NS1 antigen in sera from the cases of suspected dengue fever,and the specificity and consistency of the two methods were compared.GICA was applied to detecting IgM/IgG antibody so as to analyze the law of antibody production in different course of the disease.Real-time RT PCR was employed to detect viral nucleic acid so as to know about the temporal distribution of positive results in different course of the disease.Results Among the 463 cases of suspected dengue fever,353 cases were confirmed by laboratory test.The positive rate of nucleic acid detection within 0-3 days of disease onset was found to be the highest in 353 confirmed cases,reaching 97.08%(133/137),followed by the positive rate of NS1 antigen,with the detection rate of 91.97%(126/137).The positive rates of NS1 antigen and IgM detection within 8-14 days of disease onset were the highest,and both reached 78.94%(45/57).The positive rates of NS1 antigen,IgM antibody,IgG antibody and viral nucleic acid detection in the course of the disease≥15 days were 58.06%(18/31),61.29%(19/31),54.84%(17/31)and 87.10%(27/31),respectively.The positive,negative and overall coincidence rates of GICA and FICA to detect NS1 antigen were 94.88%(278/293),85.00%(51/60)and 93.20%(329/353),respectively,and the kappa value was 0.768,showing high consistency.Conclusion The results of NS1 antigen and nucleic acid detection showed high positive rate and consistency at the early stage of infection.The detection rates of Ig M and Ig G antibodies increased with the prolonged course of the disease,and reached the highest in the second week from disease onset.Both GICA and FICA are suitable for early diagnosis and screening in primary laboratories.

关 键 词：胶体金免疫层析 荧光免疫层析 实时荧光定量PCR 登革病毒 NS1抗原 IgM/IgG抗体 

分 类 号：K512.8[历史地理—历史学]