2018-2019年广州市区某院甲型流感流行病学特点和检测方法比较  

Comparison of the epidemiological characteristics and detection methods of influenza A in a hospital in Guangzhou from 2018 to 2019

作　　者：黄佳斯 何宇婷[2] 陈瑶 余学高 黄浩[2] 陈培松[2] HUANG Jiasi;HE Yuting;CHEN Yao;YU Xuegao;HUANG Hao;CHEN Peisong(The Third Hospital of Changsha,Changsha,Hunan,China,410000;The First Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong,China,510000)

机构地区：[1]长沙市第三医院检验科,湖南长沙410000 [2]中山大学附属第一医院检验科,广东广州510000

出　　处：《分子诊断与治疗杂志》2021年第10期1648-1651,共4页Journal of Molecular Diagnostics and Therapy

基　　金：广东省自然科学基金项目(2018A0303130246)。

摘　　要：目的分析2018至2019年广州市区某院甲型流感病毒的流行特征,评估胶体金标记免疫层析法和Real-time RT-PCR法在甲型流感病毒筛查中的临床应用。方法收集2018年8月至2019年7月本院收治的12506例流感样病例(ILI),采集其咽拭子标本,采用胶体金标记免疫层析法检测甲型流感抗原,Real-time RT-PCR法检测核酸。结果ILI甲型流感检出率4.19%,主要集中在1月至7月;不同性别ILI甲型流感检出率比较,差异无统计学意义(χ^(2)=0.606,P>0.05);不同年龄组间ILI甲型流感阳性率比较,差异有统计学意义(χ^(2)=31.260,P<0.05),7~17岁组阳性率最高(6.19%);Real-time RT-PCR法甲型流感病毒阳性检出率15.20%,以Real-time RT-PCR法为参考,胶体金标记免疫层析法灵敏度为10.48%,特异度为98.98%;阳性预测值为64.71%,阴性预测值为86.05%,符合率85.53%,尤登指数0.095,一致性Kappa值0.144(P<0.05),漏检率为89.52%,假阳性率为1.02%。结论胶体金标记免疫层析法存在较高的漏检率。临床上应该更加重视病原学的核酸检测,同时不断提高包括胶体金法在内快速法的灵敏度和特异度,以最大程度满足临床需求。Objective To analyze the epidemic characteristics of influenza A virus in a hospital in Guangzhou from 2018 to 2019 and and evaluate the clinical application of colloidal gold immunochromatography and Real-time RT-PCR in influenza A virus screening.Methods In the retrospective study,a total of 12506 cases of influenza-like illness(ILI)admitted to the hospital from August 2018 to July 2019 were recruited.Pharyngeal swabs were collected,colloidal gold-labeled immunochromatography was used to detect influenza A antigen.Real-time RT-PCR was used to detect nucleic acid.Results The detection rate of ILI influenza A was 4.19%,mainly from January to July.There was no statistically significant difference in ILI influenza A detection rate of different genders(χ^(2)=0.606,P>0.05).There was a statistically significant difference in ILI influenza A positive rate between different age groups(χ^(2)=31.260,P<0.05),and the positive rate was the highest in the 7~17 year-old group(6.19%).Real-time RT-PCR method of influenza A virus positive detection rate is 15.20%,with Real-time RT-PCR method as a reference,the sensitivity of colloidal gold immunochromatography method is 10.48%,and the specificity is 98.98%.The positive predictive value was 64.71%,the negative predictive value was 86.05%,the coincidence rate was 85.53%.The Yoden index was 0.095,the consistent Kappa value was 0.144(P<0.01),the missed detection rate was 89.52%,and the false positive rate was 1.02%.Conclusion The colloidal gold labeled immunochromatography has a high rate of missed detection.Clinically,more attention should be paid to nucleic acid detection in pathogens,and the sensitivity and specificity of rapid methods including colloidal gold methods should be continuously improved to meet clinical needs to the greatest extent.

关 键 词：甲型流感 流行特征 胶体金标记免疫层析法 Real-time RT-PCR 灵敏度与特异度 

分 类 号：R511.7[医药卫生—内科学] R181.3[医药卫生—临床医学]