单份血清肥达凝集试验在甲型副伤寒诊断中的价值  

VALUE OF A SINGLE SERUM WIDAL AGGLUTINATION TEST IN DIAGNOSIS OF PARATYPHOID FEVER A

作　　者：王树坤[1] 储从家 管新龙 罗次节 姚云波[1] 张媛春[1] 赵琼[1] 

机构地区：[1]玉溪市疾病预防控制中心检验科,云南玉溪653100 [2]玉溪市医院检验科

出　　处：《中国微生态学杂志》2003年第4期223-225,共3页Chinese Journal of Microecology

摘　　要：目的 :评价疑似甲型副伤寒病例单份血清肥达凝集试验 (WAT)的诊断价值。方法 :以甲型副伤寒沙门菌血培养阳性和 /或血清鞭毛特异性抗原阳性的甲型副伤寒病例 (n =76 )、血培养阴性和 /或血清抗原阴性的对照发热病人 (n =92 )和健康饮食从业人员 (n =6 3)为检测对象 ,用WAT测定以上三种人群血清甲型副伤寒沙门菌O、H、A抗体 ,分析评价不同O、H、A判断值诊断甲型副伤寒的敏感性、特异性、阳性预测值和阳性似然比等指标。结果 :获得三种人群O、H、A凝集价的分布及其几何平均滴度 ,2 0 %对照发热病人O抗体效价≥ 16 0 ,而健康从业人员仅有 3 2 %的O抗体效价≥ 16 0 ,对照发热病人和健康人相应H抗体效价分别占 17%和 4 8% ,A抗体效价分别占 16 %和 1 6 %。 5 3%血培养阳性和血清鞭毛抗原阳性甲型副份寒病例O抗体效价≥ 16 0 ,相应H、A抗体效价分别占 4 1%和 5 1%。用敏感性、特异性、阳性预测值、阳性似然比等指标评价单份血清WAT诊断甲型副伤寒的价值 ,提出O或H或A≥ 16 0和O≥ 16 0或A≥80可作为WAT辅助诊断甲型副伤寒的标准。结论 :单份血清WAT有助于甲型副伤寒的诊断 ,该试验对血培养阴性的临床疑似甲型副伤寒病例及其高危人群中甲型副伤寒病例的诊断有实用意义。Objective:To evaluate the diagnostic value of a single-serum Widal agglutination test (WAT) for patients with suspected paratyphoid fever A.Methods:The paratyphoid fever A cases investigated with a blood culture positive for Salmonella paratyphi A or S.paratyphi A flagellin positive in serum samples(n=76),the febrile patients confirmed by a blood culture negative for S.paratyphi A or S.paratyphi A flagellin negative in serum samples(n=92),and the healthy personnel engaged in drink and food trades (n=63) were object of study.Adopted WAT to examine O,H,A antibodies of S.paratyphi A in sera of 3 crowds.Evaluated and analyzed the diagnostic sensitivity,specificity,positive predictive value,Positive probability ratio and so on for the indicated patients of the WAT at different cutoff values.Results:Obtain O,H,A agglutinins distribution and geometric mean tiers in each crowd.An O-agglutinin titer of≥160 was found in 20% of the febrile controls and 3.2% of the healthy personnel.Corresponding values for H agglutinins were 17% and 4.8%,values for A agglutinins were 16% and 1.6%,respectively.The O-agglutinin titer was≥160 in 53% of blood culture-positive and serum flagellin positive paratyphi fever A cases,the H and A agglutinin titers were≥160 in 41% and 51%,respectively.With a cutoff titer of≥160 for O or H or A agglutinin, the WAT would diagnose correctly 64% of the blood culture positive and serum flagellin positive paratyphi fever A cases.However,37% of the positive results would be false-positive,and 30% of the negative results would be false-negative.Developed the local recommendations for the interpretation of WAT results. Conclusion:A single serum WAT can be helpful in the laboratory diagnosis of paratyphoid and tyhoid fever if interpreted with care.The WAT is of practical significance for the diagnosis of blood culture negative suspected (para)typhoid fever cases and personnel at the risk of relevant infection.

关 键 词：血清肥达凝集试验 甲型副伤寒 诊断 抗体效价 

分 类 号：R516.3[医药卫生—内科学]