天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 210-214.doi: 10.11958/20161421

• 诊断技术 • 上一篇    下一篇

发热伴血小板减少综合征实验室诊断方法的比较与评价

程宁宁 1， 杜燕华 2， 黄学勇 2,3， 李懿 2， 赵伊珂 1， 马红霞 2， 许汴利 1△   

  1. 1 郑州大学公共卫生学院流行病学教研室 （邮编 450001）； 2 河南省疾病预防控制中心传染病所； 3 河南省分子诊断与医学检验技术协同创新中心
  • 收稿日期:2016-11-29 修回日期:2016-12-15 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail: xubl@hncdc.com.cn E-mail:495504933@qq.com
  • 作者简介:程宁宁 （1990）， 女， 硕士在读， 主要从事传染病分子流行病学研究
  • 基金资助:
    国家自然科学基金资助项目 （81573204）； 河南省医学科技攻关计划项目 （201303194）

Comparison and evaluation of different assays in the diagnosis of severe fever with thrombocytopenia syndrome

CHENG Ning-ning1, DU Yan-hua2, HUANG Xue-yong2,3, LI Yi2, ZHAO Yi-ke1, MA Hong-xia2, XU Bian-li1△   

  1. 1 Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; 2 Institute for Infectious Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention; 3 Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine
  • Received:2016-11-29 Revised:2016-12-15 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail: xubl@hncdc.com.cn E-mail:495504933@qq.com

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摘要： 目的 比较不同检测方法在发热伴血小板减少综合征（SFTS）病例诊断中的结果差异， 为快速、 准确诊断新布尼亚病毒（SFTSV）感染提供依据。方法 选取 2014 年河南省 SFTS 专项监测系统收集的 158 例 SFTS 患者的急性期血清标本， 分别应用 Real-time PCR 和酶联免疫吸附试验（ELISA） -IgM 法进行检测； 选取其中有急性期和恢复期双份血清的 109 对标本， 应用 ELISA-IgM 和 ELISA-IgG 法进行检测。比较 3 种方法对 SFTS 阳性检出率的差异， 同时分析采血时间对检测结果的影响。结果 158 例 SFTS 患者的急性期血清标本， Real-time PCR 的阳性检出率 （76.58%） 高于 ELISA-IgM （47.47%）， 差异有统计学意义 （χ2=34.13， P＜0.05）； 109 例有急性期和恢复期双份血清标本的病例， ELISA-IgG 的阳性检出率 （75.23%） 与 Real-time PCR 的阳性检出率 （72.48%） 差异无统计学意义 （χ2=0.18， P＞0.05）； 无论在急性期还是恢复期， IgM 抗体的阳性检出率均高于 IgG， 差异有统计学意义（χ2 分别为 41.68 和 6.25， 均 P < 0.05）； 随着采血时间的延长， IgM 和 IgG 抗体的阳性检出率均有增加的趋势（Z 分别为 6.42 和 10.08， 均 P＜0.05）。结论 Real-time PCR 法适用于 SFTS 病例的早期诊断， ELISA-IgG 法适用于 SFTS 恢复期标本的检测， ELISA-IgM 法可作为一种辅助方法指导临床诊断。

关键词: 正布尼亚病毒属, 实验室技术和方法, 酶联免疫吸附测定, 发热伴血小板减少综合征, Real-time PCR, IgM, IgG

Abstract: Objective To evaluate different detection methods in the diagnosis of severe fever with thrombocytopenia syndrome (SFTS), and find the most quick and accurate one for the identification of new bunyavirus infection. Methods Real-time PCR and ELISA-IgM were used to detect serum samples of 158 patients with acute phase of SFTS, which were collected from the special monitoring system of SFTS in Henan Province in 2014. IgM and IgG antibodies were detected by ELISA in 109 acute and convalescent paired serum specimens. The differences of the positive rates were compared between the three methods, and the influence of the collected interval time on the detection results was analyzed. Results For 158 acute phase serum samples of SFTS patients, the positive rate detected by real-time PCR (76.58%) was higher than that of ELISA-IgM (47.47%), and the difference was statistically significant (χ2=34.13, P < 0.05). For 109 cases with acute and convalescent paired serum samples, there was no significant difference in the positive rates between ELISA-IgG (75.23%) and real-time PCR (72.48%) detections (χ2=0.18, P > 0.05). In both the acute phase and convalescent phase, the positive rate of IgM was higher than that of IgG, and the difference was statistically significant (χ2=41.68 and 6.25, P < 0.05). With the extension of collected interral time, the positive rates of IgM and IgG antibodies were both increased (Z=6.42 and 10.08, P < 0.05). Conclusion Real-time PCR is the most sensitive method for the early diagnosis of the SFTS. ELISA-IgG is suitable for the detection of SFTS at recovery period. ELISA- IgM can be used as an assistant method to guide clinical diagnosis.

Key words: orthobunyavirus, laboratory techniques and procedures, enzyme-linked immunosorbent assay, severe fever with thrombocytopenia syndrome, Real-time PCR, IgM, IgG