热带病与寄生虫学

热带病与寄生虫学 ›› 2020, Vol. 18 ›› Issue (1): 46-48,58.

• 研究报告 • 上一篇    下一篇

镜检、抗原检测和核酸检测方法在疟疾诊断中的应用比较

王加志, 李希尚, 尹授钦, 王兴娟, 杨东海, 李新和∗   

  1. 腾冲市疾病预防控制中心,腾冲 679100
  • 收稿日期:2019-12-29 出版日期:2020-03-10 发布日期:2020-03-10
  • 通信作者: ∗通讯作者,李新和,E-mail: 523990235@qq.com
  • 作者简介:王加志,男,本科,副主任技师。 研究方向:寄生虫病防治。 E-mail:tcwangjiazhi@163.com

Comparison on application of microscopy, RDT and PCR to malaria diagnosis

WANG Jia-zhi, LI Xi-shang, YIN Shou-qin, WANG Xing-juan,YANG Dong-hai, LI Xin-he∗   

  1. Tengchong City Center for Disease Control and Prevention, Tengchong 679100, China
  • Received:2019-12-29 Online:2020-03-10 Published:2020-03-10
  • Contact: ∗Corresponding author, E-mail:523990235@qq.com

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摘要： 目的 比较镜检、抗原检测(RDT)和核酸检测(PCR)三种方法对疟原虫的检测效果,为基层选择合适的 诊断方法提供依据。 方法 收集腾冲市 2015-2018 年发热病人的血样进行疟疾检测,以确诊结果为标准,对比分析镜检、RDT 和 PCR 三种疟疾检测方法的敏感性、特异性、阳性预测值、阴性预测值等指标。 结果 610 份血样中,阴性 295 份,阳性 315 份,其中恶性疟 67 份、间日疟 245 份、混合感染 2 份、三日疟 1 份。 与确诊结果比较,镜检、RDT 和 PCR 的灵敏度分别为 95. 87%、94. 60%和 99. 37%,特异度均为 100%;假阴性率分别为 4. 13%、5. 40%和 0. 63%,阴性预 测值分别为 95. 78%、94. 55%和 99. 33%;假阳性率均为 0,阳性预测值均为 100%;三种方法与确诊结果的总符合率分别 为 97. 87%、97. 70%和 99. 67%,Kappa 检验结果显示均与确诊结果高度一致(P 均<0. 001);对单一虫种恶性疟的检测, 镜检、RDT 和 PCR 的符合率分别为 88. 06%、100%和 97. 01%;对其他三种疟原虫检测的符合率,分别为 97. 97%、 93. 9%和 100%。 结论 三种检测方法均具有较高的敏感性和特异性,但综合考虑当前防治工作实际,抗原检测(RDT) 更适宜在基层推广和使用。

关键词: 疟疾, 镜检, 抗原检测, PCR

Abstract: Objective To compare the effects of microscopic examination, rapid diagnostic test ( RDT) and polymerase chain reaction (PCR) in detection of plasmodium for rational determination of diagnostic methods on grass-root level basis. Methods Blood samples were obtained in patients with fever in Tengchong city from 2015 to 2018 for malaria de- tection. The indexes, including sensitivity, specificity, positive and negative predictive values were analyzed and compared among the three testing techniques based on the final diagnosis. Results Of the 610 blood samples, 295 were negative and 315 positive, in which 67 samples were associated with Plasmodium falciparum , 245 with Plasmodium vivax, 2 with mixed infections, and 1 with Plasmodium malariae. Compared with the final diagnosis, the sensitivity was 95. 87% , 94. 60% and 99. 37% for microscopy, RDT and PCR, respectively, and specificity was 100% for the three methods. The false negative rate was 4. 13% , 5. 40 and 0. 63% , and negative predictive value was 95. 78% , 94. 55% and 99. 33% , respectively for microscopy, RDT and PCR. False positive rate was 0, and positive predictive value 100% for the three techniques. The total coincidence rate was 97. 87% , 97. 70% and 99. 67% , respectively, for microscopy, RDT and PCR. Kappa analysis dem- onstrated that the results tested by the three methods were highly consistent with the final findings (P<0. 001). Coincidence rate by microscopy, RDT and PCR in single species of falciparum was 88. 06% , 100% and 97. 01% , and 97. 97% , 93. 9% and 100% , respectively in other three species of falciparium. Conclusion The three detection methods have high sensitivity and specificity, yet RDT is worthy of wider recommendation on grass-root level by taking the real practice in current prevention and control of malaria into consideration.

Key words: Malaria, Microscopy, Rapid diagnostic test, PCR

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