布鲁菌病三种血清学检测方法一致性研究

A study on the consistency of three serological detection methods for brucellosis

目的用三种血清学检测方法对布鲁菌病高危人群血清进行检测,掌握三种方法的优劣,为布鲁菌病大面积筛查与临床诊断提供参考。方法对1016份血清同时采用虎红平板凝集试验法(rose bengal plate agglutination test,RBT)、胶体金免疫层析法(gold immune chromatography assay,GICA)、试管凝集试验法(serum agglutination test,SAT)进行检测,分析三种方法检测结果的一致性。结果1016份血清中,SAT总阳性[包括1∶50(++)的114份]201份、RBT阳性190份、GICA阳性194份;RBT阴性血清中,9份SAT1∶100(++)及以上阳性者,假阴性率10.34%;GICA阴性的血清中,14份SAT1∶100(++)及以上阳性者,假阴性率16.09%,总阳性率SAT(19.78%)>GICA(19.06%)>RBT(18.70%)。SAT≥1∶100(++)血清87份,阳性率8.56%,三种方法检测结果进行两两比对,经一致性检验,RBT与SAT的总体一致性结果Kappa值为0.665,RBT与SAT1∶100(++)及以上阳性者一致性结果Kappa值为0.505;GICA与SAT的总体一致性结果Kappa值为0.513,GICA与SAT1∶100(++)及以上阳性者一致性结果Kappa值为0.455。结论RBT、GICA的检验结果与SAT的检验结果均具有较好的一致性。建议诊断布鲁菌病患者时,为减少漏诊,可将RBT、GICA与SAT三者联合使用,再结合临床症状与接触史综合判定。

Objective To investigate the advantages and disadvantages of three serological methods for brucellosis through the serum detection of the high-risk population with brucellosis,so as to provide a reference for the large-scale screening and clinical diagnosis of brucellosis.Methods A total of 1016 cases of serum were detected by rose bengal plate agglutination test(RBT),gold immune chromatography assay(GICA)and serum agglutination test(SAT)at the same time.The consistency of the test results of three serological methods were compared.Results Of 1016 serum samples,201 were tested positive by SAT[including 114 samples of 1∶50(++)],191 tested positive by RBT and 194 tested positive by GICA.In RBT negative serum samples,9 of them were positive in SAT1∶100(++)or above,with a false negative rate of 10.34%.Among the GICA negative serum samples,14 were positive in SAT1∶100(++)or above,with a false negative rate of 16.09%.The total positive rate of SAT(19.78%)was the highest,followed by GICA(19.06%)and RBT(18.70%).There were 87 serum samples with SAT≥1∶100(++),with a positive rate of 8.56%.The results of the three methods were compared in pairs.The consistency test showed that the overall consistency of RBT and SAT was 0.665 Kappa,and the Kappa value of consistency test result of RBT and SAT≥1∶100(++)was 0.505.The Kappa value of the overall consistency test result of GICA and SAT was 0.513,and the Kappa value of consistency test result of GICA and SAT≥1∶100(++)was 0.445.Conclusion It is proved that the test results of RBT and GICA have great consistency with those of SAT.In order to decrease the rate of missed diagnosis,it is necessary to make the combined use of RBT,GICA and SAT when diagnosing patients with brucellosis,and connect the test results with their clinical symptoms and contact history.