2021年湖北省血吸虫病规范化实验室病原学盲样考核结果分析

Analysis of the results of the blind sample assessment of the etiology of the standardized laboratory of schistosomiasis in Hubei province in 2021

目的了解湖北省20个血吸虫病规范化实验室开展血吸虫病病原学检测水平,评价尼龙绢集卵孵化法和改良加藤厚涂片法(Kato-Katz法)现场检测效果,为提高血吸虫病监测体系敏感性提供技术支撑。方法由湖北省血吸虫病诊断参比实验室统一制作血吸虫虫卵孵化质控品和Kato-Katz质控品,采用随机编号的方式分发给湖北省20个血吸虫病规范化实验室。采用单盲法检测,比较检测结果与标准结果的符合率、误诊率和漏诊率。结果湖北省20个血吸虫病规范化实验室共检测质控品200份(阳性90份,阴性110份),检出阳性88份,阴性112份,总符合率91.00%(182/200),总误诊率7.27%(8/110),总漏诊率11.11%(10/90),检测结果与标准结果比较,差异有统计学意义(χ^(2)=133.819,P<0.01)。20个血吸虫病检测实验室中有6个出现误诊,占30.00%;有7个出现漏诊,占35.00%。尼龙绢集卵孵化法和Kato-Katz法两个检测项目的符合率分别为99.00%和83.00%,Kato-Katz法误诊率和漏诊率高于尼龙绢集卵孵化法,差异均有统计学意义(χ^(2)=10.353、5.406,P均<0.05)。洲滩型、垸内型和丘陵型3类地区病原学检测误诊率和漏诊率的差异无统计学意义(P均>0.05)。传播阻断和消除2类流行地区误诊率分别为8.96%和5.88%,误诊率差异无统计学意义(P>0.05);漏诊率分别为7.55%和30.77%,漏诊率差异有统计学意义(χ^(2)=5.285,P<0.05)。结论湖北省血吸虫病规范化实验室病原学检测存在误诊、漏诊现象,Kato-Katz法检测水平有待进一步提高。

Objective To understand the pathogenic detection ability of 20 standardized schistosomiasis laboratories in Hubei province,and evaluate the effects of stool hatching method and Kato-Katz method in the field,so as to supply the technical assistance for improving the sensibility of schistosomiasis monitoring system.Methods The quality control samples of egg incubation and Kato-Katz were made by the Hubei provincial schistosomiasis diagnostic reference laboratory,and were randomly distributed to 20 standardized schistosomiasis laboratories in the province.The samples were detected by single-blind method,and the total coincidence rate,false detection rate and missing rate were compared between testing results and standard results.Results A total of 200 quality control samples(90 positives and 110 negtives)were detected in the 20 standardized schistosomiasis laboratories of Hubei,and 88 positive samples and 112 negtive samples were examined.The total coincidence rate,total false detection rate and total missing rate were 91.00%(182/200),7.27%(8/110)and 11.11%(10/90),respectively,with a significant difference between testing results and standard results(χ^(2)=133.819,P<0.01).There were 6 organizations out of 20 standard labs had false dectecton,accounting for 30.00%,while 7labs had missing detection,accounting for 35.00%.The coincidence rates of stool hatching and Kato-Katz methods were99.00%and 83.00%,respetively,while the false detection rates and missing rates showed statistically significant(χ^(2)=10.353,5.406,both P<0.05).Non significant differences were found in false detection rates and missing rates of pathogen detection among mashland,inner embankment and hilly areas(both P>0.05).The false detection rates of transmission interruption areas and elimination areas were 8.96%and 5.88%,respetively,and the difference was not statistically significant(P>0.05),while the miss diagnose rates of these two endemic areas were 7.55%and 30.77%,respetively,showing a statistically significant difference(χ^(2)=5.285,P<0.05).Conclusion The false dection and miss-detection exist in the standardized schistosomiasis labs of Hubei province,and more attention should be payed to improving the Kato-Katz techinique.