33例HIV-1抗体免疫印迹试验不确定结果分析

Analysis of the uncertain results of HIV-1 antibody western blotting test in 33 cases

目的调查HIV-1抗体确证检测中不确定样本结果的血清学特征并探讨缩短患者检测窗口期的可行性方法。方法采用胶体硒快速试验、酶联免疫吸附试验及免疫印迹试验对云南省传染病专科医院确证试验中HIV抗体不确定样本结果进行带型比较,分别对gag、pol和env3个基因区对应抗原条带出现频率、出现时间、组合类型进行比对分析,同时对不确定样本的HIV核酸检测、快速试验和ELISA实验结果的敏感性和特性性进行验证,以阐明不确定样本中各WB条带出现时间顺序和组合特点,为临床检测提供理论参考。结果2013至2016年本院共检出33例HIV抗体不确定样本,其中20例在随访过程中确定为HIV感染:血清抗体检测阳转18例,核酸定量检测阳转者2例。33例不确定样本中有12例在初次确证检测与第2次随访之间进行HIV核酸定量检测,其中10例均>5000 copies/mL,且第2次血清抗体检测随访均阳转。HIV核酸检测的敏感性和特异性均达100%。33例不确定样本WB特征条带中,gp160和p24单独出现频率最高,分别为100.0%和72.7%;在组合带型中,gp160、p24出现频率最高为45.4%,20例随访阳转的样本中均包含gp160、gp120或p24条带。结论gp160、p24带型的出现提示标本有较大感染风险,对含有gp160、p24带型的不确定标本补充HIV核酸定量检测可缩短检测窗口期。

Objective To investigate the serological characteristics of uncertain sample results among HIV-1 antibody confirmation test,and explore the feasibility of shortening the patient′s HIV detective window.Methods The colloidal selenium rapid test,enzyme-linked immunosorbent assay and immunoblotting test were used to compare the results of the HIV antibody uncertain samples found in the confirmation test of our hospital,and the frequency of corresponding antigen bands in gag,pol and env gene regions.Time,combination type,comparative analysis,and verification of the sensitivity and characterization of HIV nucleic acid detection,rapid test and ELISA results in uncertain samples to clarify the chronological order of WB bands in uncertain samples.The combination features provide a theoretical reference for clinical testing.Results From 2013 to 2016,33 cases of HIV antibody uncertain samples were detected in our hospital,20 of which were identified as HIV infection during follow-up:18 cases of positive for serum antibody detection and 2 cases were positive in quantitative detection of nucleic acid.Twelve of the 33 undetermined samples were tested for HIV nucleic acid between the initial confirmation test and the second follow-up.Ten of them were>5000 copies/mL,and the second serum antibody test was positive.The sensitivity and specificity of HIV nucleic acid detection are 100%.Among the 33 undetermined samples of WB characteristic bands,the exclusive appeared gp160 or p24 bands had the highest frequency of 100.0%and 72.7%,respectively;in the combined band type:gp160,p24 had the highest frequency of 45.4%.Gp160,gp120 or p24 bands were found in 20 cases of follow-up positive conversion.Conclusions The presence of gp160 and p24 bands indicated that the specimens were at greater risk of infection.Quantitative detection of HIV nucleic acids in uncertain specimens showing gp160 and p24 bands could shorten the detective window.