金标免疫渗滤法诊断疑似并殖吸虫病及考核疗效的观察

Dot Immuno-Gold Filtration Assay in the Diagnosis of Suspected Paragonimiasis and Evaluation of Chemotherapeutic Effect

目的探讨金标免疫渗滤法(DIGFA)检测并殖吸虫抗体的临床诊断价值。方法2003-2006年由浙江省有关医院和疾病预防控制中心转诊的疑似并殖吸虫病患者72例,用并殖吸虫抗体金标快速检测法(Pw-DIGFA)检测患者血清抗体阳性者,综合其饮食史及相关临床表现,拟诊为并殖吸虫病,给予吡喹酮治疗,并于治疗后3及6个月随访、复查,分别用Pw-DIGFA和ELISA检测患者治疗前、后配对血清抗体水平。结果Pw-DIGFA和ELISA法检测结果一致,72例中抗体阳性28例,阴性44例。在28例阳性者均有生食或半生食淡水蟹或蝲蛄史,以及饮用生溪水史;21例有低热、咳嗽及胸肺部影像学改变等并殖吸虫病相关临床征状和体征,7例仅外周血嗜酸粒细胞异常增高(15%～70%)。用ELISA检测阳性者、阴性者、健康人血清抗体水平(吸光度A450值)分别为1.7361、0.2973、0.2657;经t检验,阳性者与阴性者间差异具有统计学意义(t=12.047,P<0.01),阴性者与健康人之间差异无统计学意义(t=1.919,P>0.05)。治疗后3个月复查,ELISA检测6例中有5例血清效价下降2～5个滴度,Pw-DIGFA检测抗体反应斑点色泽变淡;ELISA检测1例治疗后复发患者抗体效价升高1个滴度,Pw-DIGFA检测抗体反应斑点色泽变化不明显。治疗后6个月复查7例临床症状缓解或消失者,ELISA检测抗体效价下降3～6个滴度,Pw-DIGFA检测抗体反应斑点色泽较治疗前明显减弱。结论Pw-DIGFA检测疑似并殖吸虫病患者血清抗体有较好的临床辅助诊断价值,治疗前、后配对血清平行检测有较好疗效考核价值。Pw-DIGFA法操作简易快速,适用于并殖吸虫病较少见地区的诊断和疗效评估。

Objectiv To evaluate the usefulness of dot immuno-gold filtration assay（DIGFA） for the diagnosis of Paragonimus infection. Methods During 2003 to 2006, 72 cases suspected of paragonimiasis in Zhejiang Province were examined with DIGFA for rapid detection of specific antibodies against Paragonimus （Pw-DIGFA）. The diagnosis was primarily established with the presence of antibodies, experience of ingesting raw freshwater crabs or crayfishes and clinical presentations. The cases were treated with praziquantel and followed-up at 3 and/or 6 months post-treatment. Antibody level in patients （pre- and post-treatment） were detected in parallel and analyzed comparatively by Pw-DIGFA and ELISA. Results The result of detection by Pw-DIGFA was in agreement with that of ELISA. 28 of 72 cases were antibody positive and 44 cases were negative. Among the 28 positives, 26 cases had a history of eating raw freshwater crab or crayfishes and the other 2 cases drank freshwater from brook before. 21 cases showed paragonimiasis-related clinical symptoms such as low-grade fever, cough, or changes in image examination, while the other 7 cases showed only eosinophilia in peripheral blood （15%-70%）. The mean absorbance values （A450） of positive sera, negative sera and normal sera tested by ELISA were 1.7361, 0.2973 and 0.2657 respectively. There was significant difference between the positive cases and the negative cases （t=12.047, P〈0.01） and no significant difference between the negative cases and normal controls （t=1.919, P〉0.05）. At 3 month post-treatment, serum antibody in 5 cases whose clinical symptoms and physical signs relieved or disappeared decreased 2-5 titers and that of one case who relapsed with new signs increased by one titer. In Pw-DIGFA, the dot color of 5 cured cases showed a little weaker than that of pre-treatment and the relapsed case displayed similar response. At 6 month post-treatment, 7 sera of clinically cured cases showed significantly weaker response than that of pre-treatment. The antibodies of those sera dropped 3-6 titers. Conclusion Pw-DIGFA is of supplementary value for clinical diagnosis of paragonimiasis. Antibody detection by pre- and post-treatment using Pw- DIGFA shows potential for the evaluation of therapeutic effect.