外-斐反应与胶体金免疫色谱法对恙虫病的诊断价值

The diagnostic value of Weil-Felix test and colloidal gold immunochromatographic assay for tsutsugamushi disease

目的比较外-斐反应(WFT)与胶体金免疫色谱法(CIA)对恙虫病血清学诊断价值的差异。方法采集恙虫病暴发期间患者的血清标本,以变形杆菌OXK、OX2及OX19抗原进行WFT检测,以CIA测定恙虫病东方体特异性抗体,比较两种血清学方法对恙虫病的实验诊断效能。结果共有18例恙虫病患者接受了CIA检测,阳性率为100%(18/18);其中9例住院患者同时接受了WFT和CIA检测,抗-OXKWFT阳性率为44.4%(4/9),CIA阳性率为100%(9/9),(P<0.01)。抗-OXKWFT诊断恙虫病的灵敏度为44.4%,特异度为94.1%,假阳性率为5.9%,假阴性率为55.6%。所有患者抗OX2及抗OX19均为阴性。结论抗-OXKWFT对恙虫病有一定诊断价值,但敏感性较差,假阴性率较高。CIA作为恙虫病血清学诊断的一种新方法,具有较高的敏感性和特异性。

Objective To explore the difference between Weil-Felix tests （WFT） and colloidal gold immunochromatographic assay （CIA）as the serological diagnostic tests for tsutsugamushi disease. Methods The sera samples of 18 patients with tsutsugamushi disease were analyzed with CIA and WFT assays parallelly, and the diagnostic value was evaluated. The antigens of bacillus proteus included in the WFT kits were OXK,OX2 and OX19. Results The positive rate in diagnosing tsutsugamusbi disease was 100% with CIA in 18 cases with typical clinical features. Of 18 cases,nine hospitalized patients received CIA and WFT assays simultaneously, and the positive rate was 100 % （9/ 9） by CIA, which was significantly higher than 44. 4% （4/9） by WFT （P〈0. 01）. The sensitivity, specificity,false positive rate and false negative rate of Anti-OXK WFT were 44. 4%, 94. 1%, 5.9% and 55.6%, respectively. No anti-OX2 and anti-OX19 antibodies were detected by WFT in the nine hospitalized patients. Conclusion Anti-OXK WFT has a certain value for the diagnosis of tsutsugamushi disease, hut with low sensitivity and high false negative rate. CIA is a new standard serological test for the diagnosis of tsutsugamushi disease with noted characteristics of high sensitivity,specificity,good convenience and rapidness.