江苏省血吸虫病查病质控体系的构建与应用Ⅰ县级人员血清学检测能力

Establishment and application of quality control system for detection of schistosomiasis in Jiangsu Province I Ability of serological detection among county-level personnel

目的评价江苏省县级人员开展血清学筛查血吸虫病的检测能力，为构建血吸虫病现场查病质控体系提供技术支撑。方法制作标准血清，由县级人员在现场血吸虫病查病的同时对标准血清进行单盲检测，比较检测结果与标准结果的符合率、误检率和漏检率。结果江苏省26个县（区、市）共检测标准血清780份，检出阳性134份，阴性646份，总符合率为95．13％，总误检率为1．28％，总漏检率为19．23％，检测结果与标准结果差异有统计学意义（χ^2=11．6053，P=0．0007）。26个县（区、市）中分别有5个和21个出现了误检和漏检，分别占19．23％和80．77％。江滩、山丘、水网和湖滩4类地区血清学检测误检率为0—2．08％，漏检率为16．67％-33．33％，差异无统计学意义（χ^2误=1．590，P：0．6671；χ^2漏u=1．757，P=0．6244）。传播控制和传播阻断2类流行区血清学检测误检与漏检率分别为1．14％、1．39％与18．18％、20．00％，差异亦无统计学意义（χ^2误=0．008，P=0．931；χ^2漏N=0．001，P=0．974）。结论漏检是江苏省县级水平血吸虫病查病质量下降的主要原因，现场血清学检测能力有待进一步提高。现场血吸虫病查病同步开展标准血清检测是控制查病质量的有效方法之一。

Objective To evaluate the ability for serological screening of schistosomiasis among county-level personnel, so as to provide the evidence for establishing the quality control system of field detection of schistosomiasis. Methods The standard serum panel was prepared for the quality assessment of schistosomiasis diagnostic capability, and detected by county-level person- nel in the endemic field simultaneously using single-blind method. The rates of coincidence, misdiagnosis and missed diagnosis were calculated compared with the standard results. Results Totally 780 samples of standard serum were detected in 26 coun- ties, and showed 134 positive and 646 negative samples. The rates of coincidence, misdiagnosis and missed diagnosis were 95.13%, 1.28% and 19.23%, respectively, and there was a significant difference between the detection results and the standard results （ X2 = 11.605 3, P = 0.000 7）. Among the 26 counties investigated, the misdiagnosis occurred in 5 counties （19.23%） and missed diagnosis occurred in 21 counties （80.77%）. The misdiagnosis rate and missed diagnosis rate of serological screening of schistosomiasis were 0-2.08% and 16.67%-33.33% in beach, hilly, water net and marshland endemic areas, respectively, and no significant differences were found in.the misdiagnosis rate and the missed diagnosis rate among various types of endemic areas （ X2 = 1.590 and 1.757, P = 0.667 1 and 0.624 4）. The rates of misdiailosis and the missed diagnosis were 1.14% and 1.39%.and 18.18% and 20.00% in the schistosomiasis transmission-controlled and the schistosomiasis transmission-interrupted areas, respectively, and no significant differences were found in the misdiagnosis rate and missed diagnosis rate between the schistoso- miasis transmission-controlled and transmission-interrupted areas （ X2 = 0.008 and 0.001, P = 0.931 and 0.974）. Conclusions The missed diagnosis is a major cause for the reduction of quality of schistosomiasis detection at the county level in Jiangsu Prov- ince, and the coincidental detection of schistosomiasis with standard serum in the field is one of effective approaches for the con- trol of the quality of schistosomiasis detection.