肥达反应对儿童伤寒诊断价值的再评价——附87例分析

Reevaluation of the diagnostic value of Widal test in children with typhoid fever

目的:评价肥达反应在儿童伤寒的诊断价值以及应注意的问题。方法:对251例伤寒患儿中伤寒杆菌培养阳性的87例患儿(伤寒组)及922例非伤寒发热患儿(非伤寒组)的肥达反应结果进行回顾性分析。结果:伤寒组肥达反应的肥达反应阳性率为97%(84/87),非伤寒组为4%(40/922),两组比较差异有极显著意义,P<0.001。肥达反应的敏感性为97%,特异性为81%,准确性为82%。伤寒患儿发病后第一、二、三、四周的阳性率分别为79%、86%、94%、89%。66例伤寒患儿重复1次以上肥达反应,并非O、H抗体凝集效价都呈上升趋势。虽然非伤寒患儿肥达反应可呈假阳性反应,但O、H抗体凝集效价极少达到1∶800。结论:肥达反应仍是当今诊断儿童伤寒尤其是细菌培养阴性的伤寒患儿的可靠、有意义的辅助性诊断指标,其诊断价值应得到肯定。

Objective:To reevaluate the diagnostic value of Widal test and some problems concerned in children with typhoid fever. Methods:Widal test was analysed retrospectively in 87 bacteriologically proven cases of typhoid fever (typhoid fever group) and 922 patients with non typhoidal fever (non typhoidal fever group). Results:There was significant difference in positive rate of Widal test between the typhoid fever group and the non typhoidal fever group (97% vs 4%,P<0.001). The sensitivity of Widal test was 97%,the specificity was 81%,the accuracy was 82%. The positive rate of Widal test in typhoid children was 79%,86%,94%,89% respectively at the first week,the second week,the third week,and the fourth week after onset. Widal test was done again in 66 typhoid fever cases,but not all of them showed elevated level of O and H agglutinin titres with the duration of illness. Although non typhoidal febrile children manifested false positive Widal test,agglutinin level at titre of 1∶800 was only found in a few patients. Conclusion:Widal test is still considered to be a reliable and significant test for the diagnosis of typhoid fever in children with negative bacterial culture,and its diagnostic value should be confirmed.