登革热的实验室早期诊断

Laboratory early diagnosis of dengue fever

目的建立登革热实验室早期诊断方法。方法采用酶联免疫吸附试验(ELISA)检测登革病毒(DENV)NS1抗原,实时聚合酶链反应(Real-time PCR)检测DENV RNA并分型,对2014年广东省暴发流行期间疑似登革热的病例进行实验室早期诊断,并对两种检测方法进行比较分析。结果272例研究对象中267例临床诊断为登革热,DENV NS1抗原阳性245例,阳性率为90.1%(245/272);DENV RNA阳性256例,阳性率为94.1%(256/272)。256例核酸阳性病例中DENV-1型224例,占87.5%(224/256);DENV-2型15例,占5.9%(15/256);DENV-1型和DENV-2型同时阳性17例,占6.6%(17/256)。两种方法检出的符合率为93.0%(253/272)。结论2014年广东省登革热暴发流行主要以DENV-1为主,同时存在DENV-2型散在流行及少数DENV-1型和DENV-2型合并感染;ELISA方法检测DENV NS1抗原及Real-time PCR检测DENV RNA的两种检测方法,有助于登革热的早期检出。

Objective To establish the method for laboratory early diagnosis of dengue virus infection, and evaluate the use of it during the dengue outbreak in Guangdong in 2014. Methods During the 2014 dengue outbreak, serum samples were collected from patients clinically suspected with dengue fever. DENV NS1 was detected by ELISA; DENV RNA and virus genotyping（DENV1-4） were detected by Real-time fluorescence PCR. Results Of all the 272 clinically suspected cases, 267 clinically cases were diagnosed with dengue fever; 245 （90.1%） were positive for DENV NS1 and 256（94.1%）were positive for DENV RNA. Results showed that 87.5%（224/256） of patients were infected with DENV-1, 5.9%（15/256） were infected with DENV-2 and 6.6% （17/256） were co-infected with DENV-1 and DENV-2. Coincidence rate of two methods was 93.0%（253/272）. Conclusion The outbreak of dengue fever in Guangdong in 2014 was mainly caused by the DENV-1 ; few of patients wereinfected by DENV-2 and co-infected by DENV-1 and DENV-2. The laboratory diagnosis of both DENV NS1 antigen by ELISA and DNEV RNA by Real-time fluorescence were sensitive for early diagnosis of dengue virus infection.