核酸检测在寨卡病毒病诊断上的应用

Value of detection of nucleic acid in diagnosis of Zika virus disease

目的研究核酸检测技术测定不同样本对我国输入性寨卡病毒(Zika virus)病患者的诊断价值,探讨核酸检测寨卡病毒临床标本的适用性。方法收集医院2016年2月-10月输入性寨卡病毒病患者的血液、唾液和尿液,用于寨卡病毒核酸检测。记录和分析患者临床症状、体征和实验室检验结果。结果血液、唾液和尿液寨卡核酸首次检测阳性率分别为61.5%、76.9%和76.9%;血液、唾液和尿液的核酸总检出阳性率分别为61.5%、84.6%和100%;血液、唾液和尿液核酸阳性持续时间平均分别为2.62、5.69和11.62天,血液没有1例阳性持续时间超过1周,唾液阳性持续时间没有1例超过10天,而尿液有11例核酸阳性超过1周(其中6例超过10天)。随着病程的发展,各样本的检出率也在下降,发病后第3天和第7天采样时,血液、唾液、尿液核酸阳性率分别为25%、100%、100%和7.7%、46.2%、84.6%。少数尿液标本检测阳性有一定滞后现象。结论检测尿液中寨卡病毒核酸具有检出率高、持续时间长的优点,应作为临床诊断寨卡病毒病的主要方法,但在发病早期仍然有必要采集血液、唾液和尿液进行多样本同时检测寨卡病毒核酸。

OBJECTIVE To study the value of nucleic acid detection in diagnosis of patients with imported Zika virus disease in China and explore the applicability of the nucleic acid in detection of Zika virus in clinical samples.METHODS The blood,sputum,and urine specimens were collected from the patients with imported Zika virus disease who were treated in hospitals from Feb 2016 to Oct 2016.The clinical symptoms,signs,and results of clinical laboratory tests were recorded and observed.RESULTS The positive rate of initial detection of Zika virus nucleic acid was 61.5%in blood,76.9%in sputum,76.9%in urine.The total positive rate of detection of nucleic acid was 61.5%in blood,84.6% in sputum,100% in urine.The average duration that the nucleic acid maintained positive was 2.62 days in blood,5.69 days in sputum,11.62 days in urine;there was no case whose blood maintained positive for more than 1week and no case whose sputum maintained positive for 10 days,however,there were 11 cases whose urine maintained positive for more than 1 week,including 6cases whose urine maintained positive for more than 10 days.With the development of disease course,the detection rate was reduced in the samples.The positive rate of nucleic acid was 25%in blood on Day 3after onset,100%in sputum,100%in urine;the positive rate of nucleic acid was 7.7%in blood on Day 7after onset,46.2%in sputum,84.6%in urine.Few urine specimens showed hysteresis phenomenon to be tested positive.CONCLUSION The detection of Zika virus nucleic acid in urine has the advantages such as the high detection rate and long duration and should be used as the major method for clinical diagnosis of Zika virus disease,however,it is still necessary to collect the blood,sputum,and urine samples in early stage of the onset for simultaneous detection of the Zika virus nucleic acid.