应用配对样本提高手足口病相关肠道病毒核酸检出率

Using Paired Samples to Improve the detection rate of Hand,Foot and Mouth Disease Related Intestinal Virus Nucleic Acid

目的:比较肛拭和咽拭样本中手足口病(HFMD)相关肠道病毒核酸检测结果的差异,探讨提高实验室诊断率的方法。方法:采用实时荧光定量PCR方法,对拟诊HFMD患者肛拭和咽拭配对样本进行肠道病毒71型(EV71)、柯萨奇病毒A组16型(CA16)和肠道病毒通用型(EV)RNA检测,将不同样本中各病毒的检出率进行比对,分析检测单一样本的漏检情况。结果:EV71、CA16和非EV7l/非CV16型肠道病毒(non-EV71/non-CA16 EV)在肛拭/咽拭中的检出率依次是17.25%/12.18%、4.03%/3.54%、40.28%/45.32%,肛拭样本中EV71和CA16的检出率均高于咽拭,而non-EV71/non-CA16 EV的检出率则低于咽拭,差异均具有统计学意义(P<0.05);与配对样本检测结果比较,单一样本的漏检率为10.33%~36.27%。结论:应用肛拭或咽拭单一样本进行HFMD相关肠道病毒核酸检测漏检率高,采集配对样本检测能显著提高检出率。

Objective The detection results of intestinal virus nucleic acid related to HFMD （ hand, foot and mouth disease） from the anal swabs and throat swabs were compared so as to explore more effective methods for laboratory diagnostic of the disease. Methods Real-time fluorescence quantitative polymerase chain reaction （PCR） was used to detect RNA of enterovirus 71 （EV71 ） , coxsaekievirus A16 （CA16） , and other enterovirus （EV） in the paired samples. The virus detection results from the two sample types were compared to find out the miss rate in a single sample. Results The detection rates of EVT1, CA16 and Non-EV71/Non-CV16 enterovirus （Non-EVT1/Non-CV16 EV） in the anus swabs/throat swabs were 17.25%/12.18%, 4.03%/3.54% and 40.28%/ 45.32% , respectively. Obviously, the detection rates of EV71 and CA16 in anal swabs were higher than those in throat swabs, while the detection rates of Non-EV71Non-CV16 EV was lower than that in throat swabs. The differences were statistically significant （P 〈 0.05）. Compared with the detection results of the paired samples, the miss rate of a virus in a single sample type ranged from 10.33% to 36.27%. Conclusion The detection miss rates of HFMD related intestinal virus nucleic acid in one sample type （ anal swabs or throat swabs ） are high, while taking the detection in the paired samples can significantly improve the detection rate.