2014-2016年贵州省市(州)级疟疾实验室检测能力的评价

Evaluation of the testing ability of city/prefecture-level malaria laboratories in Guizhou Province during 2014-2016

目的贵州省级疟疾参比实验室对市(州)级疟疾实验室上送的血涂片和滤纸血样进行复核,评价市(州)级疟疾实验室的检测能力。方法2014-2016年,贵州省疟疾参比实验室通过镜检和巢式PCR分别对市(州)级疟疾实验室上送的血涂片和滤纸血样进行复核,评价上送的血涂片制作质量。以省级疟疾参比实验室镜检结果为标准,分析市(州)级疟疾实验室镜检的疟原虫阳性、阴性和虫种符合情况。分析省级疟疾参比实验室镜检和巢式PCR结果。结果 2014-2016年,市(州)级疟疾实验室共上送至省级疟疾参比实验室血涂片163份,经市(州)级疟疾实验室镜检,阳性84份,阴性79份,滤纸血样159份,上送率分别为100%(163/163)和97.6%(159/163)。血涂片制作、染色、清洁度及综合判定的合格率分别为58.9%(96/163)、75.5%(123/163)、72.4%(118/163)和69.9%(114/163),2016年血涂片制作和综合判定的合格率(71.3%、95.0%)均高于2014年(46.4%、46.4%)和2015年(48.1%、44.4%)(P<0.05)。2014-2016年,省级疟疾参比实验室与市(州)级疟疾实验室血涂片的镜检总符合率分别为67.9%(38/56)、66.7%(18/27)和88.8%(71/80),2016年总符合率高于2014年和2015年,差异有统计学意义(P<0.05);阳性符合率分别为81.3%(26/32)、70.0%(14/20)和96.9%(31/32),3年间差异无统计学意义(P>0.05);虫种符合率分别为46.9%(15/32)、65.0%(13/20)和81.3%(26/32),2014年虫种符合率与2016年比较,差异有统计学意义(P<0.05);阴性符合率分别为95.8%(23/24)、5/7和93.8%(45/48),3年间差异无统计学意义(P>0.05)。省级疟疾参比实验室镜检与巢式PCR检测结果均为阳性且虫种一致的占44.0%(70/159),均为阴性的占48.4%(77/159),结果不一致的占7.6%(12/159)。结论2016年市(州)级疟疾实验室血涂片综合判定合格率和镜检总符合率均高于2014和2015年,说明市(州)级疟疾实验室检测能力有提升。

bjective To re-examine the blood smears and the dry blood filter papers submitted by the city/prefecture-level malaria laboratories in the Malaria Reference Laboratory of Guizhou Province, to evaluate the laboratory testing ability of the city/prefecture-level malaria laboratories. Methods Microscopy and nested PCR were performed to re-examine the blood smears and dry blood filter papers in the Reference Laboratory- during 2014- 2016, and the blood smear quality was evaluated. Using the microscopic results of the Reference Laboratory as a standard, the malaria diagnostic coincidence concerning positive infection rate, negative rate and species identification were determined. The microscopic and nested PCR results of the Reference Laboratory were analyzed as well. Results From 2014 to 2016, a total of 163 blood smear samples, 84 positive and 79 negative tested in city/ prefecture-laboratories, and 159 dry blood filter papers were submitted, with a submission rate of 100% （163/163）and 97.6% （159/163）, respectively. The qualification rates of blood smear preparation, staining, cleanliness and comprehensive judgment were 58.9% （96/163）, 75.5% （123/163）, 72.4% （118/163）, and 69.9% （114/163）, respect- ively. The qualification rates of blood smear preparation （71.3%） and comprehensive judgment （95.0%） in 2016 were both higher than those in 2014 （46.4%,46.4%） and 2015 （48.1%, 44.4%）（P〈 0.05）. The total coincidence rates of microscopic results of the city/prefecture-level malaria laboratories during 2014-2016 were 67.9% （38/56）, 66.7% （18/ 27）, and 88.8% （71/80）, respectively, being highest in 2016 （P 〈 0.05）. The coincidence rates of positive infection during 2014-2016 were 81.3% （26/32）, 70.0% （14/20） and 96.9% （31/32）, respectively, with no significant difference among the three years （P〉 0.05）. The coincidence rates of species identification during 2014-2016 were 46.9% （15/32）, 65.0% （13/20） and 81.3% （26/32）, respectively （2014 vs. 2016, P〈 0.05）. The coincidence rates of negative infection during 2014-2016 were 95.8% （23/24）, 5/7 and 93.8% （45/48）, respectively, with no significant difference among the three years （P 〉 0.05）. The consistency rate between microscopic and nested PCR results in the Reference Laboratory was 44.0% （70/159） with respect to positive results and species identification, and 48.43% （77/159） with respect to negative results, and the inconsistency rate was 7.6% （12/159）. Conclusion The qualification rate of comprehensive judgment and the total coincidence rate of microscopic results in the city/prefecture-level malaria laboratories was higher in 2016 than in 2014 and 2015. The results suggested that the testing ability of city/prefecture-level malaria laboratories has increased.