采用两种检测试剂进行HIV抗体复检的效果研究

Study on the effect of HIV antibody re-examination with two kinds of reagents

目的 通过比较两种不同的HIV抗体复检策略,探讨适合实验室需求的HIV抗体筛查流程.方法 选取2015年8月1日至2016年12月31日在北京佑安医院临检中心艾滋病确证实验室进行HIV抗体筛查且结果为有反应（阳性）的873例血液样本作为研究材料,分别采用与筛查相同的试剂（策略1）和与筛查不同的两种试剂（策略2）对血液样本进行复检,再根据复检结果进行补充实验,检测HIV抗体.采用x2检验,比较不同复检策略下,HIV抗体筛查阳性预测值的差异.结果 两种策略情况下均有786例HIV抗体阳性,包括754例WB阳性、23例随访WB阳性、9例核酸阳性.其中策略1和策略2抗体筛查的HIV阳性预测值分别为90.0％（786/873）和95.9％（786/820）,差异有统计学意义（x2=21.58,P＜0.01）.在性病门诊病例中,策略1和策略2的HIV抗体筛查阳性预测值分别为92.9％（745/802）和97.3％（745/766）,差异有统计学意义（x2 =15.80,P＜0.01）;普通门诊中两种策略的HIV抗体筛查的阳性预测值为分别为57.7％（41/71）和75.9％（41/54）,差异有统计学意义（x2=4.49,P=0.03）.结论 使用HIV抗体筛查策略时,推荐性病门诊等HIV高阳性率的人群采用另外两种特异性高的试剂进行复检.

Objective To explore the screening test procedure for HIV antibody detection suitable for laboratory requirement.Methods From August 1,2015 to December 31 2016,873 primary screening positive specimens from AIDS confirmation laboratory in the Clinical Laboratory Center of Beijing youan hospital were collected.All the samples were rechecked using the same reagents （strategy 1） and two other different reagents （strategy 2）,and then the HIV antibody supplementary experiment was detected according to the results of the recheck.Chi-square test was used to compare the statistical difference of HIV antibody screening positive predictive values （PPV） among the two strategies.Results In both strategies,786 were detected HIV antibody positive,including 754 WB positive,23 follow-up WB positive and 9 nucleic acid positive.The HIV antibody screening PPV of strategy 1 and strategy 2 were 90.0 % （786/873） and 95.9 % （786/820）,respectively,and the difference was statistically significant （x2=21.58,P〈0.01）.As it to STD clinic cases,the HIV antibody screening PPV for strategy 1 and strategy 2 were 92.9 % （745/802） and 97.3 % （745/766）,respectively,and the difference was statistically significant （x2=15.80,P〈0.01）;As it to general out-patients,The HIV antibody screening PPV for two strategies were 57.7 % （41/71） and 75.9% （41/54）,respectively,the difference was statistically significant （x2=4.49,P=0.03）.Conclusions When using HIV antibody screening strategies,it is recommended that two other reagents should be used for re-examination to improve diagnostic specificity in the group of people with high prevalence of HIV,as the patients in STD clinics.