江苏省血吸虫病查病质控体系的构建与应用Ⅱ县级人员病原学检测能力评估

Establishment and application of quality control system for detection of schistosomiasis in Jiangsu Province Ⅱ Evaluation of pathogenic detection capacity of county-level personnel

目的评价江苏省县级血防机构开展血吸虫病病原学检测水平,提高专业技术人员血吸虫病病原学检测能力,为构建血吸虫病现场查病质控体系提供技术支撑。方法人工获取家兔血吸虫肝卵,制备成4个不同浓度的虫卵悬液,采用单盲法开展虫卵孵化检测,比较县级工作员检测结果与标准结果的符合率、误检率和漏检率。结果江苏省28个县(市、区)共检测虫卵悬液560份,检出阳性283份,阴性203份,总符合率为86.79%,总误检率为9.38%,总漏检率为15.77%,检测结果与标准结果差异有统计学意义(χ~2=12.99,P<0.01)。28个县(市、区)中有20个县(市、区)出现了漏检,占71.43%;13个县(市、区)出现了误检,占46.43%。江滩、山丘、水网和湖滩4类地区病原学检测误检率为4.55%~43.75%,差异有统计学意义(χ~2=30.34,P<0.01);漏检率为4.17%~20.45%,差异无统计学意义(χ~2=5.09,P=0.17)。传播控制和传播阻断2类流行区病原学检测误检与漏检率分别为7.50%、13.33%与10.42%、17.13%,差异无统计学意义(χ~2=0.229、0.575,P均>0.05)。达到血吸虫病传播控制10年及以上和不足10年地区误检与漏检率分别为11.81%、5.00%与16.67%、14.17%,差异无统计学意义(χ~2=2.804、2.848,P均>0.05)。达到血吸虫病传播阻断10年及以上与不足10年地区误检率分别为11.54%与10.00%,差异无统计学意义(χ~2=0.069,P=0.792);漏检率分别为10.90%与35.00%,差异有统计学意义(χ~2=17.364,P<0.01)。结论江苏省县级水平血吸虫病查病工作存在漏检、误检现象,现场病原学检测能力有待进一步提高。

Objective To evaluate the pathogenic detection capacity of county-level organizations in Jiangsu Province, and to improve the field schistosomiasis detection capacity of professional personnel, thus to provide the technical support for the construction of quality control system of schistosomiasis field detection. Method The eggs of Schistosoma japonicum were obtained from rabbit schistosomiasis models and were produced into suspensions at four different concentrations. The county-level workers were invited to hatch the eggs, and the accuracy, detection error rate and omission rate were compared between the detection results and the standard results. The single-blind method was used in the capacity examination. Result A total of 560 suspensions were detected by 28 counties （districts, cities）, and 283 positive samples and 203 negative samples were detected. The total accuracy was 86.79%, total error rate was 9.38%, and total omission rate was 15.77%. The difference between the detection result and standard result was statistically significant （χ^2 = 12.99, P 〈 0.01）. Twenty out of 28 counties （districts, cities） had omission detections, accounting for 71.43%; and 13 had fault detections, accounting for 46.43%. The error rates of workers from the river marshland, hilly areas, water networks, and lake marshland ranged from 4.55% to 43.75%, and the difference was statistically significant （χ^2 = 30.34, P 〈 0.01 ）. The omission rate ranged from 4.17% to 20.45%, and the difference was not statistically significant （χ^2 = 5.09, P = 0. 17）. The error rates and omission rates of workers from the transmission control areas and transmission interruption areas were 7.50%, 13.33% and 10.42%, 17.13%, respectively, and the differences were not statistically significant （χ^2 = 0.229, 0.575, both P 〉 0.05 ）. The error rates and omission rates of workers from the areas with or without at least ten years history of transmission control were 11.81%, 5.00% and 16.67%, 14.17%, respectively, and the differences were not statistically significant （χ^2= 2.804, 2.848, both P 〉 0.05）. The error rates of workers from the areas with or without at least ten years history of transmission interruption were 11.54% and 10.00%, respectively, and the difference was not statistically significant （χ^2 = 0.069, P = 0.792）, while the correspondent omission rates were 10.90% and 35.00% respectively, and the difference was statisti- cally significant （χ^2 = 17.364, P 〈 0.01）. Condusion The detection error and omission exist in the schistosomiasis examina- tions in the county-level organizations in Jiangsu Province, and therefore, the field pathogen detection capacity of the professional personnel needs to be further improved.