人布鲁杆菌感染血清学检测及其临床应用价值

Detection and value of serological methods in the diagnosis of human brucellosis

目的分析5种常用诊断人布鲁菌病的血清学检测方法的效果,为布鲁菌病的诊断制定最有效、最实用的血清学检测方案,并评估试管凝集滴度在判断布鲁杆菌感染严重程度中意义。方法收集137例布鲁菌病确诊病例血清标本作为实验组,78例非布鲁菌患者血清标本作为对照组;采用虎红凝集试验(RBPT)、乳胶凝集试验(LAT)、标准试管凝集试验(SAT)、间接酶联免疫吸附试验(iELISA)、免疫胶体金法(GICA)检测两组受试者血清抗-布鲁菌,比较以上5种检测方法的敏感度、特异度和约登指数,分析其诊断意义;并分析试管凝集试验不同抗体滴度患者血清C-反应蛋白(CRP)变化,评价试管凝集试验滴度效价在评估布鲁菌病严重程度中的作用。结果 RBPT、LAT、SAT、iELISA和GICA 5种检测方法的敏感度分别为97.08%、97.81%、95.62%、95.62%和90.51%,特异度分别为97.44%、96.15%、98.72%、79.49%和93.59%,约登指数分别为0.95、0.94、0.94、0.75和0.84;不同SAT滴度患者的CRP水平差异无统计学意义(H=3.706、P>0.05)。结论临床实践中应根据病程选择合适的血清学检测方法;RBPT、LAT、SAT的检测效果均较好,RBPT联合LAT进行初筛以减少漏诊;而SAT滴度效价并不能反映疾病严重程度。

Objective To evaluate the effect of the five commonly used methods of serologic test for the diagnosis of brucellosis and provide an effective and practical serological detection scheme, and to investigate the significance of serum agglutination test（SAT） titer in assessing the severity of brucellosis. Methods The serum samples of 137 patients with brucellosis were collected as the experimental group, while the serum samples of 78 non-brucella patients were treated as the control group. The levels of anti-Brucella in patients of the two groups were detected by rose bengal plate agglutination（RBPT）, latex agglutination test（LAT）, serum agglutination test（SAT）, indirect enzyme-linked immunosorbent assay（iELISA） and gold immunochromatography assay（GICA）. The sensitivity specificity, and Youden index of the above five methods were compared, respectively. The changes of serum C-reactive protein（CRP） in patients with different antiBrucella were analyzed, and the effect of STA on assessing the severity of brucella was evaluated. ResultsThe sensitivity of RBPT, LAT, SAT, iELISA and GICA were 97.08%, 97.81%, 95.62%, 95.62% and 90.51%, respectively; and the specific degrees were 97.44%, 96.15%, 98.72%, 79.49% and 93.59%, respectively; the Youden indexes were 0.95, 0.94, 0.94, 0.75 and 0.84, respectively. There was no significant difference in the levels of CRP among patients with different titer detected by SAT（H = 3.706, P〉0.05）. Conclusions In clinical practice, the appropriate serological detection method should be selected according to the duration of the disease. RBPT, LAT and SAT all had well detection effect. In order to reduce missed diagnosis, RBPT combined with LAT should be applied for initial screening. The titer detected by SAT does not reflect the severity of the disease.