发热伴血小板减少综合征实验室诊断方法的比较与评价

Comparison and evaluation of different assays in the diagnosis of severe fever with thrombocytopenia syndrome

目的比较不同检测方法在发热伴血小板减少综合征(SFTS)病例诊断中的结果差异,为快速、准确诊断新布尼亚病毒(SFTSV)感染提供依据。方法选取2014年河南省SFTS专项监测系统收集的158例SFTS患者的急性期血清标本,分别应用Real-time PCR和酶联免疫吸附试验(ELISA)-Ig M法进行检测;选取其中有急性期和恢复期双份血清的109对标本,应用ELISA-Ig M和ELISA-Ig G法进行检测。比较3种方法对SFTS阳性检出率的差异,同时分析采血时间对检测结果的影响。结果 158例SFTS患者的急性期血清标本,Real-time PCR的阳性检出率(76.58%)高于ELISA-Ig M(47.47%),差异有统计学意义(χ~2=34.13,P<0.05);109例有急性期和恢复期双份血清标本的病例,ELISA-Ig G的阳性检出率(75.23%)与Real-time PCR的阳性检出率(72.48%)差异无统计学意义(χ~2=0.18,P>0.05);无论在急性期还是恢复期,Ig M抗体的阳性检出率均高于Ig G,差异有统计学意义(χ~2分别为41.68和6.25,均P<0.05);随着采血时间的延长,Ig M和Ig G抗体的阳性检出率均有增加的趋势(Z分别为6.42和10.08,均P<0.05)。结论 Real-time PCR法适用于SFTS病例的早期诊断,ELISA-Ig G法适用于SFTS恢复期标本的检测,ELISA-Ig M法可作为一种辅助方法指导临床诊断。

Objective To evaluate different detection methods in the diagnosis of severe fever with thrombocytopeniasyndrome(SFTS),and find the most quick and accurate one for the identification of new bunyavirus infection.MethodsReal-time PCR and ELISA-IgM were used to detect serum samples of158patients with acute phase of SFTS,which werecollected from the special monitoring system of SFTS in Henan Province in2014.IgM and IgG antibodies were detected byELISA in109acute and convalescent paired serum specimens.The differences of the positive rates were compared betweenthe three methods,and the influence of the collected interval time on the detection results was analyzed.Results For158acute phase serum samples of SFTS patients,the positive rate detected by real-time PCR(76.58%)was higher than that ofELISA-IgM(47.47%),and the difference was statistically significant(χ2=34.13,P<0.05).For109cases with acute andconvalescent paired serum samples,there was no significant difference in the positive rates between ELISA-IgG(75.23%)and real-time PCR(72.48%)detections(χ2=0.18,P>0.05).In both the acute phase and convalescent phase,the positiverate of IgM was higher than that of IgG,and the difference was statistically significant(χ2=41.68and6.25,P<0.05).Withthe extension of collected interral time,the positive rates of IgM and IgG antibodies were both increased(Z=6.42and10.08,P<0.05).Conclusion Real-time PCR is the most sensitive method for the early diagnosis of the SFTS.ELISA-IgG is suitable for the detection of SFTS at recovery period.ELISA-IgM can be used as an assistant method to guide clinicaldiagnosis.