化学发光法检测HIV抗体在骨科急诊手术术前筛查中的应用评价

Evaluation of the application of chemical luminescent detection of HIV antibody in preoperative screening of orthopaedic emergency surgery

目的评估化学发光法检测艾滋病病毒(HIV)抗体在骨科急诊手术术前筛查中的应用情况。方法用化学发光法(CLIA)和酶联免疫吸附法(ELISA)对本院2017年5月-2019年12月的手术患者进行HIV抗体筛查,有反应样本进行免疫印迹法(WB)确证,统计分析2种方法学检测HIV抗体结果的差异。结果33596例术前患者中,CLIA和ELISA均有反应性69例,WB法58例阳性,7例阴性,4例不确定。CLIA和ELISA检测结果不一致16例,6例ELISA单独有反应性,WB法均阴性;10例CLIA单独有反应性,WB法9例阴性,1例不确定,该例"不确定"患者4周后复查为阳性。以WB法为"金标准",化学发光法(CLIA)S/CO值≥100时,WB法均为阳性;化学发光法(CLIA)S/CO值<100时,检测结果存在假阳性。结论CLIA更加适合于骨科急诊手术术前HIV抗体的检测,提高工作效率,增加医护人员职业防护意识。

Objective To evaluate the application of chemical luminescence detection of HIV antibody in preoperative screening of orthopedic emergency surgery.Methods The patients who underwent operation in our hospital from May 2017 to December2019 were screened for HIV antibody by chemiluminescent immunoassay(CLIA)and enzyme linked immunosorbent assay(ELISA).The response samples were sent to CDC for Western blotting(WB)confirmation,and the difference between the two methods was statistically analyzed.Results Among the 33596 preoperative samples,69 were responsive to CLIA and ELISA,58 were positive by gold standard WB method,7 were negative,and 4 were uncertain.The results of 16 cases of CLIA and ELISA were inconsistent,among them,6 were single ELISA reactive,and the results of WB method were all negative;10 cases of CLIA were single reactive,9 cases of WB method were negative,and 1 case was uncertain.The"uncertain"patient was followed up and reexamined 4 weeks later,and the reexamination results were positive.When the S/CO value of CLIA is≥100,the results of WB are all HIV positive;when the S/CO value of CLIA is<100,the results sometimes have false positive.Conclusion Chemical luminescence method is more suitable for the detection of HIV antibody before orthopedic emergency operation,improving work efficiency,increasing the awareness of occupational protection of medical staff.