免疫印迹法HIV-1抗体检测结果不确定者的转归分析

Analysis on outcome of patients with indeterminate western-blot results of HIV-1 antibody

目的 探讨HIV-1抗体确证试验(免疫印迹法)检测结果为不确定的患者的转归特点。方法 选取HIV-1抗体免疫印迹法检测结果为不确定的患者75例,收集其一般资料、初筛试验[酶联免疫吸附试验(ELISA)、胶体硒法]的检测结果、免疫印迹法带型及随访后的转归情况。结果 75例患者中有53例完成随访,随访时间为10~721 d。男性、女性之间随访后转阳率差异有统计学意义(P<0.05)。53例HIV-1抗体检测结果为不确定的随访患者中,2种初筛试验均阳性45例,与随访后确证结果的阳性符合率为100%。受试者工作特征(ROC)曲线分析结果显示,ELISA S/CO值判定HIV-1抗体不确定样本为阳性的曲线下面积(AUC)为0.969,最佳临界值为4.995,敏感性为84.8%,特异性为100.0%。随着ELISA S/CO值的增大,免疫印迹法带型更复杂,HIV-1抗体不确定样本的转阳率逐渐升高。免疫印迹法env带gp41和gag带p66、p51的出现率均随随访时间的延长而升高。结论 免疫印迹法HIV-1抗体检测的不确定结果可通过胶体硒法、ELISA S/CO值和免疫印迹法条带的分析来协助判断。

Objective To investigate the characteristics and outcomes of patients with indeterminate western-blot results of human immunodeficiency virus(HIV)-1 antibody. Methods Totally,75 patients with indeterminate western-blot results of HIV-1 antibody were enrolled. The general data,screening test results [enzyme-linked immunosorbent assay(ELISA)and colloid se method],western-blot results and the outcomes of follow-up were collected. Results In the 75 cases,53 cases were followed up,and the follow-up time was 10-721 d. The difference of positive conversion rate between males and females had statistical significance(P<0.05). Among the 53 cases,the positive consistency rate of the 2 screening tests was 100%(45 cases). Using receiver operating characteristic(ROC) curve analysis,the optimal cut-off value of ELISA S/CO value was 4.995,the area under curve(AUC)was 0.969,the sensitivity was 84.8%,and the specificity was 100.0%. With the increase of ELISA S/CO values,the western-blot bands turned into positive correspondingly,and the occurrence rates of env gp41,gag p66 and p51 were also increased correspondingly. Conclusions The collaborative analysis of colloid se method,ELISA S/CO value and western-blot band will be helpful for the determination of indeterminate HIV-1 antibody.