用MCAb-AST对山丘疫区黑热病漏诊的实验诊断研究

Research on Laboratory Diagnosis for the Missing-diagnosed Kala-azar in Hill Foci by Using McAb-AST

本文报道McAb-AST法对我国山丘疫区骨髓涂片检查漏诊的黑热病病例实验诊断价值。观察的81例中骨髓涂片法漏诊者有13例,经McAb-AST显阳性反应,而给予锑剂治疗,治后11例临床痊愈,用McAb-AST复查者也转为阴性反应(1例复发除外),从而表明骨髓涂片法漏诊率高达16.05％,而McAb—AST显假阴性反应者仅有1例(1.23％)。本文还对McAb-AST的实验条件进行了改进,并以实验结果论证了McAb-AST阳性反应系由于特异性McAb-与循环抗原的结合,而不是非特异性反应所致。

The paper reports the significance of laboratory diagnosis for the misssing-diagnosed kala-azar in hill foci by using McAb-AST. Among the 81 kala-azar patients diagnosed by typical clinical symptoms examined, 13 cases were found to be negative of pathogen based on bone marrow smear examination. At the same time, McAb-AST revealed positivity for kala-azar of all these 13 sera samples. After anti-Leishmania chemotherapy with stibii hexonas, 11 out of 13 cases completely cured clinically. All the cases examined by McAb-AST showed negative reaction after the treatment also (except 1 case with relapse). Therefore, it was confirmed that the rate of missing-diagnosis by bone marrow smear reached as high as 16.05%, while 1 case (1/81, 1.23%) revealed false negative reaction by MbAb-AST method. An unique case (No.8) reported here revealed negative result by bone marrow smear method for 3 times successively in the early stage of the dissease whereas repeated positive reactions were shown by McAb-AST. Six months later the Leishmania amastigotes found in bone marrow aspirate of this patient.