湖北省血吸虫病规范化实验室病原学检测能力评估

doi:10.12140/j.issn.1000-7423.2021.05.002

摘要/Abstract

摘要：

目的了解湖北省60家血吸虫病规范化实验室病原学检测水平,评价尼龙绢集卵孵化法现场检测效果,为提高全省基层血防专业技术人员检测检验能力提供参考依据。方法将日本血吸虫尾蚴采用腹部贴片法感染日本大耳兔[（1 500 ± 100）条/兔],感染后40 d,取肝脏,分离虫卵,制备虫卵悬液。取1 ml虫卵悬液孵化并计数,将虫卵悬液密度调配成每毫升能孵化出（50 ± 10）只毛蚴,再将部分悬液稀释至2倍与4倍的体积,制备成强阳性、阳性、弱阳性等3种虫卵悬液,实验室保存的虫卵悬液经灭活后制成阴性样品。将孵化参考样品采用随机编号的方式分成60组分发给湖北省60个血吸虫病规范化实验室,采用单盲法检测孵化质量控制样品。应用SPSS 20.0软件统计不同县（市、区）实验室检测人员的检测水平,符合率、误检率和漏检率的比较采用χ²检验。结果湖北省13个市级、47个县（市、区）级血吸虫病规范化实验室共检测样品300份（阳性138份、阴性162份）,检出阳性125份,阴性148份,总符合率为91.0%（273/300）,总误检率为8.6%（14/162）,总漏检率为9.4%（13/138）,差异有统计学意义（χ² = 201.207,P < 0.01）。13个市级血吸虫病规范化实验室中有12个检测结果与标准结果一致。47个县（市、区）级血吸虫病规范化实验室中有34个检测结果与标准结果一致;存在漏检的有9个,占19.1%;存在误检的有10个,占比21.3%;同时出现漏检和误检的有6个,占12.8%。独立血吸虫病防制机构与非独立血吸虫病防制机构误检率分别为8.1%（5/62）和9.0%（9/100）,差异无统计学意义（χ² = 0.042, P > 0.05）;漏检率分别为12.5%（6/48）和7.8%（7/90）,差异无统计学意义（χ² = 0.818, P > 0.05）。传播阻断有螺县、消除有螺县、消除无螺县等3类流行区误检与漏检率分别为6.5%（5/77）、12.1%（7/58）,15.0%（6/40）、8.6%（3/35）,16.7%（3/18）、13.6%（3/22）,差异均无统计学意义（χ² = 3.330、0.414,P > 0.05）。结论湖北省血吸虫病规范化实验室尼龙绢集卵孵化法总符合率较高,县（市、区）级实验室存在误检和漏检情况。

关键词: 血吸虫病, 尼龙绢集卵孵化法, 规范化实验室, 现场评估

Abstract:

Objective To understand the capability of etiological detection in 60 standardized laboratories for schistosomiasis in Hubei Province, evaluate the efficacy of on-site detection method of egg-hatching with nylon sheer-concentration, and provide reference basis for improving detection and test capability of local professional health workers in schistosomiasis control in the province. Methods Schistosoma japonicum cercariae were used to infect japanese big-eared rabbits with abdominal patch method [(1 500 ± 100) cercariae/rabbit]. On 40 days post-infection, rabbit livers were collected for separating worm eggs, which were used to prepare, egg suspension. Then 1 ml of egg suspension was hatched and miracdia counted, and the egg density of the suspension was adjusted to a density that 1 ml suspension would hatch out (50 ± 10) mircaria. Meantime, part of the suspension was then diluted 2 and 4 times of volume to prepare three classes of suspensions: strong positive, positive and weakly positive. The egg suspensions stored in the laboratory were inactivated and used as negative samples. The hatching reference samples were aliquoted into 60 groups by random numbering and distributed to 60 standardized laboratories for schistosomiasis in the province. The hatching quality control samples were tested using single-blind method. SPSS 20.0 software was used to analyze the detection capability of examiners in the laboratories in different localities (county, cities), and the overall coincidence rate, false detection rate and miss-detection rate were compared with χ² tests. Results A total of 300 samples (138 positives and 162 negatives) were examined in the standard laboratories 13 cities and 47 counties (city, district) in Hubei. Of the examined, 125 samples were found positive, and 148 negative, showing an overall coincidence rate 91.0% (273/300), overall false detection rate 8.6% (14/162), and overall miss-detection rate 9.4% (13/138), with the differences being statistically significant (χ² = 201.207, P < 0.01). In 12 out of 13 cities and 34 out of 47 counties (city, districts) standard laboratories, the detection results were consistent with the standard ones; miss-detection occurred in 9 laboratories, accounting for 19.1% of the total, false detection occurred in 10 laboratories, accounting for 21.3%; simultaneous occurrence of both miss-detection and false detection were found in 6 laboratories, accounting for 12.8%. The false detection rate from the laboratories in independent institutions and non-independent institutions for schistosomiasis control was 8.1% (5/62) and 9.0% (9/100), respectively, with the difference not statistically significant (χ² = 0.042, P > 0.05); the miss-detection rate was 12.5% (6/48) and 7.8% (7/90) respectively, the difference was not statistically significant (χ² = 0.818, P > 0.05). The false-detection and miss-detection rate were found from the laboratories in counties at the schistosomiasis status of transmission interrupted with existing snails, elimination with existing snails, elimination with snail free was 6.5% (5/77), 15.0% (6/40); 16.7% (3/18) and 12.1% (7/58); and 8.6% (3/35), 13.6% (3/22), respectively, with the differences not statistically significant(χ² = 3.330, 0.414, P > 0.05). Conclusion The overall coincidence rate detected by the method of egg-hatching with nylon sheer-concentration is considerably high in the standardized schistosomiasis laboratories in Hubei Province. It is noted that false detection and miss-detection occurred in county (city, district)-based laboratories.

Key words: Schistosomiasis, Stool hatching method, Standardized laboratories, Field assessment

中图分类号:

R532.21

李博, 张聪, 单晓伟, 易佳, 涂珍, 何汇, 唐丽, 朱红, 刘建兵. 湖北省血吸虫病规范化实验室病原学检测能力评估[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(5): 572-576.

LI Bo, ZHANG Cong, SHAN Xiao-wei, YI Jia, TU Zhen, HE Hui, TANG Li, ZHU Hong, LIU Jian-bing. Evaluation of the pathogen detection capacity in standardized schistosomiasis laboratories in Hubei Province[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(5): 572-576.

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