湖北省消除疟疾前后输入性疟疾实验室检测能力分析

doi:10.12140/j.issn.1000-7423.2024.02.007

摘要/Abstract

摘要：

目的了解湖北省消除疟疾前后输入性疟疾实验室检测的能力。方法从国家传染病报告信息管理系统中收集2017—2022年湖北省网络报告疟疾病例资料，并收集病例血液样品和复核检测登记单。由湖北省疟疾诊断参比实验室专业技术人员对血涂片和血样进行疟原虫检测复核。血涂片采用镜检法复核，并对血涂片的制片、染色和清洁度进行评价；血样采用荧光定量PCR检测核酸复核。以省级疟疾诊断参比实验室的复核结果为标准，分析比较消除疟疾前（2017—2019年）和消除疟疾后（2020—2022年）各市（州）级疟疾实验室检测结果阳性符合率、虫种符合率、血片合格率、送样及时性等情况。结果 2017—2022年湖北省网络报告输入性疟疾病例501例，其中2017—2019年报告409例，2020—2022年报告92例。2017—2019年的样品收集率为99.3%（406/409），收集到的样品合格率为99.3%（403/406）；2020—2022年的样品收集率为94.6%（87/92），收集到的样品合格率为82.8%（72/87）。501例报告病例中，经省级疟疾复核确诊疟疾病例451例。2017—2019年确诊疟疾病例373例，其中恶性疟261例（70.0%）、间日疟48例（12.9%）、卵形疟52例（13.9%）、三日疟12例（3.2%）；2020—2022年确诊疟疾病例78例，其中恶性疟34例（43.6%）、间日疟20例（25.6%）、卵形疟19例（24.4%）、三日疟5例（6.4%）；消除疟疾前后的4种疟疾构成比差异有统计学意义（χ² = 20.037，P < 0.05）。2017—2019年送样时间中位数为3 d（0~16 d），平均4 d；2020—2022年送样时间中位数为4 d（0~224 d），平均8 d；消除疟疾后各地送样时间更长（χ² = 25.591，P < 0.05）。2017—2019年和2020—2022年湖北省网络报告疟疾病例阳性符合率分别为91.9%（373/406）和89.7%（78/87）（χ² = 0.452，P > 0.05）；虫种符合率分别为88.7%（331/373）和78.2%（61/78），消除疟疾前的虫种符合率更高（χ² = 6.296，P < 0.05）。2017—2019年各市（州）级疟疾实验室共误判75例，误判率为18.5%（75/406），其中定性误判33例，病种误判42例；2020—2022年共误判26例，误判率为29.9%（26/87），其中定性误判9例，病种有误17例。消除疟疾前后各地对于恶性疟的定种符合率差异有统计学意义（χ² = 4.571，P < 0.05）。2017—2019年共复核血片492张，制片合格率85.2%（419/492），染色合格率83.3%（410/492），清洁度合格率85.8%（422/492）；2020—2022年共复核血片209张，制片合格率71.8%（150/209），染色合格率76.1%（159/209），清洁度合格率76.6%（160/209）；消除疟疾前后的血片制作、染色和清洁度评价差异均有统计学意义（χ² = 17.213、5.054、8.842，均P < 0.05）。结论消除疟疾后湖北省的输入性病例数下降，疟疾实验室检测能力略有下降，但仍维持在稳定水平。

关键词: 疟疾, 消除, 参比实验室, 检测

Abstract:

Objective To understand the laboratory detection capability of imported malaria before and after malaria elimination in Hubei Province. Methods Data of malaria cases reported in Hubei Province from 2017 to 2022 were collected from National Infectious Disease Surveillance Reporting and Management System. The blood samples and detection review record forms of malaria cases reported in Hubei Province from 2017 to 2022 were collected. A review of the blood smears and blood samples was conducted by the professional technicians from the Hubei Provincial Malaria Diagnosis Reference Laboratory to identify malaria parasites. The blood smears were reviewed using microscopic examination, and the preparation, staining, and cleanliness of the blood smears were evaluated. The blood samples were reviewed for Plasmodium nucleic acids using fluorescence quantitative PCR. Using the retest results from the Provincial Malaria Diagnosis Reference Laboratory as the standard to analyze and compare the detection results provided by the malaria laboratories at the city (prefecture) levels on the positive qualification rate, parasite species coincidence rate, blood smear qualification rate, and sample delivery timeliness before (from 2017 to 2019) and after (from 2020 to 2022) malaria elimination. Results From 2017 to 2022, 501 cases of imported malaria were reported in Hubei Province, with 409 cases reported from 2017 to 2019 and 92 cases reported from 2020 to 2022. The sample collection rate from 2017 to 2019 was 99.3% (406/409), with a sample qualification rate of 99.3% (403/406). From 2020 to 2022, the sample collection rate was 94.6% (87/92), with a sample qualification rate of 82.8% (72/87). Among the 501 reported cases, 451 were confirmed as malaria by provincial malaria diagnosis review. From 2017 to 2019, a total of 373 confirmed malaria cases were reviewed, including 261 cases of falciparum malaria (70.0%), 48 cases of vivax malaria (12.9%), 52 cases of ovale malaria (13.9%), and 12 cases of malariae malaria (3.2%); from 2020 to 2022, a total of 78 confirmed malaria cases were reviewed, including 34 cases of falciparum malaria (43.6%), 20 cases of vivax malaria (25.6%), 19 cases of ovale malaria (24.4%), and 5 cases of malariae malaria (6.4%). There was a statistically significant difference in the composition of the 4 types of malaria before and after malaria elimination (χ² = 20.037, P < 0.05). The median sample submission time was 3 days (0-16 d) from 2017 to 2019, with an average of 4 days. From 2020 to 2022, the median sample submission time was 4 days (0-224 d), with an average of 8 days. The sample submission time was longer in all regions after malaria elimination (χ² = 25.591, P < 0.05). The positive compliance rates of the reported malaria cases in Hubei Province from 2017 to 2019 and from 2020 to 2022 were 91.9% (373/406) and 89.7% (78/87), respectively (χ² = 0.452, P > 0.05). The parasite specie compliance rates were 88.7% (331/373) and 78.2% (61/78), respectively, with a higher parasite compliance rate before malaria elimination (χ² = 6.296, P < 0.05). A total of 75 cases were misdiagnosed by city (prefecture) level malaria laboratories from 2017 to 2019, with a misdiagnosis rate of 18.5% (75/406), including 33 cases of qualitative misdiagnosis and 42 cases of species misdiagnosis; from 2020 to 2022, a total of 26 cases were misdiagnosed, with a misdiagnosis rate of 29.9% (26/87), including 9 cases of qualitative misdiagnosis and 17 cases of species misdiagnosis. There was a statistically significant difference in the species compliance rate for falciparum malaria before and after malaria elimination (χ² = 4.571, P < 0.05). A total of 492 blood smears were reviewed from 2017 to 2019, with a slide preparation qualification rate of 85.2% (419/492), staining qualification rate of 83.3% (410/492), and cleanliness qualification rate of 85.8% (422/492). From 2020 to 2022, a total of 209 blood smears were reviewed, with a slide preparation qualification rate of 71.8% (150/209), staining qualification rate of 76.1% (159/209), and cleanliness qualification rate of 76.6% (160/209). There were statistically significant differences in blood smear preparation, staining, and cleanliness evaluations before and after malaria elimination (χ² = 17.213, 5.054, 8.842, all P < 0.05). Conclusion After the elimination of malaria, the number of imported cases in Hubei Province has decreased. The laboratory detection capability of malaria has reduced slightly but remains stable.

Key words: Malaria, Elimination, Reference laboratory, Detection

中图分类号:

R531.3

易佳, 吴冬妮, 董小蓉, 朱红, 林文, 张聪, 孙凌聪. 湖北省消除疟疾前后输入性疟疾实验室检测能力分析[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(2): 177-181.

YI Jia, WU Dongni, DONG Xiaorong, ZHU Hong, LIN Wen, ZHANG Cong, SUN Lingcong. Analysis of laboratory detection capability for imported malaria in Hubei Province before and after malaria elimination[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2024, 42(2): 177-181.

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年份 Year	网络报告病例数/例 No. reported case	确诊病例数/例（构成比/%） No. confirmed case (Composition rate/%)
年份 Year	网络报告病例数/例 No. reported case	恶性疟 Falciparum malaria	间日疟 Vivax malaria	卵形疟 Ovale malaria	三日疟 Malariae malaria	合计 Total
2017—2019	409	261（70.0）	48（12.9）	52（13.9）	12（3.2）	373
2020—2022	92	34（43.6）	20（25.6）	19（24.4）	5（6.4）	78
合计 Total	501	295（65.4）	68（15.1）	71（15.7）	17（3.8）	451

送样时长/d Time for delivery/d	2017—2019		2020—2022
送样时长/d Time for delivery/d	收集样品数/份 No. collected sample	构成比/% Composition rate/%	收集样品数/份 No. collected sample	构成比/% Composition rate/%
≤ 1	98	24.1	16	18.4
2~3	113	27.8	24	27.6
4~7	139	34.2	16	18.4
> 7	56	13.8	31	35.6
合计 Total	406	100.00	87	100.0

市（州） City (prefecture)	2017—2019					2020—2022
市（州） City (prefecture)	复核病例数/例 No. rechecked case	确诊病例数/例 No. confirmed case	阳性符合率/% Coincidence rate/%	虫种符合病例数/例 No. species coincidenced case	虫种符合率/% Species coincidence rate/%	复核病例数/例 No. rechecked case	确诊病例数/例 No. confirmed case	阳性符合率/% Coincidence rate/%	虫种符合病例数/例 No. species coincidenced case	虫种符合率/% Species coincidence rate/%
武汉 Wuhan	117	116	99.2	116	100	23	22	95.7	20	90.9
黄石 Huangshi	50	43	86.0	34	79.1	16	13	13/16	9	9/13
十堰 Shiyan	31	25	80.6	24	96.0	8	7	7/8	7	7/7
荆州 Jingzhou	10	10	10/10	10	10/10	4	4	4/4	2	2/4
宜昌 Yichang	58	53	91.4	40	75.5	13	12	12/13	8	8/12
襄阳 Xiangyang	32	31	96.9	29	93.5	4	4	4/4	4	4/4
鄂州 E’zhou	3	2	2/3	2	2/2	1	1	1/1	0	0/1
荆门 Jingmen	12	12	12/12	12	12/12	4	4	4/4	2	2/4
黄冈 Huanggang	30	23	76.7	17	73.9	7	7	7/7	5	5/7
孝感 Xiaogan	16	16	16/16	13	13/16	3	1	1/3	1	1/1
咸宁 Xianning	7	6	6/7	4	4/6	3	2	2/3	2	2/2
随州 Suizhou	17	17	17/17	13	13/17	-	-	-	-	-
恩施 Enshi	14	11	11/14	10	10/11	1	1	1/1	1	1/1
仙桃 Xiantao	2	1	1/2	1	1/1	-	-	-	-	-
潜江 Qianjiang	3	3	3/3	3	3/3	-	-	-	-	-
天门 Tianmen	4	4	4/4	3	3/4	-	-	-	-	-
神农架 Shennongjia	-	-	-	-	-	-	-	-	-	-
合计 Total	406	373	91.9	331	88.7	87	78	89.7	61	78.2