目的 湖北省省级疟疾诊断参比实验室对各级疟疾实验室上送的输入性疟疾病例留存血样进行复核,并对诊断和复核结果进行分析,评估全省各级疟疾实验室的检测能力。 方法 收集中国疾病预防控制信息系统中2016—2020年湖北省报告的输入性疟疾病例诊断单位、诊断结果和留存样品,对诊断单位进行描述性分析,并由省级疟疾诊断参比实验室对疟疾病例样品采用血涂片镜检和巢式PCR进行复核,比较各级疟疾实验室诊断结果与省级疟疾诊断参比实验室复核结果的阳性和虫种符合情况,分析不同疟原虫虫种诊断符合情况,应用SPSS 17.0软件进行统计学分析。 结果 2016—2020年湖北省共报告疟疾病例608例,疟疾病例诊断单位医疗机构占89.5%（544/608）,疾病预防控制中心占10.5%（64/608）,其中地市级医疗机构诊断病例占54.6%（332/608）。2016—2020年医疗机构占疟疾病例诊断单位的比例分别为84.1%（132/157）、84.4%（92/109）、90.4%（122/135）、95.2%（157/165）和97.6%（41/42）（χ² = 16.815,P < 0.05）。省级疟疾诊断参比实验室共复核604例留存样品,其中92.4%（558/604）的病例被各级疟疾实验室确诊为疟疾,88.5%（494/558）感染虫种判定正确。不同年份疟疾病例诊断疟原虫阳性符合率为82.9%（34/41）~96.2%（151/157）、虫种符合率为79.4%（77/97）~94.4%（118/125）,差异均有统计学意义（χ² = 9.273、13.787,P < 0.05）。医疗机构的诊断疟原虫阳性符合率（93.2%,503/540）和虫种符合率（89.5%,450/503）均高于疾病预防控制中心的（85.9%,55/64）和（80.0%,44/55）,省、市、县、乡级医疗机构诊断疟原虫阳性符合率分别为100%（74/74）、93.3%（308/330）、90.2%（110/122）、和11/14,虫种符合率分别为100%（74/74）、88.3%（272/308）、86.4%（95/110）、9/11,呈现级别越高诊断正确率越高的趋势（χ² = 13.092、15.598,P < 0.05）。恶性疟原虫、间日疟原虫、三日疟原虫、卵形疟原虫、混合感染诊断虫种符合率分别为96.9%（373/385）、96.0%（72/75）、10/16、48.8%（39/80）和0,差异有统计学意义（χ² = 132.880,P < 0.05）。 结论 湖北省疟疾病例的诊断单位主要是医疗机构,各级疟疾实验室检测能力总体较高,对非恶性疟原虫的虫种鉴别能力有待提高。

Objective To evaluate the detection capability of the malaria laboratories at all local levels in Hubei Province, the provincial malaria diagnosis reference laboratory re-examine the reserved blood samples of imported malaria cases sent from local malaria laboratories at all levels, and the results produced by local and provincial laboratories were analyzed for capability evaluation. Methods Information of imported malaria cases including the diagnosis institution, diagnosis outcome and the samples reserved in 2016—2020 in Hubei Province. The diagnosis institution was analyzed descriptively. The reserved blood samples from local malaria laboratories were checked by Hubei Provincial Malaria Diagnosis Reference Laboratory through microscopy and nested PCR, and the coincidence of malaria positives and parasite species between local laboratories and provincial laboratory were compared, and analyzed. Results From 2016 to 2020, a total of 608 imported malaria cases were reported in Hubei Province, among them 89.5% (544/608) were diagnosed in medical institutions, 10.5% (64/608) in CDCs, with 54.6% (332/608) being diagnosed in district (city)-based medical institutions. From 2016 to 2020, the proportion of medical institutions in the malaria diagnosis units were 84.1% (132/157), 84.4% (92/109), 90.4% (122/135), 95.2% (157/165) and 97.6% (41/42) respectively (χ² = 16.815, P < 0.05), The Hubei Provincial Malaria Diagnosis Reference Laboratory re-examined 604 reserved samples, of them 92.4% (558/604) were diagnosed as malaria in local malaria laboratories, of them 88.5%（494/558） were recorded with correct identification of parasite species. Over the years checked, the coincidence rates between locals and province in Plasmodium positives and parasite species identification were 82.9% to 96.2% and 79.4% to 94.4%, respectively, with the difference being statistically significant (χ ² = 9.273, 13.787, P values < 0.05); the coincidence rates of malaria diagnosis and parasite species identification at medical institutions were(93.2%, 503/540; 89.5%, 450/503), which were higher than that of CDCs (85.9%, 55/64; 80.0%, 44/55). The coincidence rates of malaria diagnosis and parasite species identification at the provincial, city, county and township medical institutions were (100%, 100%), (93.3%, 88.3%), (90.2%, 86.4%) and (11/14, 9/11) respectively, showing a trend that the higher the level of medical institutions, the higher the correctness rat of diagnosis (χ ² = 13.092, 15.598, P < 0.05). The coincidence rates in identification of P. falciparum, P. vivax, P. malariae, P. ovale and mixed infection identification were 96.9%, 96.0%, 62.5%, 48.8% and 0, respectively, with significant difference(χ ² = 132.880, P < 0.05). Conclusion The diagnosis of malaria cases were made mainly in medical institutions in Hubei province. Overall, the local malaria laboratories show comparatively high detection capability, however the parasite species identification other than P. Falciparum remains to be improved.