目的 分析河南省疟疾诊断参比实验室对各级诊断机构上报的疟疾病例血样进行复核的结果，评价各级诊断机构的疟疾检测能力。 方法 收集2015—2019年河南省疟疾病例和疑似疟疾病例的血涂片、全血样品以及病例的诊断单位、诊断结果等资料，省级疟疾参比实验室通过镜检、RDT和PCR等3种方法对血样进行复核检测，分析检测结果、虫种误判情况以及各级诊断机构阳性符合及虫种误判情况。不同诊断机构的阳性符合率和误判率采用χ²检验进行统计学分析。 结果 2015—2019年河南省疟疾诊断参比实验室共收集1 194份疟疾样品，经3种方法复核检测共确诊阳性1 078份（90.3%），阴性116份（9.7%）。PCR、RDT、镜检阳性符合率分别为98.7%（1 064/1 078）、96.9%（1 045/1 078）、89.1%（960/1 078）。镜检和PCR检测结果一致的样品934份，其中恶性疟711份、间日疟58份、三日疟32份、卵形疟133份。2015—2019年虫种误判率总体呈下降趋势，分别为12.4%（25/202）、12.2%（28/230）、7.3%（15/206）、11.3%（27/239）和5.4%（17/317）；恶性疟原虫、间日疟原虫、卵形疟原虫、三日疟原虫、混合感染、诺氏疟原虫误判率分别为3.7%（30/820）、23.4%（15/64）、39.9%（59/148）、34.3%（12/35）、9/10、1/1。疾病预防控制机构（疾控机构）、医疗机构和其他机构诊断的疟疾病例分别占23.7%（283/1 194）、74.5%（890/1 194）、1.8%（21/1 194）。疾控机构诊断的283例病例中，省、市、县（区）级疾控机构阳性符合率分别为9/9、93.2%（69/674）、91%（182/200），差异无统计学意义（χ² = 0.438，P > 0.05）；虫种误判率分别为1/9、20.3%（14/69）、11.5%（21/182），差异无统计学意义（χ² = 3.271，P < 0.05）。医疗机构诊断的890例病例中，省、市、县（区）、乡（镇）医疗机构阳性符合率分别81.0%（17/21）、91.7%（742/809）、92.2%（47/51）、6/9，差异有统计学意义（χ² = 55.392，P < 0.05）；虫种误判率分别为7/17、10.9%（81/742）、10.6%（5/47）、1/6，差异有统计学意义（χ² = 11.978，P < 0.05）。 结论 河南省疟疾病例的诊断单位主要为医疗机构，各级疟疾实验室检测能力总体较高，应继续加强对医疗机构疟疾检测人员的培训，维持疟疾较高的检测能力。

Objective To analyze the rechecking results of the reference laboratory for malaria diagnosis in Henan Province on malaria blood samples submitted by malaria diagnosis institutions at all levels and evaluate the malaria detection capacity of malaria diagnosis institutions in Henan Province. Methods Blood smears and whole blood samples, and the diagnosis institute information, diagnosis results and other information on the malaria cases and suspected malaria cases were collected in Henan Province from 2015 to 2019. The provincial malaria reference laboratory rechecked and tested the blood samples through three methods, including microscopy, rapid diagnostic test (RDT) and PCR, and analyzed the detection results, the misjudgment of worm species, and the positive coincidence and misjudgment of worm species in diagnostic institutions at all levels. The positive coincidence rate and misdiagnosis rate of different diagnostic institutions were analyzed by χ² test. Results From 2015 to 2019, the Malaria Diagnostic Reference Laboratory of Henan Province received a total of 1 194 malaria samples, of which 1 078 samples (90.3%) were confirmed positive, and 116 negative (9.7%) by using the three testing methods. The positive coincidence rate by PCR, RDT and microscopy was 98.7% (1 064/1 078), 96.9% (1 045/1 078) and 89.1% (960/1 078), respectively. A total of 934 samples had the same results between microscopy and PCR, among them, 711 were falciparum malaria, 58 vivax malaria, 32 quartan malaria and 133 ovale malaria. From 2015 to 2019, the rate of species misidentification showed a decreasing trend, which were 12.4% (25/202), 12.2% (28/230), 7.3% (15/206), 11.3% (27/239), and 5.4% (17/317), respectively. The misdiagnosis rates of Plasmodium falciparum, P. vivax, P. ovale, P. malariae, mixed infection and P. knowlesi were 3.7% (30/820), 23.4% (15/64), 39.9% (59/148), 34.3% (12/35), 9/10 and 1/1, respectively. The malaria cases diagnosed by disease prevention and control institutions (CDC), medical institutions and other institutions accounted for 23.7% (283/1 194), 74.5% (890/1 194) and 1.8% (21/1 194) respectively. Among the 283 cases diagnosed by disease control institutions, the positive coincidence rates of provincial, municipal and county (district) level disease control institutions were 9/9, 93.2% (69/674) and 91% (182/200), respectively, with no significant difference (χ² = 0.438, P > 0.05）. The error rate of Plasmodium species was 1/9, 20.3% (14/69) and 11.5% (21/182) respectively, with no significant difference (χ² = 3.271, P < 0.05). Among 890 cases diagnosed by medical institutions, the positive coincidence rates of provincial, municipal, county (district) and township (town) medical institutions were 81.0% (17/21), 91.7% (742/809), 92.2% (47/51) and 6/9 respectively, with a statistically significant difference (χ² = 55.392, P < 0.05); the misdiagnosis rate of Plasmodium species was 7/17, 10.9% (81/742), 10.6% (5/47) and 1/6 respectively, with statistical significance (χ² = 11.978, P < 0.05). Conclusion The local settings for diagnosis units of malaria cases in Henan Province are mainly medical institutions, and the detection capacity of malaria laboratories at all levels is generally high. It is imperative to continuously strengthen. The training for malaria diagnosis professionals in medical institutions to maintain the higher capacity of malaria diagnosis.